23G TVS在治疗玻璃体视网膜疾病中的应用

Application of 23-gauge transconjunctival sutureless vitrectomy system for vitreoretinopathy disease

目的探讨23G经结膜无缝合玻璃体切割系统(23GTVS)在玻璃体视网膜疾病中的应用,评估其疗效及安全性。方法回顾性分析2008年8月至2009年9月在我院行23G玻璃体切割术的患者42例(43眼)。其中,特发性黄斑裂孔16眼(37.2%),特发性黄斑前膜8眼(18.6%),玻璃体积血19眼(44.2%)。观察手术效果及时间、最佳矫正视力、眼压及术中、术后并发症等。术后随访1～10个月。结果所有病例均顺利完成手术,术后最佳矫正视力均有提高,术后1周矫正视力平均为0.88±0.54,末次随访为0.46±0.24,与术前比较差异均有显著统计学意义(均为P<0.01)。术后1周平均眼压为(14.0±4.5)mmHg(1kPa=7.5mmHg),接近术前水平。术中2眼套管滑脱,6眼结膜下轻微出血,3眼结膜下气泡;所有病例在随访期间无严重并发症发生。结论 23GTVS目前主要应用于黄斑疾病和玻璃体积血,术后恢复快,疗效好,并发症少,是一种安全有效的微创手术方法。

Objective To investigate the application of 23-gauge transconjunctival sutureless vitrectomy system in the treatment of vitreoretinopathy disease and evaluate its efficacy and safety.Methods A retrospective case of 23-gauge vitrectomy performed in 42 cases （43 eyes） in our hospital from August 2008 to September 2009.The diseases included idiopathic macular hole（16 eyes,37.2%）,idiopathic macular epiretinal membrane（8 eyes,18.6%）,vitreous hemorrhage（19 eyes,44.2%）.The main observations were the surgical effects,surgical time,best corrected visual acuity,intraocular pressure,intraoperative and postoperative complications.The follow-up time was from 1 month to 10 months.Results All cases were successfully completed surgery and each surgical indication experienced a significant best corrected visual acuity improvement.The mean best corrected visual acuity was 0.88±0.54 at postoperative 1 week and 0.46±0.24 at the last follow-up;Compared with that before operation,there were all significant statistical differences（all P0.01）.The mean intraocular pressure at postoperative 1 week was （14.0±4.5） mmHg （1 kPa=7.5 mmHg）,closed to preoperative level.The intraoperative complications included intubation tube slippage in 2 eyes,little hemorrhage under conjunctiva in 6 eyes,bubble under conjunctiva in 3 eyes;No serious postoperative complication was observed during the follow-up time in all cases.Conclusion 23-gauge transconjunctival sutureless vitrectomy system with faster postoperative recovery,better curative effect and rare complications,is an effective and safe surgical technique in the management of macular diseases and vitreous hemorrhage currently.