Chronic hypotony management using endoscopy-assisted vitrectomy after severe ocular trauma or vitrectomy

·AIM: To report outcomes of endoscopy-assisted vitrectomy(EAV) in patients with chronic hypotony following severe ocular trauma or vitrectomy.·METHODS: This was a retrospective, noncomparative case series. Ciliary bodies were evaluated using ultrasound biomicroscopy pre-operatively and direct visualisation intraoperatively. All selected individuals(seven patients/seven eyes) underwent EAV. Removal of ciliary membrane and traction, gas/silicone oil tamponade(GT/SOT), and scleral buckling(SB) were performed in selected eyes. Outcome measurements mainly included intraocular pressure(IOP) and best-corrected visual acuity(BCVA).·RESULTS: Seven eyes from 7 male aphakic patients with a mean age of 45(range, 20-68)y were included in this study;the average follow-up time was 12(9-15)mo. GT was performed in 2 eyes;membrane peeling(MP) and SOT in 2 eyes;and MP, SOT, and SB in 3 eyes. The mean preand post-operative IOP were 4.5(range, 4.0±0.11 to 4.8±0.2) mm Hg and 9.9(range, 5.6±0.17 to 12.1±0.2) mm Hg at 52wk(12mo), respectively. BCVA improved in six eyes;one eye still showed light perception, and no bulbi phthisis was observed.·CONCLUSION: Endoscopy offers improved judgment and recognition and has an improved prognosis for chronic hypotony. Therefore, endoscopy can be an effective and promising operative technique for chronic traumatic hypotony management.

Endoscopy-assisted vitrectomy in the anterior vitreous

Endoscopy-assisted ocular surgery is a relatively old technique that is increasingly being recognized for its application in cases of vitreoretinal disease. This technique is especially useful when both the vitreous and retina are difficult to access because of media opacity, a small pupil, or a microcornea. In this context, the anterior vitreous is often difficult to dissect because of its complex pathological changes. This article reviews the common anatomical features and pathologies that are observed in the anterior vitreous, as well as the applications and indications of endoscopy-assisted vitrectomy in the anterior vitreous.

Subconjunctival trypsin injection for anterior chamber fibrin exudates in eyes with globe rupture following vitrectomy

AIM:To compare the safety and clinical outcomes of subconjunctival trypsin and dexamethasone(DEX)injections in the treatment of anterior chamber fibrin exudates in eyes with globe rupture following primary wound repair and vitrectomy.METHODS:A retrospective analysis included 42 males and 10 females(mean age 46.0±6.0y,range 34 to 58y)who underwent primary wound sutures and vitrectomy for globe rupture.Patients with pupil-covered fibrinous exudate or/and membrane in the anterior chamber were treated.On the first postoperative day,subconjunctival injections of either 5000 units(0.4 mL)of trypsin solution(n=25)or 0.5 mL(1 mg)DEX(n=27)were administered to accelerate exudate absorption.Efficacy was assessed by observing break time and partial absorption of the fibrin exudate membrane.Safety and comfort were evaluated by monitoring intraocular pressure(IOP),allergy,pain,and foreign body sensation.RESULTS:Both groups achieved 1/3 absorption of the anterior chamber fibrin exudate membrane,but the trypsin group exhibited shorter break time and partial absorption time compared to the DEX group(P<0.05).Trypsin treatment was also less irritating to patients.No adverse reactions were reported,and IOP remained stable.Visual acuity improved in both groups without statistical difference.CONCLUSION:Compared to DEX,trypsin demonstrates a shorter absorption time for the fibrin exudate membrane with a more comfortable process in treating pupil-covered fibrinous exudate or/and membrane after vitrectomy for globe rupture.

Effectiveness and safety of early lens extraction during par plana vitrectomy for proliferative diabetes retinopathy with mild cataract:a randomized clinical trial

