25G微创玻璃体手术治疗特发性黄斑裂孔

A clinical observation of idiopathic macular hole surgery using 25G transconjunctiva sutureless vitrectomy

目的 探讨 2 5G经结膜无缝线微创玻璃体手术 ( 2 5GTSV)治疗特发性黄斑裂孔的疗效及并发症。方法 采用 2 5GTSV手术系统 ,对IMH1 5例 1 5眼 ,行玻璃体切除术。术后随访 1～ 1 3个月 ,平均 7个月。结果 1 5眼均顺利完成手术 ,手术时间 2 0～ 2 5分钟 ,平均约 2 1 . 4分钟。 1 5眼中 9眼采用表面麻醉 ,6眼采用球后麻醉。 1 4眼可顺利剥除黄斑裂孔旁内界膜 ,1眼未能完整的撕除。术后 1～ 6个月行OCT检查 ,显示 1 5眼中 1 4眼裂孔闭合 ,1眼裂孔缩小但未闭合 ,裂孔闭合率为93 3%。术后随访期间未发生裂孔再裂开现象。最后一次随访 ,术后最佳矫正视力 0 . 1～ 1 .0 ,平均0 . 35。 9眼 ( 6 0 % )的病人视力至少提高两行。手术并发症包括一过性眼压升高 ( 2眼 )、结膜下气泡( 2眼 )、晶状体后囊下羽毛状混浊 ( 5眼 ) ,晶状体核硬化 ( 2眼 ) ,未发生感染性眼内炎、医源性视网膜裂孔及视网膜脱离、脉络膜脱离以及切口持续性渗漏等并发症。结论 采用 2 5G经结膜无缝线微创玻璃体手术治疗IMH ,具有手术时间短、创伤小、并发症少、术后恢复快 ,手术疗效确切的优点 ,特别是可在表面麻醉下手术 ,避免了球后麻醉所引起的并发症 ,可用于门诊开展IMH的手术治疗。

Objective To observe the values and complication of performing vitreo retinal surgery using the 25G transconjunctiva sutureless vitrectomy system(25G TSVs)in idiopathic macular hole.Methods Using the 25G TSVs,15 eyes of idiopathic macular hole of 15 patients were performed vitreo-retinal surgery.Results In all of 15 eyes,the vitreo-retinal surgery can be finished successfully using the 25G TSVs.9 of 15 eyes were operated under the topical anesthesia,6 eyes under the retro ocular anesthesia.The operation duration ranged from 20 minutes to 25 minutes,average 21 4 minutes.The internal limiting membrane was peeled successfully in 14 eyes.The macular hole were closed in 14 eyes confirmed by OCT after operation,the success rate was 93 3%.At the last follow up,the best-corrected vision acuity was 0 1～1 0.The vision acuity improved at least 2 line in 9 of 15 patients(60%).Complications included transient increasing of IOP(2 eyes),feather-like opacity of lens(5 eyes),air-bleb under conjunctiva(2 eye).There were no endophthalmitis,iatrogenic retinal tears and retinal detachment,choroidal detachment and persist leakage of incision.All patients recovered rapidly post operation.Conclusions The idiopathic macular hole can be treated successfully with 25GTSVs.It has many advantages such as simple,micro-invasive,reduce operation time,and less complications compared with the standard three portions 20G vitrectome surgery,especially it can be performed under the topical anesthesia.