目的 比较孔源性视网膜脱离患者行23G免缝合微创玻璃体切除术(PPV)和玻璃体切除术联合超声乳化白内障摘除术(PPVCE)的术后视力及临床并发症.方法 回顾性病例分析研究.收集2013年1月至2014年10月在南宁爱尔眼科医院住院治疗的173例173只眼孔源性视网膜脱离患者,PPV组112例112只眼,PPVCE组61例61只眼.主要观察术后1个月及6个月的最佳矫正视力、眼压以及术中、术后并发症.结果 术后随访6-15个月.术前视力光感～0.6,术后视力光感～1.0.术后1个月,PPV组视力提高102只眼(91.07％,102/112),PPVCE组视力提高57只眼(93.44％,57/61);术后6个月,PPV组视力提高98只眼(87.5％,98/112),PPVCE组视力提高55只眼(90.16％,55/61).早期并发症(术后≤3个月),PPV组:角膜水肿及前房渗出2只眼(1.78％,2/112),暂时性高眼压23只眼(20.54％,23/112);PPVCE组角膜水肿及前房渗出5只眼(8.20％,5/61),暂时性高眼压21只眼(34.43％,21/61);两组术后早期并发症比较,PPVCE组角膜水肿及前房渗出发生率(x2=4.181,P=0.041)及暂时性高眼压发生率(x2=4.018,P=0.045)均比PPV组高,差异有统计学意义.晚期并发症(术后＞3个月),PPV组:新生血管性青光眼5只眼(4.46％/,5/112),虹膜后粘连、瞳孔变形5只眼(4.46％,5/112),晶状体后囊膜混浊7只眼(6.25％,7/112),复发性视网膜脱离3只眼(2.68％,3/112);PPVCE组:新生血管性青光眼2只眼(3.28％,2/61),虹膜后粘连、瞳孔变形3只眼(4.92％,3/61),视网膜脱离复发2只眼(3.28％,2/61);两组比较新生血管性青光眼(x2=0.143,P=0.705),虹膜后粘连(x2=0.081,P=0.892),视网膜脱离复发(x2=0.189,P=0.664)的发生率差异均无统计学意义.结论 23G免缝合微创玻璃体切除联合超声乳化白内障摘除术治疗合并白内障的孔源性视网膜脱离患者是安全有效的.联合手术避免了二次白内障手术,并利于术后眼底的随访观察.
目的 比較孔源性視網膜脫離患者行23G免縫閤微創玻璃體切除術(PPV)和玻璃體切除術聯閤超聲乳化白內障摘除術(PPVCE)的術後視力及臨床併髮癥.方法 迴顧性病例分析研究.收集2013年1月至2014年10月在南寧愛爾眼科醫院住院治療的173例173隻眼孔源性視網膜脫離患者,PPV組112例112隻眼,PPVCE組61例61隻眼.主要觀察術後1箇月及6箇月的最佳矯正視力、眼壓以及術中、術後併髮癥.結果 術後隨訪6-15箇月.術前視力光感～0.6,術後視力光感～1.0.術後1箇月,PPV組視力提高102隻眼(91.07％,102/112),PPVCE組視力提高57隻眼(93.44％,57/61);術後6箇月,PPV組視力提高98隻眼(87.5％,98/112),PPVCE組視力提高55隻眼(90.16％,55/61).早期併髮癥(術後≤3箇月),PPV組:角膜水腫及前房滲齣2隻眼(1.78％,2/112),暫時性高眼壓23隻眼(20.54％,23/112);PPVCE組角膜水腫及前房滲齣5隻眼(8.20％,5/61),暫時性高眼壓21隻眼(34.43％,21/61);兩組術後早期併髮癥比較,PPVCE組角膜水腫及前房滲齣髮生率(x2=4.181,P=0.041)及暫時性高眼壓髮生率(x2=4.018,P=0.045)均比PPV組高,差異有統計學意義.晚期併髮癥(術後＞3箇月),PPV組:新生血管性青光眼5隻眼(4.46％/,5/112),虹膜後粘連、瞳孔變形5隻眼(4.46％,5/112),晶狀體後囊膜混濁7隻眼(6.25％,7/112),複髮性視網膜脫離3隻眼(2.68％,3/112);PPVCE組:新生血管性青光眼2隻眼(3.28％,2/61),虹膜後粘連、瞳孔變形3隻眼(4.92％,3/61),視網膜脫離複髮2隻眼(3.28％,2/61);兩組比較新生血管性青光眼(x2=0.143,P=0.705),虹膜後粘連(x2=0.081,P=0.892),視網膜脫離複髮(x2=0.189,P=0.664)的髮生率差異均無統計學意義.結論 23G免縫閤微創玻璃體切除聯閤超聲乳化白內障摘除術治療閤併白內障的孔源性視網膜脫離患者是安全有效的.聯閤手術避免瞭二次白內障手術,併利于術後眼底的隨訪觀察.
