23G玻璃体视网膜手术治疗孔源性视网膜脱离

Primary 23-gauge vitreoretinal surgery for rhegmatogenous retinal detachment

摘要:

目的：报告23G玻璃体视网膜手术治疗孔源性视网膜脱离（rhegmatogenous retinal detachment，RRD）的有效性和安全性。 方法：本回顾性研究中，49例49眼RRD患者于2007-01/2009-07在我院行23G经巩膜无缝线玻璃体切除术纳入研究。 结果：平均随访时间8.9±7.7mo(1~28mo)。47眼(95.9%)视网膜再次脱离经一次手术治愈，2眼因新出现裂孔的视网膜再次脱离通过23G经巩膜无缝线玻璃体切除术治愈。术前平均logMAR视力2.01±0.47，术后1.3±0.5(P<0.001, Paired t-test)。术前平均眼压（intraocular pressure，IOP）14.1±2.8mmHg，术后1d平均眼压12.3±3.6mmHg，术后1wk平均眼压13.1±2.1mmHg，术后1mo平均眼压14.3±2.2mmHg。术中医源性周边视网膜裂孔1眼(2.0%)。巩膜或结膜切口不要求缝合，无1眼需要转换为20G玻璃体切除术。 结论：23G经巩膜无缝线玻璃体切除术可以有效，安全的治疗RRD。

Abstract:

AIM: To report the effectiveness and safety of primary 23-Gauge (G) vitreoretinal surgery for rhegmatogenous retinal detachment (RRD). METHODS: In this retrospective study, 49 eyes of 49 consecutive patients who underwent primary 23-G transconjunctival sutureless vitrectomy (TSV) for RRD between January 2007 and July 2009 at our institution were evaluated. RESULTS: Mean follow-up time was 8.9±7.7 months. Retinal reattachment was achieved with a single operation in 47(95.9%) of 49 eyes. In two eyes (4.1%), retinal redetachment due to new breaks was successfully treated with reoperation using the 23-G TSV system. Mean logMAR visual acuity was 2.01±0.47 preoperatively and 13±0.5 postoperatively (P<0.001, Paired t-test). Mean preoperative intraocular pressure (IOP) was 14.1±2.8mmHg. Mean postoperative IOP was 12.3±3.6mmHg at 1 day, 131±2.1mmHg at 1 week, 14.3±2.2mmHg at 1 month. Iatrogenic peripheral retinal break was observed in 1 eye (2.0%) intraoperatively. No sutures were required to close the scleral or conjunctival openings, and no eyes required convertion of surgery to 20-G vitrectomy. CONCLUSION: Primary 23-G TSV system was observed to be effective and safe in the treatment of RRD.