目的 比较20G与23G玻璃体切割手术治疗感染性眼内炎的疗效和安全性.方法 回顾性病例研究.有外伤史或内眼手术史,经最佳矫正视力、眼压、裂隙灯显微镜、间接检眼镜、B型超声及CT检查确诊的感染性眼内炎患者67例67只眼纳入本研究.其中,男性49例49只眼,女性18例18只眼.年龄18～72岁,平均年龄(43±13)岁.外伤史60例60只眼,内眼手术后7例7只眼.因仪器拥有与否之原因分为20G玻璃体切除手术组(20G组)和23G玻璃体切除手术组(23G组).前者35例35只眼,后者32例32只眼.两组患者手术开始时常规抽取脓性玻璃体液作细菌和真菌培养以及药物敏感试验.手术中均行人工玻璃体后脱离,切除大部分玻璃体,酌情行内界膜剥离和(或)眼内激光光凝、冷冻治疗并联合眼内填充硅油或气体.手术后全身应用广谱抗生素及适量糖皮质激素1周,真菌感染者忌用糖皮质激素.随访2～9个月,平均随访时间(7±1)个月.对比分析两组患者手术时间、手术后炎症控制情况、手术后视力、眼压变化,视网膜复位率,医源性视网膜裂孔发生率,球结膜瘢痕形成率,再次手术及最终眼球保存情况等,比较两组治疗效果差异.结果 手术时间,20G组83～165 min,平均时间(126±12) min,23G组65～125 min,平均时间(89±12)min;两组间手术时间比较,差异有统计学意义(t=3.125,P＜0.05).手术中主要并发症为锯齿缘离断或其它医源性视网膜裂孔,共34只眼,其中,20G组30只眼,占85.71％;23G组4只眼,占12.50％(x2=35.85,P＜0.05),均为异物取出患眼.67只眼中65只眼眼内炎得到控制,治疗成功率97.01％.其中,20G组34只眼,治疗成功率97.14％;23G组31只眼,治疗成功率96.88％.两组治疗成功率比较,差异无统计学意义(x2=0,004,P＞0.05).末次随访时,两组患者视力比较,差异无统计学意义(t=3.12,P＞0.05).硅油填充共14只眼,其中,20G组13只眼,硅油填充率37.14％；23G组1只眼,硅油填充率3.13％.两组硅油填充率比较,差异有统计学意义(x2=11.703,P＜0.05).再手术眼共9只眼,均为再次手术行硅油填充,占13.43％.其中,20G组8只眼,再手术率22.86％;23G组1只眼,再手术率3.13％.两组再手术率比较,差异有统计学意义(x2=5.597,P＜0.05).再手术眼中,20G组中感染复发1只眼,手术后视网膜脱离7只眼,23G组中感染复发1只眼.手术后两组的视网膜脱离发生率比较,差异有统计学意义(x2=7.147,P＜0.05).球结膜瘢痕形成共40只眼,其中,20G组35只眼,占100.00％,均为切口处球结膜维痕形成；23G组5只眼,占15.63％,均为原有外伤所致.结论 20G与23G玻璃体切割手术均能有效控制感染性眼内炎,但是在缩短手术时间、减少再手术率、降低手术后视网膜脱离和瘢痕形成发生率等方面,23G玻璃体切除手术系统有着明显的优势.
