CAJ | 학술논문

目的探讨应用23-G微创玻璃体手术联合吊顶灯治疗上方球形孔源性视网膜脱离(RRD)的临床疗效.方法回顾性系列病例研究.50例50眼因上方球形RRD行23-G微创玻璃体手术.术中采用23-G两步法经结膜、巩膜穿刺置微套管,于下方6点位睫状体平坦部插入吊顶灯,在非接触式全视野镜下行23-G微创玻璃体手术联合眼内激光光凝封闭裂孔并注入全氟丙烷(C3Fs)填充.随访5～49个月,平均(23.9±1.3)个月.分析术中、术后并发症,术后结膜充血状态及眼部刺激征和炎症反应,分析视网膜解剖复位率、术后最佳矫正视力、眼压变化.数据采用配对t检验进行分析.结果术中巩膜切口渗漏需缝合17眼(34％),无医源性裂孔、出血等术中并发症发生.术后结膜充血、眼部刺激征及炎症反应轻,1眼(2％)术后第1天出现一过性低眼压,翌日恢复,16眼(32％)一过性眼压升高,经降眼压治疗在平均4d内恢复正常.无出血、渗出、脉络膜脱离、眼内炎等术后并发症发生.一次手术视网膜复位49眼(98％),最终视网膜复位50眼(100％).42只黄斑脱离眼术前、术后最佳矫正视力分别为2.82±0.69、4.34±0.49,差异具有统计学意义(t=13.72,P＜0.01);8只黄斑未脱离眼术前、术后最佳矫正视力分别为4.61±0,19、4.70±0.19,差异无统计学意义(t=2.20,P＞0.05).结论 23-G微创玻璃体手术联合吊顶灯治疗上方球形RRD是一种安全有效的手术方法.
목적 탐토응용23-G미창파리체수술연합조정등치료상방구형공원성시망막탈리(RRD)적림상료효.방법 회고성계렬병례연구.50례50안인상방구형RRD행23-G미창파리체수술.술중채용23-G량보법경결막、공막천자치미투관,우하방6점위첩상체평탄부삽입조정등,재비접촉식전시야경하행23-G미창파리체수술연합안내격광광응봉폐렬공병주입전불병완(C3Fs)전충.수방5～49개월,평균(23.9±1.3)개월.분석술중、술후병발증,술후결막충혈상태급안부자격정화염증반응,분석시망막해부복위솔、술후최가교정시력、안압변화.수거채용배대t검험진행분석.결과 술중공막절구삼루수봉합17안(34％),무의원성렬공、출혈등술중병발증발생.술후결막충혈、안부자격정급염증반응경,1안(2％)술후제1천출현일과성저안압,익일회복,16안(32％)일과성안압승고,경강안압치료재평균4d내회복정상.무출혈、삼출、맥락막탈리、안내염등술후병발증발생.일차수술시망막복위49안(98％),최종시망막복위50안(100％).42지황반탈리안술전、술후최가교정시력분별위2.82±0.69、4.34±0.49,차이구유통계학의의(t=13.72,P＜0.01);8지황반미탈리안술전、술후최가교정시력분별위4.61±0,19、4.70±0.19,차이무통계학의의(t=2.20,P＞0.05).결론 23-G미창파리체수술연합조정등치료상방구형RRD시일충안전유효적수술방법.
Objective To investigate the clinical results of 23-G minimally invasive vitrectomy combined with chandelier illumination for treatment of superior bullous rhegmatogenous retinal detachment (SBRRD),and to analyze the intraoperative and postoperative complications.Methods In a retrospective case series study,50 eyes of 50 consecutive patients with SBRRD were analyzed.For all cases,a 23-G three-port vitrectomy system with a two-step incision was used,inserting the chandelier lighting probe at six o'clock via the pars plana with the help of a noncontact panoramic viewing system,23-G vitrectomy with endolaser photocoagulation and C3F8 tamponade.Postoperative follow-up ranged from 5 to 49 months (mean 23.9±1.3 months).Main outcome measures included complications from the operation,postoperative inflammatory reaction,retinal anatomical status,and best corrected visual acuity (BCVA).Results Intraoperative suture placement was required for leaking selerotomies in 17 cases (34％).No iatrogenic retinal breaks or hemorrhage occurred during the operations.The results showed only mild signs of postoperative inflammatory reaction.One patient (2％) had hypotony on postoperative day 1.Early ocular hypertension in 16 eyes (32％) was controlled by hypotensive treatment in four days.No choroidal detachment,hyphema,effusion or endophthalmitis occurred.All congestion cleared up after 2 weeks.The primary anatomical success rate was 98％;the final retinal reattachment rate was 100％.For the off-macular cases,BCVA improved from the preoperative mean of 2.82±0.69 to the postoperative mean of 4,34±0.49,and the difference was statistically significant (t=13.72,P＜0.01).For the on-macular cases,BCVA improved from the preoperative mean of 4.61±0.19 to the postoperative mean of 4.70±0.19 but the difference was not statistically significant (t=2.20,P=0.064).Postoperative cataract progression occurred in 7 eyes (14％).Conclusion The 23-G minimally invasive vitrectomy combined with chandelier illumination is a safe and effective therapeutic method for superior bullous rhegmatogenous retinal detachment.