목적 비교공원성시망막탈리환자행23G면봉합미창파리체절제술(PPV)화파리체절제술연합초성유화백내장적제술(PPVCE)적술후시력급림상병발증.방법 회고성병례분석연구.수집2013년1월지2014년10월재남저애이안과의원주원치료적173례173지안공원성시망막탈리환자,PPV조112례112지안,PPVCE조61례61지안.주요관찰술후1개월급6개월적최가교정시력、안압이급술중、술후병발증.결과 술후수방6-15개월.술전시력광감～0.6,술후시력광감～1.0.술후1개월,PPV조시력제고102지안(91.07％,102/112),PPVCE조시력제고57지안(93.44％,57/61);술후6개월,PPV조시력제고98지안(87.5％,98/112),PPVCE조시력제고55지안(90.16％,55/61).조기병발증(술후≤3개월),PPV조:각막수종급전방삼출2지안(1.78％,2/112),잠시성고안압23지안(20.54％,23/112);PPVCE조각막수종급전방삼출5지안(8.20％,5/61),잠시성고안압21지안(34.43％,21/61);량조술후조기병발증비교,PPVCE조각막수종급전방삼출발생솔(x2=4.181,P=0.041)급잠시성고안압발생솔(x2=4.018,P=0.045)균비PPV조고,차이유통계학의의.만기병발증(술후＞3개월),PPV조:신생혈관성청광안5지안(4.46％/,5/112),홍막후점련、동공변형5지안(4.46％,5/112),정상체후낭막혼탁7지안(6.25％,7/112),복발성시망막탈리3지안(2.68％,3/112);PPVCE조:신생혈관성청광안2지안(3.28％,2/61),홍막후점련、동공변형3지안(4.92％,3/61),시망막탈리복발2지안(3.28％,2/61);량조비교신생혈관성청광안(x2=0.143,P=0.705),홍막후점련(x2=0.081,P=0.892),시망막탈리복발(x2=0.189,P=0.664)적발생솔차이균무통계학의의.결론 23G면봉합미창파리체절제연합초성유화백내장적제술치료합병백내장적공원성시망막탈리환자시안전유효적.연합수술피면료이차백내장수술,병리우술후안저적수방관찰.
Objective To compare visual acuity outcomes and clinical complications after 23-gauge sutureless microincisional pars plana vitrectomy (PPV) versus combined pars plana vitrectomy and phacoemulsification (PPVCE) in patients with rhegmatogenous retinal detachment.Methods Retrospective case series study.A total of 173 eyes of 173 patients with rhegmatogenous retinal detachment (PPV=112, PPVCE=61) underwent either combined PPVCE or PPV alone from January 2013 to October 2014.Main outcome measures were best-corrected visual acuity at one month and six months follow-up, intraoperative complications, intraocular pressure and postoperative complications in the follow-up.Results Postoperative follow-up time was between 6 and 15 months.Preoperative vision ranged from light perception to 0.6, postoperative vision ranged from light perception to 1.0.Postoperatively, one month after surgery, PPV visual acuity improved in 102 eyes (91.07％,102/112).PPVCE visual acuity improved in 57 eyes (93.44％, 57/61).And six months after surgery,PPV visual acuity improved in 98 eyes (87.5％, 98/112).PPVCE visual acuity improved in 55 eyes (90.16％, 55/61).Early complications (≤3 months after surgery) in PPV: 2 eyes (1.78％, 2/112) corneal edema and fibrinous exudation in the anterior chamber, 23 eyes (20.54％, 23/112) showed transient intraocular pressure rise.And in PPVCE: 5 eyes (8.20％, 5/61) comeal edema and fibrinous exudation in the anterior chamber, 21 eyes (34.43％, 21/61) showed transient intraocular pressure rise.Subgroup analysis revealed fibrinous exudation in the anterior chamber (x2=4.181, P =0.041) and transient intraocular pressure rise (x2=4.018, P =0.045) to be significantly more frequent after PPVCE.Late complications (＞ 3 months after surgery) in PPV included secondary glaucoma occurred in 5 eyes (4.46％, 5/112), forma-tion of posterior synechia and discoria was observed in 5 eyes (4.46％, 5/112), posterior capsual opacification occurred in 7 eyes (6.25％, 7/112), recurrent retinal detachment occurred in 3 eyes (2.68％, 3/112).And in PPVCE included secondary glaucoma occurred in 2 eyes (3.28％, 2/61), formation of posterior synechia and discoria was observed in 3 eyes (4.92％, 3/61), recurrent retinal detachment occurred in 2 eyes (3.28％, 2/61).There were no significant differences comparing secondary glaucoma (x2=0.143, P =0.705), formation of posterior synechia (x2=0.081, P =0.892), recurrent retinal detachment (x2=0.189, P =0.664) between PPV eyes and PPVCE eyes.Conclusions Combined 23-gauge sutureless pars plana vitrectomy surgery and phacoemulsification is safe and effective in treating rhegmatogenous retinal detachment co-existing with cataract.Combined surgery may prevent a second operation for postvitrectomy cataract, and facilitate postoperative retinal follow-up observation.