●AIM:To evaluate the effectiveness and safety of early lens extraction during pars plana vitrectomy(PPV)for proliferative diabetic retinopathy(PDR)compared to those of PPV with subsequent cataract surgery.●METHODS:This multicenter randomized controlled trial was conducted in three Chinese hospitals on patients with PDR,aged>45y,with mild cataracts.The participants were randomly assigned to the combined(PPV combined with simultaneously cataract surgery,i.e.,phacovitrectomy)or subsequent(PPV with subsequent cataract surgery 6mo later)group and followed up for 12mo.The primary outcome was the change in best-corrected visual acuity(BCVA)from baseline to 6mo,and the secondary outcomes included complication rates and medical expenses.●RESULTS:In total,129 patients with PDR were recruited and equally randomized(66 and 63 in the combined and subsequent groups respectively).The change in BCVA in the combined group[mean,36.90 letters;95%confidence interval(CI),30.35–43.45]was significantly better(adjusted difference,16.43;95%CI,8.77–24.08;P<0.001)than in the subsequent group(mean,22.40 letters;95%CI,15.55–29.24)6mo after the PPV,with no significant difference between the two groups at 12mo.The overall surgical risk of two sequential surgeries was significantly higher than that of the combined surgery for neovascular glaucoma(17.65%vs 3.77%,P=0.005).No significant differences were found in the photocoagulation spots,surgical time,and economic expenses between two groups.In the subsequent group,the duration of work incapacity(22.54±9.11d)was significantly longer(P<0.001)than that of the combined group(12.44±6.48d).●CONCLUSION:PDR patients aged over 45y with mild cataract can also benefit from early lens extraction during PPV with gratifying effectiveness,safety and convenience,compared to sequential surgeries.

Differential distribution of fibrovascular proliferative membranes in 25-gauge vitrectomy for proliferative diabetic retinopathy

AIM:To analyze the distribution of fibrovascular proliferative membranes(FVPMs)in proliferative diabetic retinopathy(PDR)patients that treated with pars plana vitrectomy(PPV),and to evaluate the outcomes separately.METHODS:This was a retrospective and cross-sectional study.Consecutive 25-gauge(25-G)PPV cases operated for PDR from May 2018 to April 2020.According to the FVPMs images outlined after operations,subjects were assigned into three groups:arcade type group,juxtapapillary type group,and central type group.All patients were followed up for over one year.General characteristics,operation-related variables,postoperative parameters and complications were recorded.RESULTS:Among 103 eyes recruited,the FVPMs distribution of nasotemporal and inferiosuperioral was significantly different(both P<0.01),with 95(92.23%)FVPMs located in the nasal quadrants,and 74(71.84%)in the inferior.The eyes with a central FVPM required the longest operation time,with silicon oil used in most patients,generally combined with tractional retinal detachment(RD)and rhegmatogenous RD,the worst postoperative bestcorrected visual acuity(BCVA)and the highest rates of recurrent RD(all P<0.05).FVPM type,age of onset diabetes mellitus,preoperative BCVA,and combined with tractional RD and rhegmatogenous RD were significantly associated with BCVA improvement(all P<0.05).Compared with the central type group,the arcade type group had higher rates of BCVA improvement.CONCLUSION:FVPMs are more commonly found in the nasal and inferior mid-peripheral retina in addition to the area of arcade vessels.Performing 25-G PPV for treating PDR eyes with central FVPM have relatively worse prognosis.

Investigation and analysis of negative emotion in patients with diabetic retinopathy after vitrectomy

BACKGROUND As the incidence of diabetes continues to increase,the number of patients with diabetic retinopathy(DR)also increases each year.After undergoing vitrectomy for DR,patients often experience negative emotional problems that negatively affect their recovery.AIM To investigate negative feelings in patients with DR after vitrectomy and to explore related influencing factors.METHODS A total of 146 individuals with DR who were accepted for treatment at The Third People’s Hospital of Changzhou from May 2021 to April 2023 were recruited to participate in this study.All patients underwent vitrectomy.The self-rating anxiety scale(SAS)and self-rating depression scale(SDS)were used to assess the degree of anxiety and depression 2-3 days after the operation.The participants were divided into a healthy control group and a negative emotion group.The patients’general demographic characteristics and blood glucose levels were collected.Logistic regression analysis was used to analyze the factors influencing negative feelings post-operation.Pearson’s correlation coefficient was used to analyze the association between SAS scores,SDS scores,and blood glucose levels.RESULTS The control group included 85 participants.The negative emotion group comprised 40 participants with anxiety,13 with depression,and eight with both.Logistic regression showed that being female(OR=3.090,95%CI:1.217-7.847),a family per capita monthly income of<5000 yuan(OR=0.337,95%CI:0.165-0.668),and a longer duration of diabetes(OR=2.068,95%CI:1.817-3.744)were risk factors for negative emotions in patients with DR after vitrectomy(P<0.05).The concentrations of fasting plasma glucose(FPG),2-hour postprandial glucose(2hPG),and glycated hemoglobin(HbA1c)in the negative emotion group exceeded those in the control group(P<0.05).SAS scores were positively associated with FPG(r=0.422),2hPG(r=0.334),and HbA1c(r=0.362;P<0.05).SDS scores were positively correlated with FPG(r=0.218)and 2hPG(r=0.218;P<0.05).CONCLUSION Sex,income level,and duration of diabetes were factors that influenced negative emotions post-vitrectomy.Negative emotions were positively correlated with blood glucose levels,which can be used to develop intervention strategies.

