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新型经内镜玻璃体手术联合大气内镜技术和/或视网膜内镜技术治疗伴有 C 级增生性玻璃体视网膜病变的孔源性视网膜脱离

NOVEL ENDOSCOPE-ASSISTED VITREOUS SURGERY COMBINED WITH ATMOSPHERIC ENDOSCOPIC TECHNIQUE AND/OR SUBRETINAL ENDOSCOPIC TECHNIQUE FOR RHEGMATOGENOUS RETINAL DETACHMENT WITH GRADE C PROLIFERATIVE VITREORETINOPATHY.

机构信息

Department of Ophthalmology, Japan Community Health Care Organization Chukyo Hospital, Nagoya, Japan.

Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan.

出版信息

Retina. 2019 Jun;39(6):1066-1075. doi: 10.1097/IAE.0000000000002121.

Abstract

PURPOSE

The purpose of this study was to investigate the clinical outcomes of novel endoscope-assisted vitreous surgery techniques in patients with rhegmatogenous retinal detachment complicated by Grade C proliferative vitreoretinopathy.

METHODS

Eight consecutive patients who had undergone endoscope-assisted vitreous surgery for rhegmatogenous retinal detachment complicated by Grade C proliferative vitreoretinopathy were investigated. The peripheral vitreous was cut under air with the aid of endoscopic view (atmospheric endoscopic technique), and the subretinal proliferation was removed under subretinal endoscopic observation (subretinal endoscopic technique).

RESULTS

Retinal reattachment was achieved after the primary surgery without a large retinotomy and scleral buckling in each case. The mean follow-up was 16.8 months (range, 8-28 months). Atmospheric endoscopic technique was performed in all cases, and subretinal endoscopic technique was performed in three cases. After surgery, the mean best-corrected visual acuity significantly improved from 20/778 to 20/111 (P = 0.014). Although microretinal breaks occurred during the removal of vitreous using atmospheric endoscopic technique in all cases, there were no severe postoperative complications, such as retinal detachment or proliferative vitreoretinopathy.

CONCLUSION

Endoscope-assisted vitreous surgery with atmospheric endoscopic technique and/or subretinal endoscopic technique is safe and effective in the treatment of rhegmatogenous retinal detachment with Grade C proliferative vitreoretinopathy.

摘要

目的

本研究旨在探讨新型内窥镜辅助玻璃体手术技术治疗伴有 C 级增生性玻璃体视网膜病变的孔源性视网膜脱离的临床效果。

方法

本研究共纳入 8 例接受内窥镜辅助玻璃体手术治疗伴有 C 级增生性玻璃体视网膜病变的孔源性视网膜脱离的患者。在直视下(大气内窥镜技术)切割周边玻璃体,在视网膜下内窥镜观察下(视网膜下内窥镜技术)切除视网膜下增殖。

结果

所有患者均在初次手术中无需大切口和巩膜扣带即成功实现视网膜复位。平均随访时间为 16.8 个月(8-28 个月)。所有患者均行大气内窥镜技术,3 例患者行视网膜下内窥镜技术。术后最佳矫正视力从 20/778 显著提高至 20/111(P = 0.014)。尽管所有患者在使用大气内窥镜技术切除玻璃体时均发生微小视网膜裂孔,但无严重术后并发症,如视网膜脱离或增生性玻璃体视网膜病变。

结论

大气内窥镜技术和/或视网膜下内窥镜技术辅助的内窥镜玻璃体手术治疗伴有 C 级增生性玻璃体视网膜病变的孔源性视网膜脱离是安全有效的。

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