目的 比較20G與23G玻璃體切割手術治療感染性眼內炎的療效和安全性.方法 迴顧性病例研究.有外傷史或內眼手術史,經最佳矯正視力、眼壓、裂隙燈顯微鏡、間接檢眼鏡、B型超聲及CT檢查確診的感染性眼內炎患者67例67隻眼納入本研究.其中,男性49例49隻眼,女性18例18隻眼.年齡18～72歲,平均年齡(43±13)歲.外傷史60例60隻眼,內眼手術後7例7隻眼.因儀器擁有與否之原因分為20G玻璃體切除手術組(20G組)和23G玻璃體切除手術組(23G組).前者35例35隻眼,後者32例32隻眼.兩組患者手術開始時常規抽取膿性玻璃體液作細菌和真菌培養以及藥物敏感試驗.手術中均行人工玻璃體後脫離,切除大部分玻璃體,酌情行內界膜剝離和(或)眼內激光光凝、冷凍治療併聯閤眼內填充硅油或氣體.手術後全身應用廣譜抗生素及適量糖皮質激素1週,真菌感染者忌用糖皮質激素.隨訪2～9箇月,平均隨訪時間(7±1)箇月.對比分析兩組患者手術時間、手術後炎癥控製情況、手術後視力、眼壓變化,視網膜複位率,醫源性視網膜裂孔髮生率,毬結膜瘢痕形成率,再次手術及最終眼毬保存情況等,比較兩組治療效果差異.結果 手術時間,20G組83～165 min,平均時間(126±12) min,23G組65～125 min,平均時間(89±12)min;兩組間手術時間比較,差異有統計學意義(t=3.125,P＜0.05).手術中主要併髮癥為鋸齒緣離斷或其它醫源性視網膜裂孔,共34隻眼,其中,20G組30隻眼,佔85.71％;23G組4隻眼,佔12.50％(x2=35.85,P＜0.05),均為異物取齣患眼.67隻眼中65隻眼眼內炎得到控製,治療成功率97.01％.其中,20G組34隻眼,治療成功率97.14％;23G組31隻眼,治療成功率96.88％.兩組治療成功率比較,差異無統計學意義(x2=0,004,P＞0.05).末次隨訪時,兩組患者視力比較,差異無統計學意義(t=3.12,P＞0.05).硅油填充共14隻眼,其中,20G組13隻眼,硅油填充率37.14％；23G組1隻眼,硅油填充率3.13％.兩組硅油填充率比較,差異有統計學意義(x2=11.703,P＜0.05).再手術眼共9隻眼,均為再次手術行硅油填充,佔13.43％.其中,20G組8隻眼,再手術率22.86％;23G組1隻眼,再手術率3.13％.兩組再手術率比較,差異有統計學意義(x2=5.597,P＜0.05).再手術眼中,20G組中感染複髮1隻眼,手術後視網膜脫離7隻眼,23G組中感染複髮1隻眼.手術後兩組的視網膜脫離髮生率比較,差異有統計學意義(x2=7.147,P＜0.05).毬結膜瘢痕形成共40隻眼,其中,20G組35隻眼,佔100.00％,均為切口處毬結膜維痕形成；23G組5隻眼,佔15.63％,均為原有外傷所緻.結論 20G與23G玻璃體切割手術均能有效控製感染性眼內炎,但是在縮短手術時間、減少再手術率、降低手術後視網膜脫離和瘢痕形成髮生率等方麵,23G玻璃體切除手術繫統有著明顯的優勢.
목적 비교20G여23G파리체절할수술치료감염성안내염적료효화안전성.방법 회고성병례연구.유외상사혹내안수술사,경최가교정시력、안압、렬극등현미경、간접검안경、B형초성급CT검사학진적감염성안내염환자67례67지안납입본연구.기중,남성49례49지안,녀성18례18지안.년령18～72세,평균년령(43±13)세.외상사60례60지안,내안수술후7례7지안.인의기옹유여부지원인분위20G파리체절제수술조(20G조)화23G파리체절제수술조(23G조).전자35례35지안,후자32례32지안.량조환자수술개시시상규추취농성파리체액작세균화진균배양이급약물민감시험.수술중균행인공파리체후탈리,절제대부분파리체,작정행내계막박리화(혹)안내격광광응、냉동치료병연합안내전충규유혹기체.수술후전신응용엄보항생소급괄량당피질격소1주,진균감염자기용당피질격소.수방2～9개월,평균수방시간(7±1)개월.대비분석량조환자수술시간、수술후염증공제정황、수술후시력、안압변화,시망막복위솔,의원성시망막렬공발생솔,구결막반흔형성솔,재차수술급최종안구보존정황등,비교량조치료효과차이.결과 수술시간,20G조83～165 min,평균시간(126±12) min,23G조65～125 min,평균시간(89±12)min;량조간수술시간비교,차이유통계학의의(t=3.125,P＜0.05).수술중주요병발증위거치연리단혹기타의원성시망막렬공,공34지안,기중,20G조30지안,점85.71％;23G조4지안,점12.50％(x2=35.85,P＜0.05),균위이물취출환안.67지안중65지안안내염득도공제,치료성공솔97.01％.기중,20G조34지안,치료성공솔97.14％;23G조31지안,치료성공솔96.88％.량조치료성공솔비교,차이무통계학의의(x2=0,004,P＞0.05).말차수방시,량조환자시력비교,차이무통계학의의(t=3.12,P＞0.05).규유전충공14지안,기중,20G조13지안,규유전충솔37.14％；23G조1지안,규유전충솔3.13％.량조규유전충솔비교,차이유통계학의의(x2=11.703,P＜0.05).재수술안공9지안,균위재차수술행규유전충,점13.43％.기중,20G조8지안,재수술솔22.86％;23G조1지안,재수술솔3.13％.량조재수술솔비교,차이유통계학의의(x2=5.597,P＜0.05).재수술안중,20G조중감염복발1지안,수술후시망막탈리7지안,23G조중감염복발1지안.수술후량조적시망막탈리발생솔비교,차이유통계학의의(x2=7.147,P＜0.05).구결막반흔형성공40지안,기중,20G조35지안,점100.00％,균위절구처구결막유흔형성；23G조5지안,점15.63％,균위원유외상소치.결론 20G여23G파리체절할수술균능유효공제감염성안내염,단시재축단수술시간、감소재수술솔、강저수술후시망막탈리화반흔형성발생솔등방면,23G파리체절제수술계통유착명현적우세.