Effects of vitrectomy combined with internal limiting membrane peeling in patients with diabetic macular edema

BACKGROUND Diabetic macular edema(DME),a chronic microvascular complication of diabetes,is a leading cause of visual impairment and blindness.Pars plana vitrectomy(PPV)can restore the normal macular structure and reduce macular edema,whereas internal limiting membrane(ILM)peeling is used to treat tractional macular diseases.Despite the advantages,there is limited research on the combined effects of PPV with ILM peeling.AIM To observe the effects of PPV combined with ILM peeling on postoperative central macular thickness(CMT),best-corrected visual acuity(BCVA),cystoid macular edema(CME)volume,and complications in patients with DME.METHODS Eighty-one patients(92 eyes)diagnosed with DME at the Beijing Shanqu Liangxiang Hospital between January and December 2022 were randomly divided to undergo PPV alone(control group:41 patients,47 eyes)or PPV+ILM peeling(stripping group:40 patients,45 eyes);a single surgeon performed all surgeries.The two groups were compared preoperatively and 1 and 3 months postoperatively.RESULTS Preoperatively,both groups had comparable values of CMT,BCVA,and CME volume(P>0.05).After surgery(both 1 and 3 months),both groups showed significant reductions in CMT,BCVA,and CME volume compared to preoperative levels,with the stripping group showing more significant reductions compared to the control group(P<0.05).Further repeated-measures ANOVA analysis for within-group differences revealed significant effects of group and time,and interaction effects for CMT,BCVA,and CME volume(P<0.05).There were no significant differences in the incidence of complications between the groups(retinal detachment:control=2,stripping=1;endophthalmitis:Control=4,stripping=1;no cases of secondary glaucoma or macular holes;χ^(2)=0.296,P=0.587).CONCLUSION PPV with ILM peeling can significantly improve the visual acuity of patients with DME,reduce CMT,and improve CME with fewer complications.

Pharmacological adjuvants for diabetic vitrectomy surgery

Diabetic vitrectomy is a highly intricate surgical procedure performed during the advanced stages of diabetic retinopathy(DR).It is used to treat conditions such as tractional or combined retinal detachment,vitreous hemorrhage,and subhyaloid hemorrhage,which are all severe manifestations of proliferative DR.The results of the surgery are uncertain and variable.Vitreoretinal surgery has made significant progress since the early stages of vitrectomy.In the past ten years,advancements in intravitreal pharmacotherapy have emerged,offering new possibilities to improve the surgical results for our patients.Within the realm of medical terminology,an"adjunct"refers to a pharmaceutical or substance employed to aid or expedite the primary therapeutic intervention for a particular ailment.Their introduction has broadened the range of therapeutic choices that are accessible prior to,during,and following surgical procedures.This review article will specifically analyze the pharmacological adjuncts used in diabetic vitrectomy surgery,with a focus on their role in facilitating or aiding specific steps of the procedure.The implementation of this system of categorization offers benefits to the surgeon by allowing them to foresee potential difficulties that may occur during the surgical procedure and to choose the appropriate pharmacological agent to effectively tackle these challenges,thus enhancing surgical success rates.

Axial length,vitreoretinal pathology,and anterior chamber depth can predict postoperative refractive outcomes in phacovitrectomy/silicone oil removal

