3D数字化平视玻璃体视网膜手术技术在永存胎儿血管增生症中应用的初步研究

Preliminary research of 3D digital vitrectomy in the treatment of persistent fetal vasculature

目的对比观察3D数字化平视玻璃体视网膜手术与传统光学显微镜下手术在永存胎儿血管增生症(PFV)手术治疗中应用的临床效果。方法回顾性病例分析研究。2017年11月至2019年8月在北京同仁医院眼科中心接受3D数字化平视玻璃体视网膜手术的PFV患儿19例20只眼(观察组)和传统光学显微镜下玻璃体视网膜手术的PFV患儿26例26只眼(对照组)纳入研究。两组患儿手术年龄均≤14岁且随诊至少1个月以上。两组患儿性别分布(χ2=0.114)、平均手术年龄(t=0.337)、眼轴长度(t=0.578)比较,差异均无统计学意义(P=0.267、0.782、0.650)。所有患儿均在全身麻醉状态下接受手术。所有手术均由同一经验丰富的手术医生完成。观察组采用NGENUITY 3D视频显示系统,主刀医生及助手医生通过佩戴3D眼镜进行手术操作和观摩。对照组患者接受传统光学显微镜下玻璃体视网膜手术,即主刀医生和第一助手医生均通过手术显微镜目镜进行手术操作。对比观察两组患者的手术持续时间、患者手术前后视功能和局部解剖变化以及手术相关并发症的发生情况。由手术者对观察组和对照组的手术难度进行评分。1分:无难度;2分:难;3分:较难;4分:很难;5:非常难。记录参与患者手术治疗过程的非眼科医护人员(麻醉医生和手术室巡回护士)以及眼科医生(主刀医生、第一助手医生、第二助手医生)观看或使用3D平视玻璃体视网膜手术的体会。两组患儿之间计量资料比较采用独立样本t检验,计数资料比较采用χ2检验。结果观察组平均手术持续时间为(34.7±8.5)min,平均手术难度评分为(2.8±0.9)分。对照组平均手术持续时间为(37.5±1.6)min,平均手术难度评分为(3.1±1.1)分。两组手术持续时间、手术难度评分比较,差异无统计学意义(t=0.782、0.438,P=0.703、0.562)。末次随访时,观察组视力提高、不变分别为7、13只眼,对照组视力提高、不变分别为8、18只眼。两组患儿手术前后视力变化比较,差异无统计学意义(χ2=0.279,P=0.254)。两组患儿均未发生眼内炎、继发性青光眼等手术并发症。所有参与手术的医护人员均表示3D数字化平视玻璃体视网膜手术视频立体感和清晰度优于传统光学显微镜手术视频。结论在PFV手术治疗方面,3D数字化平视玻璃体视网膜手术视频图像立体感和清晰度较高,且可获得与传统光学显微镜手术相同的临床效果。

Objective To observe the clinical effect of 3D digital head-up vitreoretinal surgery and conventional optical microscope surgery in the treatment of persistent fetal vasculature(PFV).Methods A retrospective case analysis study was performed.From November 2017 to August 2019,the enrolled patienres included that 20 eyes of 19 patients with PFV undergoing 3D digital head-up vitreoretinal surgery and 26 eyes of 26 patients with PFV undergoing traditional microscopic vitrectomy in the Eye Center of Beijing Tongren Hospital.The operation age of patients in the two groups were≤14 years old and followed up for at least 1 month.There were no significantly statistical differences in gender(χ2=0.114),age(t=0.337),axial length(t=0.578)between the two groups(P=0.267,0.782,0.650).All the patients were operated under general anesthesia by the same doctor.All the surgical procedures were completed by the surgeon watching the 3D screen with 3D glasses,and all the surgical process were observed by the other medical staff including the nurses and the anaesthetists in the observation group.While in the observation group,the surgical doctor and one assistant doctor watched the surgery through the operating microscope,the other doctors watched the 2D surgical video system.The general information,pre-and postoperative visual acuity,anatomical changes and surgical complications were reviewed and compared between the two groups.Difficulty and complexity of each surgery were classified by the chief surgical doctor into 5 scores.1:easy,2:a little difficult,3:much difficult,4 very difficult;5:most difficult.Opinions of medical staff majored in or not majored in ophthalmology were also recorded.Independent sample t test was used to compare the count data between the two groups,while chi-square test was used to compare the measurement data.Results The average operating time was 34.7±8.5 minutes and the difficulty score was 2.8±0.9 in the observation group.The average operating time was 37.5±1.6 minutes and the difficulty score was 3.1±1.1 in the comparison group.There was no significant statistically differences between the two groups(t=0.782,0.938;P=0.703,0.562).Seven eyes had visual acuity improvement at last visit while 13 eyes with no changes compared with pre-operative visual acuity in the observation group,8 eyes showed visual acuity improvement at last visit while 18 eyes showed no changes compared with pre-operative visual acuity in the comparison group.There was no significantly statistical differences between the two groups(χ2=0.279,P=0.254).No surgical complications such as endophthalmitis or secondary glaucoma were observed in the two groups.3D digital system showed better stereoscopic pictures and better resolution compared with traditional microscopic vitrectomy.All the medical staff which participated in the surgery preferred to the 3D digital vitrectomy system.Conclusions 3D heads-up digital vitrectomy shows better stereoscopic pictures and better resolution.3D heads-up digital vitrectomy and traditional microscopic vitrectomy yielded comparable visual and anatomical outcomes for treatment of pediatric vitreoretinal diseases,however,there is not a significant difference in clinical outcomes.