初期开展23G微创玻璃体切割术的临床观察

Therapeutic effects of 23G minimally invasive vitrectomy

目的：评估初期开展23G经结膜玻璃体切割手术的治疗效果。方法回顾性分析2013年3月至2014年9月在我院行23G微创玻璃体切割术的60例（60只眼）患者的临床资料，完成剥除视网膜增生膜，剥除黄斑前膜、内界膜，异物取出，眼内激光光凝，眼内电凝，气液交换，巩膜外冷凝，重水使用，染色剂使用以及眼内填充硅油、C3 F8、灌注液或空气等关键技术。术后随访2-6个月，记录手术方式、手术效果、最佳矫正视力、眼压及并发症的发生情况。结果所有病例均顺利完成手术，术后1个月最佳矫正视力较术前提高51只眼（85％），不变9只眼（15％）。其中，2只眼孔源性视网膜脱离患者行玻璃体切割联合C3 F8填充，于术后2个月视网膜脱离复发，均再次手术复位视网膜；1只眼玻璃体积血患者因术后再次出血，予行玻璃体灌洗术。术中发生医源性视网膜裂孔4只眼；硅油入前房3只眼；术后早期一过性低眼压2只眼；术后高眼压5只眼；重水残留1只眼；早期晶状体后囊混浊3只眼；硅油眼并发白内障3只眼。结论23 G微创玻璃体切割系统适用于多种玻璃体视网膜疾病，手术适应证广，创伤小，患者舒适度好，由于已有20G的手术基础，转型顺利，学习曲线不长，适合临床广泛开展。

Objective Objective To evaluate the therapeutic effects of 23-gauge （23G） vitrectomy surgeries per-formed in our hospital between March 2013 and September 2014.Methods This is a retrospective analysis.Clinical data were collected for 60 patients （60 eyes）.The purposes of vitrectomy included peeling of retinal membranes （proliferative, epiretinal, or internal limiting membrane）, foreign body extraction, intraocular laser photocoagulation or electrocoagula-tion, gas-liquid exchange, sclera condensation, intraocular infusion of heavy water, dyeing agents, silicone oil, perfluoro-propane gas （ C3 F8 ） , liquid, or air.The follow-up ranged from 2 -6 months.Best corrected visual acuity, intraocular pressure and surgical complications were analyzed.Results All cases were successfully operated.At 1 month, best cor-rected visual acuity improved in 51 eyes （85%） and remained unchanged in 9 eyes （15%）.Two patients with rhegmatog-enous retinal detachment underwent vitrectomy combined with C3 F8 tamponade, and a following surgery 2 months later that resulted in successful reattachment.In 1 patient with vitreous hemorrhage, bleeding recurred after vitrectomy and was trea-ted by vitreous lavage.Other complications included iatrogenic retinal tear （ n =4）, silicone oil anterior chamber leakage （ n =3）, transient hypotony （ n =2）, high intraocular pressure （ n =5）, residual heavy water （ n =1）, early posterior capsule opacification （ n =3）, cataract （ n =3;all patients received silicone oil implantation）.Conclusion Although previously inexperienced, we successfully operated vitrectomy using 23G minimally invasive procedures in patients with a variety of diseases.The advantages of 23G vitrectomy include broad indications, minimally invasive operation, high degree of patient comfort, and easy transition from the use of 20G systems.