AIM:To evaluate the postoperative refractive prediction error(PE)and determine the factors that af fect the refractive outcomes of combined pars plana vitrectomy(PPV)or silicone oil removal(SOR)with cataract surgery.METHODS:The study is a retrospective,case-series study.Totally 301 eyes of 301 patients undergoing combined PPV/SOR with cataract surgery were enrolled.Eligible individuals were separated into four groups according to their preoperative diagnoses:silicone oil-filled eyes after PPV(group 1),epiretinal membrane(group 2),macular hole(group 3),and primary retinal detachment(RD;group 4).The variables af fecting postoperative refractive outcomes were analyzed,including age,gender,preoperative best-corrected visual acuity(BCVA),axial length(AL),keratometry average,anterior chamber depth(ACD),intraocular tamponade,and vitreoretinal pathology.The outcome measurements include the mean refractive PE and the proportions of eyes with a PE within±0.50 diopter(D)and±1.00 D.RESULTS:For all patients,the mean PE was-0.04±1.17 D,and 50.17%of patients(eyes)had a PE within±0.50 D.There was a significant difference in refractive outcomes among the four groups(P=0.028),with RD(group 4)showing the least favorable refractive outcome.In multivariate regression analysis,only AL,vitreoretinal pathology,and ACD were strongly associated with PE(all P<0.01).Univariate analysis revealed that longer eyes(AL>26 mm)and a deeper ACD were correlated with hyperopic PE,and shorter eyes(AL<26 mm)and a shallower ACD were correlated with myopic PE.CONCLUSION:RD patients have the least favorable refractive outcome.AL,vitreoretinal pathology,and ACD are strongly associated with PE in the combined surgery.These three factors affect refractive outcomes and thus can be used to predict a better postoperative refractive outcome in clinical practice.

Analysis of postoperative ocular surface changes and intervention effect after pars plana vitrectomy in meibomian gland dysfunction dry eye patients

AIM:To observe ocular surface changes after phacovitrectomy in patients with mild to moderate meibomian gland dysfunction(MGD)-type dry eye and track clinical treatment response using a Keratograph 5M and a Lipi View interferometer.METHODS:Forty cases were randomized into control group A and treatment group B;the latter received meibomian gland treatment 3d before phacovitrectomy and sodium hyaluronate before and after surgery.The average non-invasive tear film break-up time(NITBUTav),first noninvasive tear film break-up time(NITBUTf),non-invasive measured tear meniscus height(NTMH),meibomian gland loss(MGL),lipid layer thickness(LLT)and partial blink rate(PBR)were measured preoperatively and 1wk,1 and 3mo postoperatively.RESULTS:The NITBUTav values of group A at 1wk(4.38±0.47),1mo(6.76±0.70),and 3mo(7.25±0.68)were significantly lower than those of group B(7.45±0.78,10.46±0.97,and 11.31±0.89;P=0.002,0.004,and 0.001,respectively).The NTMH values of group B at 1wk(0.20±0.01)and 1mo(0.22±0.01)were markedly higher than those of group A(0.15±0.01 and 0.15±0.01;P=0.008 and P<0.001,respectively);however,there was no difference at 3mo.The LLT of group B at 3mo[91.5(76.25-100.00)]significantly exceeded that of group A[65.00(54.50-91.25),P=0.017].No obvious intergroup difference was found in MGL or PBR(P>0.05).CONCLUSION:Mild to moderate MGD dry eye worsens in the short term after phacovitrectomy.Preoperative cleaning,hot compresses,and meibomian gland massage as well as preoperative and postoperative sodium hyaluronate promote the rapid recovery of tear film stability.

A novel approach for 25-gauge transconjunctival sutureless vitrectomy to evaluate vitreous substitutes in rabbits

AIM:To improve the standard three-port vitrectomy for establishing and evaluating an endotamponade model in rabbits.METHODS:Three ports were prepared near the third eyelid of rabbits,and the infusion port was placed at the inferior nasal quadrant with the inserted cannula linking with a self-designed handheld rigid infusion catheter.All right eyes of rabbits underwent a modified 25-gauge vitrectomy and were subsequently filled with balanced salt solution,silicone oil,and eight-arm polyethylene glycols(8-arm PEGs)hydrogel separately for comparison.Ophthalmic examinations were performed regularly to record the changes after the surgery.RESULTS:Successful vitrectomy was achieved among 44 chinchilla rabbits.The mean operation time was 4.51±1.25min.Four eyes(9.1%)presented limited lens touch and two eyes(4.5%)showed retinal touch during surgery.Incision leakage was found in three eyes(6.8%)after surgery.There was no endophthalmitis,hemorrhage,or retinal detachment during the observation period and ophthalmic examinations after the implantation of vitreous substitutes.CONCLUSION:The modified technique of the standard vitrectomy applied in the endotamponade model in rabbits shows excellent safety and practicality.