Objective To compare the outcomes and safety of 23G and 20G vitrectomy for treatment of infectious endophthalmitis.Methods This was a retrospective case study.Sixty-seven eyes of 67 eyes suffering from infectious endophthalmitis with a history of trauma or intraocular operation history were enrolled in this study.They were diagnosed by the examinations of best corrected visual acuity,intraocular pressures,slit lamp microscope,indirect ophthalmoscopy,B-scan ultrasound and CT.There were 49 males (49 eyes) and 18 females (18 eyes).The patients aged from 18 to 72 years with a mean age of (43±13)years.There were 60 patients (60 eyes) with a history of trauma,7 patients (7 eyes) with intraocular operation history.The patients were enrolled into 20G vitrectomy group (35 patients,35 eyes) before December,2009 and 23G vitrectomy group (32 patients,32 eyes) after January,2010 when 23G vitrectomy system was imported in this hospital.Vitreous purulence was taken in all patients at the beginning of the surgery for bacteria and fungal culture and drug sensitivity test. A standard vitrectomy with artificial posterior vitreous detachment followed by internal limiting membrane peeling,and (or) intraocular laser photocoagulation,cryocoagulation,fluid-air exchange with intraocular silicone oil or gas tamponade were performed in all eases.Broad-spectrum antibiotics and glucocorticoids were used systematically for one week after surgery,but glucocorticoids were not used for fungal infections.The follow-up was ranged from two to nine months with a mean of (7 ± 1) months.The surgical time,inflammation situation,visual acuity,intraocular pressure, retinal reattachment rare,iatrogenic retinal hole rate, bulbar conjunctiva scar formation rate,reoperation rate and eye retention situation before and after surgery were comparatively analyzed.Results The mean surgical times were (126 ± 12) and (89 ± 12) minutes in 20G and 23G group,which was significantly different (t=3.125,P＜0.05).The major surgery complications were ora serrata dialysis and other iatrogenic retinal breaks,and were occurred in 34 eyes,including 30 eyes (85.71％) in 20G group and 4 eyes (12.50％) in 23G group (x2 =35.85,P＜0.05).These 4 eyes in 23G group received foreign body removal surgery previously.The inflammation was controlled in 65 eyes (97.01％) including 34 eyes (97.14％) and 31 eyes (96.88％) in 20G and 23G group respectively,which was not significantly different (x2=0.004,P＞0.05).At last follow-up,There was no statistical difference of visual acuity between the two groups (t=3.12,P＞0.05).Fourteen eyes underwent silicone oil tamponade including 13eyes (37.14％) and 1 eye (3.13％) in 20G and 23G group respectively,which was significantly different (x2=11.703,P＜0.05).Nine eyes underwent reoperation (13.43％),including 8 eyes (22.86％) and 1eye (3.13％) in 20G and 23G group respectively,which was significantly different (x2=5.597,P＜0.05).The 8 re-operated eyes in 20G group included 1 eye of recurrent endophthalmitis and 7 eyes with retinal detachment,the 1 re-operated eye in 23G group was of recurrent endophthalmitis.There was significantly different (x2=7.147,P＜0.05) for the rate of retinal detachment between the 2 groups.There were 40eyes with bulbar conjunctiva scar including 35 eyes (100.00％) and five eyes (15.63％) in 20G and 23G group.Conclusion 23G vitrectomy is an effective treatment for infectious endophthalmitis with shorter surgery time,lower reoperation rate,lower retinal reattachment rate and fewer bulbar conjunctiva scar.
