CAJ | 학술논문

目的探讨无灌注25-G玻璃体手术系统在白内障超声乳化吸除术中处理玻璃体脱出的有效性和安全性.方法回顾性病例系列研究.收集山东省眼科研究所2007年9月至2009年9月期间收治的白内障超声乳化术中后囊膜破裂的病例18例(18眼),其中年龄相关性白内障13例,糖尿病性白内障2例,并发性白内障3例,年龄41～86岁,平均(64.8±11.6)岁.所有患者均行白内障超声乳化吸除术,术中发现后囊膜破裂、玻璃体脱出后,即以无灌注25-G玻璃体切除头通过透明角膜切口进入前房,切除残余晶状体皮质和脱出玻璃体.25-G玻璃体手术系统设置最快玻切频率为1500次/min,负压吸引为250 mmHg.人工晶状体(IOL)通过原角膜切口植入晶状体囊袋内或睫状沟,术后予以药物抗炎治疗.术后随访3～13个月,平均4个月.患者均于术前及术后1、3、7 d进行相关眼科检查,记录最佳矫正视力、眼压和术后并发症.结果应用25-G玻璃体手术系统过程中,患者前房稳定,无前房消失和眼球塌陷情况发生.所有病例均一期植入了IOL.患者术后视力均有不同程度的提高,有14例(77.8%)术后最佳矫正视力≥0.5,仅2例眼底病变患者及2例高度近视患者的最佳矫正视力＜0.5.术后第1天,角膜水肿10例(55.6%),至术后第7天角膜均恢复透明.4例(22.2%)术后发生一过性高眼压,予前房放液或药物治疗后恢复正常.随访期间无继发性青光眼、黄斑囊样水肿、角膜内皮失代偿、视网膜脱离等严重并发症.结论无灌注25-G玻璃体手术系统处理白内障超声乳化术中玻璃体脱出的方法安全、有效,术后炎症反应轻,恢复快.
목적 탐토무관주25-G파리체수술계통재백내장초성유화흡제술중처리파리체탈출적유효성화안전성.방법 회고성병례계렬연구.수집산동성안과연구소2007년9월지2009년9월기간수치적백내장초성유화술중후낭막파렬적병례18례(18안),기중년령상관성백내장13례,당뇨병성백내장2례,병발성백내장3례,년령41～86세,평균(64.8±11.6)세.소유환자균행백내장초성유화흡제술,술중발현후낭막파렬、파리체탈출후,즉이무관주25-G파리체절제두통과투명각막절구진입전방,절제잔여정상체피질화탈출파리체.25-G파리체수술계통설치최쾌파절빈솔위1500차/min,부압흡인위250 mmHg.인공정상체(IOL)통과원각막절구식입정상체낭대내혹첩상구,술후여이약물항염치료.술후수방3～13개월,평균4개월.환자균우술전급술후1、3、7 d진행상관안과검사,기록최가교정시력、안압화술후병발증.결과 응용25-G파리체수술계통과정중,환자전방은정,무전방소실화안구탑함정황발생.소유병례균일기식입료IOL.환자술후시력균유불동정도적제고,유14례(77.8%)술후최가교정시력≥0.5,부2례안저병변환자급2례고도근시환자적최가교정시력＜0.5.술후제1천,각막수종10례(55.6%),지술후제7천각막균회복투명.4례(22.2%)술후발생일과성고안압,여전방방액혹약물치료후회복정상.수방기간무계발성청광안、황반낭양수종、각막내피실대상、시망막탈리등엄중병발증.결론 무관주25-G파리체수술계통처리백내장초성유화술중파리체탈출적방법안전、유효,술후염증반응경,회복쾌.
Objective To investigate the efficacy and safety of dry anterior vitrectomy using a 25-Gauge (25-G) vitrectomy system in the management of vitreous loss associated with phacoemulsification. Methods This retrospective review was comprised of the records of 18 patients who underwent dry anterior vitrectomy using a 25-G vitrectomy system to manage vitreous loss resulting from posterior capsule rupture during phacoemulsification. The group consisted of 18 eyes of 18 patients, 13 eyes with age-related cataract, 2 eyes with diabetic cataract,and 3 eyes with combined cataract. Patients ranged in age from 41 to 86 years [mean age (64.8±11.6)years]. All patients had ophthalmic examinations preoperatively, 1 day postoperatively and 3 to 7 days postoperatively. Topical anesthesia was used on 15 patients and paraocular anesthesia was used on 3patients. When finding vitreous prolapse into the anterior chamber, an anterior vitrectomy was performed with a 25-G vitrectomy system using a dry technique to clear the anterior chamber of vitreous. The 25-G vitrectomy system was set on the fastest cutting frequency, 1500 times/min, and suction was 250 mmHg. Intraocular lenses were implanted in the capsule or sulcus, and steroid eye drops were prescribed. The follow-up period was 3-13 months (average 4 months). Additional outcome measurements were best corrected visual acuity (BCVA), intraocular pressure, and postoperative complications. Results All procedures were uneventful and all intraocular lenses were primary implants. No intraoperative complications were attributed to the small-gauge instruments. Excluding 2 eyes with pre-existing conditions, 14 of 18 eyes (77.8%) had a final BCVA of 0.5 or better, and 38.9% (7/18) had a final BCVA of 1.0 or better. The other 2 patients with poor postoperative visual acuity were diagnosed with high myopia associated with pathologic change. Transient high intraocular pressure occurred in 4 eyes (22.2%) and was controlled with drugs and/or aqueous humor release in 3 days. Corneal edema was noted in 10 eyes (55.6%) during the first days postoperatively and all recovered in 7 days. Conclusion Dry anterior vitrectomy using a 25-G vitrectomy system is a safe, effective method to manage vitreous loss during phacoemulsification, and it leads to rapid visual recovery.