A sutureless technique for securing leaking sclerotomies with viscoelastic substances in 23-gauge microincision vitrectomy surgery

AIM:To introduce and evaluate the clinical efficacy of a new technique,the use of viscoelastic substances(VS)to close leaking sclerotomy in 23G microincision vitrectomy,and to observe its effect on the visual acuity and intraocular pressure(IOP)of patients.METHODS:Patients who underwent 23G vitrectomy in Ningbo Eye Hospital before the use of VS technique(June 2019 to September 2020)and after the use of VS technique(October 2020 to December 2021)were selected as the subjects of this study.The above cases underwent operation by the same surgeon and were retrospectively analyzed.VS technique was used as the alternative to suturing,in which a small amount of VS was injected at the leaking sclerotomy and then gently massaged to confirm leaking sclerotomy closure.RESULTS:A total of 174 eyes were covered in the study,including 84 eyes in the control group(before the use of VS technique)and 90 eyes in the VS technique group.The number of eyes that needed to be sutured decreased considerably from 42.9%in the control group to 3.3%in the VS technique group,and the proportion of subconjunctival hemorrhage at 1-2d after surgery decreased remarkably from 35.7%in the control group to 2.2%in the VS technique group.No substantial differences in the incidence of mean IOP and low IOP were found between 1-2 and 3-20d after surgery in the VS technique group.No major complications associated with VS technique were identified during the study.CONCLUSION:In 23G microincision vitrectomy,VS technique is a safe,simple,and effective method to close leaking sclerotomy.

Surgical Approaches in Primary Rhegmatogenous Retinal Detachment: A Systematic Review and Meta-Analysis Comparing Vitrectomy vs. Vitrectomy Combined with Scleral Buckling, Lens-Sparing vs. Phako Procedures

Aim: This study aimed to assess and compare the functional and anatomical results of pars plana vitrectomy (PPV) alone versus PPV combined with scleral buckling (SB), and lens-sparing versus phaco-procedures for treating rhegmatogenous retinal detachment. Methods: A comprehensive literature search was performed using the Web of Science, MEDLINE, EMBASE, and Cochrane Library databases to retrieve comparative studies. The main objective was to assess the BCVA, while reattachment rates and ocular adverse events were considered secondary measures. Rev Manager software was used for statistical analysis. Results: The literature search identified 10 articles comprising 1518 eyes, with 682 eyes in the PPV group, 193 eyes in the lens-sparing versus phaco-procedure group, and 643 eyes in the combined PPV and SB surgery group. Quality assessment revealed a low risk of bias in most domains. The meta-analysis results revealed a significant difference in postoperative BCVA between the PPV and PPV combined with SB groups (WMD = −0.17, 95% CI [0.27, 0.07], p = 0.001). The primary reattachment rates were 82.80% for PPV alone and 87.52% for PPV combined with SB (p = 0.34). The final reattachment rates did not differ significantly between PPV and PPV combined with SB (99% vs. 99.8%;RR = 1.00, 95% CI [1.01, 0.99], p = 0.96). PPV alone demonstrated a significantly reduced risk of macular edema compared to PPV combined with scleral buckling (9.9% vs. 23%;p = 0.006). The incidences of macular hole development (p = 0.46), recurrent retinal detachment (p = 0.27), proliferative vitreoretinopathy development (p = 0.48), epiretinal membrane proliferation (p = 0.77), and limited choroidal hemorrhage (p = 0.69) were not significantly different between the two groups. Conclusions: These findings suggest that PPV alone may be a more effective treatment option in terms of visual acuity (VA) improvement, lower risk of macular edema and cataract development. However, there was no significant difference in VA improvement or complication rates between the lens-sparing and phaco-procedure groups. .

