27G玻璃体切割联合空气填充术治疗孔源性视网膜脱离的疗效及安全性

Surgical outcomes of 27-gauge vitrectomy for rhegmatogenous retinal detachment with air tamponade

目的观察和评价27G经睫状体平坦部玻璃体切割（PPV）联合空气填充术治疗孔源性视网膜脱离（RRD）的疗效及安全性。方法对2016年4月至2017年1月在中山眼科中心实施27G PPV联合空气填充术治疗的35例RRD患者的35眼临床资料进行回顾性分析，患者术后平均随访时间为8.6个月。观察术眼手术前及术后1周和3个月最佳矫正视力（BCVA）（LogMAR）和眼压变化，记录手术持续时间、巩膜切口渗漏及缝合情况、术后视网膜复位率及术中术后并发症。结果27G PPV联合空气填充术的平均手术时间为（34.5±4.8）min，平均玻璃体切割时间为（15.3±3.6）min。所有患眼术毕均无需行巩膜切口缝合。27G PPV联合空气填充术一次性手术后视网膜完全复位率为100%。术眼术前平均BCVA为1.01±0.40，术后1周和3个月平均BCVA分别为0.82±0.31和0.68±0.30，总体比较差异有统计学意义（F＝64.12，P〈0.01），术后1周和3个月BCVA均明显高于术前，差异均有统计学意义（均P〈0.05）。术眼术前平均眼压为（14.69±3.66）mmHg（1 mmHg＝0.133 kPa），术后1周和3个月平均眼压分别为（17.37±2.32）mmHg和（16.69±2.45）mmHg，总体比较差异有统计学意义（F＝14.82，P〈0.01），术后1周和3个月眼压均明显高于术前，差异均有统计学意义（均P〈0.05）。术中发生医源性裂孔2眼，随访期间发生低眼压和高眼压者分别为1眼和5眼，经合理处理后均恢复正常。结论27G PPV联合空气填充术治疗RRD是安全、有效的。

ObjectiveTo evaluate the efficacy and safety of 27-gauge sutureless vitrectomy with air tamponade for rhegmatogenous retinal detachment （RRD）.MethodsThe clinical data of 35 consecutive eyes with primary RRD from 35 patients who received 27-gauge vitrectomy with intraocular air tamponade in Zhongshan Eye Center from April 2016 to January 2017 were retrospectively analyzed.The mean follow-up duration was 8.6 months.Best corrected visual acuity （BCVA） （LogMAR） and intraocular pressure （IOP） were examined before surgery, 1 week and 3 months after surgery.The operative duration, sclerotomy sites, retinal reattachment rate, intraoperative and postoperative complications were recorded.ResultsThe mean duration of vitreous removal was （15.3±3.6） minutes, and the mean duration of operation was （34.5±4.8） minutes.No suturing process was performed at sclerotomy sites in all eyes.The retinal reattachment rate following a single procedure was 100%.The mean BCVA was significantly different among before surgery, 1 week and 3 months after surgery （F=64.12, P〈0.01）, and the BCVA at 1 week and 3 months after surgery was evidently improved in comparison with before surgery （0.82±0.31 vs. 1.01±0.40; 0.68±0.30 vs.1.01±0.40） （both at P〈0.05）. The mean IOP was （14.69±3.66）, （17.37±2.32） and （16.69±2.45）mmHg （1 mmHg =0.133 kPa） before surgery, 1 week and 3 months after surgery, showing a significant difference among them （F=14.82, P〈0.01）, and the IOP 1 week and 3 months after surgery was evidently higher than that before surgery （both at P〈0.05）. The complications included intraoperative iatrogenic retinal breaks in 2 eyes, postoperative hypotony in 1 eye and hypertension in 5 eyes.These complications were curable.Conclusions27-Gauge vitrectomy and air tamponade for RRD is an effective and safe approach.