Yokoyama Sho, Kojima Takashi, Mori Toshio, Matsuda Taisuke, Sato Hiroyuki, Yoshida Norihiko, Kaga Tatsushi, Smith R Theodore, Ichikawa Kazuo
Department of Ophthalmology, Japan Community Healthcare Organization Chukyo Hospital, Nagoya, Japan.
Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan.
Clin Ophthalmol. 2017 Nov 14;11:2003-2010. doi: 10.2147/OPTH.S147690. eCollection 2017.
We evaluated the clinical outcomes for ophthalmic endoscope-assisted vitrectomy in consecutive patients with uncomplicated rhegmatogenous retinal detachment (RRD). The primary success rate was 98.4% (125/127) without performing a posterior drainage retinotomy or using perfluorocarbon liquids (PFCL) for subretinal fluid drainage.
To investigate the clinical outcomes of endoscope-assisted vitrectomy in patients with uncomplicated RRD.
We examined 127 eyes from consecutive patients who underwent repair of RRD by 23- or 25-gauge endoscope-assisted vitrectomy, with a minimum follow-up of 3 months. Eyes with the following criteria were excluded: Giant retinal tears, grade C proliferative vitreoretinopathy, dense vitreous hemorrhage, retinal detachment secondary to other ocular diseases, and prior retinal or vitreous surgery. All cases underwent subretinal fluid drainage, endolaser photocoagulation and fundus inspection were performed under ophthalmic endoscopic observation. Success rate, visual acuity, surgery time and complications were evaluated.
Primary and final success rate was 98.4% (125/127) and 100% (127/127), respectively, Surgery time was 59.6±26.3 minutes. The best-corrected visual acuity significantly improved from 20/100 to 20/20 (<0.0001). There were 2 cases (1.6%) of creation of a peripheral drainage retinotomy and 4 cases (3.1%) of using PFCL to suppress movement of the detached retina, but there were no cases of creation of a posterior drainage retinotomy or using PFCL for subretinal fluid drainage. There was 1 case of presumed endophthalmitis after surgery. There were 12 hypotonous cases at postoperative day 1 and one of them needed additional scleral sutures at postoperative day 4 for prolonged hypotony.
The present study demonstrated the efficacy of endoscope-assisted vitrectomy for patients with uncomplicated RRD. To perform endoscope-assisted vitrectomy safely, sufficient closure of sclerotomies is necessary at the end of surgery.
我们评估了连续的单纯孔源性视网膜脱离（RRD）患者接受眼科内窥镜辅助玻璃体切除术的临床结果。在未进行后引流视网膜切开术或使用全氟碳液体（PFCL）进行视网膜下液引流的情况下，主要成功率为98.4%（125/127）。
探讨内窥镜辅助玻璃体切除术治疗单纯RRD患者的临床结果。
我们检查了连续接受23或25Gauge内窥镜辅助玻璃体切除术修复RRD的患者的127只眼，随访至少3个月。排除符合以下标准的眼睛：巨大视网膜裂孔、C级增生性玻璃体视网膜病变、严重玻璃体出血、继发于其他眼部疾病的视网膜脱离以及既往视网膜或玻璃体手术史。所有病例均进行视网膜下液引流，在内窥镜观察下进行视网膜光凝和眼底检查。评估成功率、视力、手术时间和并发症。
主要成功率和最终成功率分别为98.4%（125/127）和100%（127/127），手术时间为59.6±26.3分钟。最佳矫正视力从20/100显著提高到20/20（<0.0001）。有2例（1.6%）进行了周边引流视网膜切开术，4例（3.1%）使用PFCL抑制脱离视网膜的移动，但没有进行后引流视网膜切开术或使用PFCL进行视网膜下液引流的病例。术后有1例疑似眼内炎。术后第1天有12例低眼压病例，其中1例在术后第4天因持续性低眼压需要额外的巩膜缝合。
本研究证明了内窥镜辅助玻璃体切除术治疗单纯RRD患者的有效性。为了安全地进行内窥镜辅助玻璃体切除术，手术结束时巩膜切口需要充分闭合。