结膜无缝合玻璃体切割系统联合微切口白内障超声乳化在白内障合并增殖型糖尿病视网膜病变患者中的应用效果

目的探讨结膜无缝合玻璃体切割系统联合微切口白内障超声乳化在白内障合并增殖型糖尿病视网膜病变患者中的应用效果。方法选取2020年1月至2022年12月南昌大学第二附属医院收治的40例(80眼)白内障合并增殖型糖尿病视网膜病变患者作为研究对象,所有患者均为双眼病变,按照随机数字表法将其分为观察组(20例,40眼)与对照组(20例,40眼)。对照组采用常规玻璃体切割术与白内障超声乳化吸除术,观察组采用结膜无缝合玻璃体切割系统联合微切口白内障超声乳化吸除术。比较两组手术前,术后7 d,术后1、3个月视力水平、眼压水平及内皮细胞数目以及两组术后并发症发生情况。结果两组患者术后7 d,术后1、3个月视力水平高于手术前,差异有统计学意义(P<0.05);手术前、术后7 d、术后1个月,两组患者的视力水平比较,差异无统计学意义(P>0.05);术后3个月,观察组患者的视力水平高于对照组,差异有统计学意义(P<0.05)。术后7 d及术后1、3个月,两组患者的眼压水平低于手术前,差异有统计学意义(P<0.05);手术前,术后7 d,术后1、3个月,两组患者的眼压水平比较,差异无统计学意义(P>0.05)。术后7 d及术后1、3个月,两组患者的内皮细胞数目低于手术前,差异有统计学意义(P<0.05);术后1、3个月,两组患者的内皮细胞数目均高于术后7 d,差异有统计学意义(P<0.05);术后7 d及术后1、3个月,观察组患者的内皮细胞数高于对照组,差异有统计学意义(P<0.05)。观察组患者的并发症总发生率低于对照组,差异有统计学意义(P<0.05)。结论结膜无缝合玻璃体切割系统联合微切口白内障超声乳化治疗白内障合并增殖型糖尿病视网膜病变效果显著,可改善患者视力水平,不增加患者术后眼压,且可减少术后内皮细胞的丢失,术后并发症发生率较低。

25G玻璃体切除联合超声乳化手术中散光人工晶状体的应用

目的观察25G玻璃体切除联合超声乳化手术中植入环曲面人工晶状体(Toric intraocular lens,Toric IOL)的临床效果及稳定性。方法回顾分析武汉市第一医院行白内障超声乳化吸出+ToricIOL植入患者58例(58眼),其中A组20例(20眼)为1期行25G玻璃体切除联合白内障超声乳化吸出+ToricIOL植入患者。B组18例(18眼)为25G玻璃体切除术后,2期行白内障超声乳化吸出+ToricIOL植入患者。C组20例(20眼)为单纯白内障超声乳化吸出+ToricIOL植入患者。术后随访6月。观察三组患者术前及术后视力、残余散光度、术后ToricIOL在眼内的旋转度、偏心量及像差。结果术后6月,三组患者裸眼远视力(uncorrected distance visual acuity,UCVA)、最佳矫正视力(best corrected visual acuity,BCVA)均显著高于术前,差异有统计学意义(均P<0.05)。术后1周、1月、3月及6月,A组散光分别为(0.95±0.34)D、(1.01±0.34)D、(1.23±0.35)D、(1.21±0.32)D,B组散光分别为(0.92±0.31)D、(1.14±0.33)D、(1.21±0.31)D、(1.22±0.33)D,均明显高于C组各时间点[(0.65±0.29)D、(0.73±0.24)D、(0.91±0.34)D、(0.96±0.37)D],差异有统计学意义(均P<0.05)。术后6月,A组IOL平均旋转(4.85±1.23)°,B组IOL平均旋转(4.78±1.56)°,显著高于C组[(3.80±1.20)°](均P<0.05),A组与B组间比较差异没有统计学意义。A组与B组全眼总像差、全眼总低阶像差(不包括离焦)、全眼总高阶像差差异没有统计学意义,但均高于C组,差异有统计学意义(均P<0.05)。A组、B组、C组平均偏心量分别为(0.284±0.060)mm、(0.278±0.069)mm、(0.265±0.047)mm,差异无统计学意义(P>0.05)。结论对于伴有角膜散光和玻璃体疾病的白内障患者,选择ToricIOL植入,能够实现较好的旋转稳定性,偏心程度小,从而获得更好的视觉质量。1期行玻璃体切除联合白内障手术与2期白内障手术比较,植入ToricIOL的稳定性没有明显差异。

“肝脾同调-血水同治”对增殖性糖尿病性视网膜病变PPV围手术期的影响

目的探究“肝脾同调-血水同治”对增殖性糖尿病性视网膜病变(proliferative diabetic retinopathy,PDR)玻璃体切除术(pars plana vitrectomy,PPV)患者围手术期的影响。方法选取2021年6月—2023年6月本院收治的63例PDR患者,按照简单随机法分为常规组(n=31)和同调组(n=32),常规组给予常规围术期治疗(术前3~5 d至术后7 d),同调组在常规组基础上实施“肝脾同调-血水同治”治法,比较2组临床指标、并发症(高眼压、玻璃体积血、视力下降)、眼压、炎症反应分级(前房闪辉、前房炎症细胞、纤维蛋白渗出),干预前后炎症因子水平[前房液白细胞介素-6(Interleukin-6,IL-6)、血清C反应蛋白(C-reactive protein,CRP)]。结果同调组手术时间、住院时间低于常规组(P<0.05);2组并发症总发生率比较无统计学意义(P>0.05);术后1 d、3 d,2组眼压均随时间延长而下降(P<0.05),且术后1 d同调组低于常规组(P<0.05);术后1 d、1周,2组前房闪辉、前房炎症细胞和纤维蛋白渗出评级随时间延长明显减轻(P<0.05),且术后1 d同调组前房闪辉评级明显低于常规组(P<0.05);术后1 d、1周,2组前房液IL-6、血清CRP均随时间延长而降低(P<0.05),且同调组均低于常规组(P<0.05)。结论“肝脾同调-血水同治”应用于PPV治疗的PDR患者,可减少患者围术期并发症,有效控制炎症反应,缩短手术时间和住院时长,具有临床应用价值。

少量中心玻璃体切除后再行白内障超声乳化手术治疗伴玻璃体积血白内障患者的效果

目的研究因玻璃体积血而无红光反射的眼睛中,白内障手术前先行少量中心玻璃体切除术的有效性和安全性。方法回顾性分析。2022年1—4月郑州大学第一附属医院东院区眼一科收治的40例(40眼)伴玻璃体积血的白内障患者,眼底红光反射不清,分为A(20眼)和B(20眼)两组,A组患者先接受白内障超声乳化联合人工晶体植入手术,然后在进行全玻璃体切除术。B组患者先接受少量中心玻璃体切除术(0.5~1 mL),然后进行白内障超声乳化联合人工晶体植入手术,最后进行全玻璃体切除术。术后随访时间不少于6个月。所有患者均行23G超声乳化联合玻璃体切除术。观察手术时间(连续环形撕囊总时间、白内障手术总时间)及手术相关并发症的发生率。结果B组的连续环形撕囊总时间和白内障手术总时间均短于A组(P<0.05)。在并发症中,A组的前囊撕裂发生率高于B组(P=0.072);白内障手术期间,B组瞳孔缩小发生率大于A组(P=0.152);两组均未出现后囊膜破裂的情况。A组和B组的术后最佳矫正视力(BCVA)同术前比,均有提高,差异有统计学意义(P<0.05)。结论对伴有玻璃体积血的白内障患者行超声乳化白内障手术前先行少量中心玻璃体切除术(0.5~1 mL),有助于获得良好的红光反射,可减少白内障手术时间和白内障手术相关并发症。

高度近视黄斑裂孔性视网膜脱离行玻璃体切割术后C_(3)F_(8)与硅油填充的疗效比较

目的:比较高度近视黄斑裂孔性视网膜脱离(MHRD)行玻璃体切割联合内界膜剥离后玻璃体腔内分别行硅油或C_(3)F_(8)填充治疗的疗效观察。方法:回顾性临床研究。2019-01/2022-08就诊于我院的45例45眼高度近视MHRD患者,根据手术方式分为硅油组(23例)及C_(3)F_(8)组(22例),两组患者均常规三切口玻璃体切割手术,内界膜剥离后行内界膜填塞、自体血覆盖,硅油填充组行硅油填充,C_(3)F_(8)组行15%C_(3)F_(8)气体填充。两组患者分别观察最佳矫正视力(BCVA)、多焦视网膜电图(mfERG)、裂孔的闭合及视网膜复位情况,统计两组患者术后并发症情况。结果:C_(3)F_(8)组、硅油组患者裂孔闭合率为77%、83%(P>0.05),视网膜复位率分别为95%、96%(P>0.05)。C_(3)F_(8)组、硅油组术后视力分别为0.99±0.34、1.22±0.37,C_(3)F_(8)组视力优于硅油组(t=-2.156,P=0.037),两组均较术前显著提高。术后12 mo,两组患者mfERG一阶函数1环(C_(3)F_(8)组114.27±26.37 nV/deg2,硅油组98.08±24.36 nV/deg2)及2环(C_(3)F_(8)组80.45±14.94 nV/deg2,硅油组67.73±15.33 nV/deg2)P1波反应密度较术前(1环P1波反应密度:C_(3)F_(8)组58.13±13.96 nV/deg2、硅油组55.30±10.48 nV/deg2;2环P1波反应密度:C_(3)F_(8)组51.18±8.19 nV/deg2、硅油组47.43±11.97 nV/deg2)明显增加(均P<0.05),C_(3)F_(8)组较硅油组增加明显(P<0.05)。硅油组与C_(3)F_(8)组患者术后并发症发生情况无差异(P>0.05)。结论:玻璃体切割联合内界膜剥离后玻璃体腔内分别行硅油或C_(3)F_(8)填充均可促进高度近视MHRD患者视网膜复位及黄斑裂孔闭合,而且在视功能恢复C_(3)F_(8)填充优于硅油填充。

开放性眼外伤玻璃体切割手术预后及影响因素

目的探讨开放性眼外伤行玻璃体切割手术(PPV)治疗的预后情况,并对其相关影响因素进行分析。方法回顾性研究2013-01至2022-12在武警四川总队医院、乐山市眼科中心、成都中医药大学附属眼科医院行PPV治疗的开放性眼外伤患者241例(241眼)的临床资料。记录术前临床特征,包括性别、年龄、外伤类型、外伤分区、眼内异物、视力、眼压、相对性传入性瞳孔障碍、受伤至PPV时间(受伤~手术时间)、感染性眼内炎和组织受累情况。根据患者情况制定相应的PPV方案,术后随访6个月,每次随访记录视力、眼压、屈光介质情况,视网膜复位情况,眼球保留和摘除情况。根据末次随访结果评判手术预后情况。采用多因素回归分析术前临床特征与手术预后的相关性。结果241眼中,解剖痊愈113眼(46.9%),功能痊愈93眼(38.6%),总治愈206眼(85.5%),未愈35眼(14.5%),眼球摘除17眼(7.1%)。多因素回归分析显示总治愈率与外伤类型、外伤分区、受伤~手术时间相关,眼球摘除率与外伤类型、术前视力、受伤~手术时间相关。结论PPV治疗开放性眼外伤疗效显著,外伤类型、外伤分区、术前视力和受伤~手术时间是影响手术预后的相关因素。

聚焦解决模式对糖尿病性视网膜病变玻璃体切割术患者心理韧性及生活质量的影响

目的探讨聚焦解决模式对糖尿病性视网膜病变玻璃体切割术患者正念水平、心理韧性及生活质量的影响。方法前瞻性选取济南市第二人民医院2023年2月至2024年1月收治的158例糖尿病性视网膜病变玻璃体切割术患者为研究对象,采取随机数字表法将其分为观察组和对照组,各79例。对照组男49例,女30例,年龄(58.06±6.67)岁,病程(3.91±0.69)d;观察组男47例,女32例,年龄(58.85±7.35)岁,病程(3.68±0.90)d。对照组患者住院期间给予常规糖尿病性视网膜病变玻璃体切割术护理干预,观察组在常规护理基础上采用聚焦解决模式干预。两组患者均从入院开始干预至出院时。观察并比较两组患者干预前(入院时)、干预后(出院时)的觉知、心理韧性、心理资本及生活质量评分。采用t检验、χ^(2)检验。结果干预后,观察组正念注意觉知量表的注意力评分[(66.77±11.12)分]、觉知能力评分[(68.15±10.17)分]、行为意识评分[(65.23±11.27)分]、情绪反应评分[(66.23±10.26)分]均高于对照组[(50.09±10.04)分、(50.23±8.18)分、(52.33±9.64)分、(56.73±8.64)分],心理韧性量表的自强评分[(76.25±5.26)分]、乐观评分[(84.21±4.62)分]均高于对照组[(69.31±5.71)分、(79.55±5.31)分],心理资本量表的自我效能评分[(59.35±6.91)分]、韧性评分[(69.15±3.14)分]、乐观评分[(70.25±6.42)分]、希望评分[(80.21±6.16)分]均高于对照组[(53.83±7.27)分、(60.12±3.10)分、(62.31±6.73)分、(69.55±6.33)分],生活质量量表的症状和视功能评分[(87.27±9.35)分]、身体机能评分[(79.15±5.11)分]、社会活动评分[(69.35±6.91)分]、精神心理评分[(69.15±7.16)分]均高于对照组[(69.16±6.75)分、(73.13±7.36)分、(61.83±7.37)分、(65.12±6.18)分],差异均有统计学意义(t=9.896、12.204、7.731、6.295、7.945、5.885、4.892、18.190、7.588、10.727、13.959、5.972、6.616、3.787,均P<0.001)。结论将聚焦解决模式干预应用于糖尿病性视网膜病变玻璃体切割术患者,能显著提高患者的感知、心理韧性、心理资本及生活质量,并改善其康复效果。