23G微创玻璃体切除或联合超声乳化白内障摘除术治疗孔源性视网膜脱离临床观察被引量：7

Clinical observation of 23-gauge sutureless microincisional vitrectomy or combined phacoemulsification for treatment of rhegmatogenous retinal detachment

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摘要目的比较孔源性视网膜脱离患者行23G免缝合微创玻璃体切除术（PPV）和玻璃体切除术联合超声乳化白内障摘除术（PPVCE）的术后视力及临床并发症.方法回顾性病例分析研究.收集2013年1月至2014年10月在南宁爱尔眼科医院住院治疗的173例173只眼孔源性视网膜脱离患者,PPV组112例112只眼,PPVCE组61例61只眼.主要观察术后1个月及6个月的最佳矫正视力、眼压以及术中、术后并发症.结果术后随访6-15个月.术前视力光感～0.6,术后视力光感～1.0.术后1个月,PPV组视力提高102只眼（91.07％,102/112）,PPVCE组视力提高57只眼（93.44％,57/61）;术后6个月,PPV组视力提高98只眼（87.5％,98/112）,PPVCE组视力提高55只眼（90.16％,55/61）.早期并发症（术后≤3个月）,PPV组：角膜水肿及前房渗出2只眼（1.78％,2/112）,暂时性高眼压23只眼（20.54％,23/112）;PPVCE组角膜水肿及前房渗出5只眼（8.20％,5/61）,暂时性高眼压21只眼（34.43％,21/61）;两组术后早期并发症比较,PPVCE组角膜水肿及前房渗出发生率（x2=4.181,P=0.041）及暂时性高眼压发生率（x2=4.018,P=0.045）均比PPV组高,差异有统计学意义.晚期并发症（术后＞3个月）,PPV组：新生血管性青光眼5只眼（4.46％/,5/112）,虹膜后粘连、瞳孔变形5只眼（4.46％,5/112）,晶状体后囊膜混浊7只眼（6.25％,7/112）,复发性视网膜脱离3只眼（2.68％,3/112）;PPVCE组：新生血管性青光眼2只眼（3.28％,2/61）,虹膜后粘连、瞳孔变形3只眼（4.92％,3/61）,视网膜脱离复发2只眼（3.28％,2/61）;两组比较新生血管性青光眼（x2=0.143,P=0.705）,虹膜后粘连（x2=0.081,P=0.892）,视网膜脱离复发（x2=0.189,P=0.664）的发生率差异均无统计学意义.结论 23G免缝合微创玻璃体切除联合超声乳化白内障摘除术治疗合并白内障的孔源性视网膜脱离患者是安全有效的.联合手术避免了二次白内障手术,并利于术后眼底的随访观察。 Objective To compare visual acuity outcomes and clinical complications after 23-gauge sutureless microincisional pars plana vitrectomy （PPV） versus combined pars plana vitrectomy and phacoemulsification （PPVCE） in patients with rhegmatogenous retinal detachment.Methods Retrospective case series study.A total of 173 eyes of 173 patients with rhegmatogenous retinal detachment （PPV=112, PPVCE=61） underwent either combined PPVCE or PPV alone from January 2013 to October 2014.Main outcome measures were best-corrected visual acuity at one month and six months follow-up, intraoperative complications, intraocular pressure and postoperative complications in the follow-up.Results Postoperative follow-up time was between 6 and 15 months.Preoperative vision ranged from light perception to 0.6, postoperative vision ranged from light perception to 1.0.Postoperatively, one month after surgery, PPV visual acuity improved in 102 eyes （91.07%,102/112）.PPVCE visual acuity improved in 57 eyes （93.44%, 57/61）.And six months after surgery,PPV visual acuity improved in 98 eyes （87.5%, 98/112）.PPVCE visual acuity improved in 55 eyes （90.16%, 55/61）.Early complications （≤3 months after surgery） in PPV： 2 eyes （1.78%, 2/112） corneal edema and fibrinous exudation in the anterior chamber, 23 eyes （20.54%, 23/112） showed transient intraocular pressure rise.And in PPVCE： 5 eyes （8.20%, 5/61） comeal edema and fibrinous exudation in the anterior chamber, 21 eyes （34.43%, 21/61） showed transient intraocular pressure rise.Subgroup analysis revealed fibrinous exudation in the anterior chamber （x2=4.181, P =0.041） and transient intraocular pressure rise （x2=4.018, P =0.045） to be significantly more frequent after PPVCE.Late complications （〉 3 months after surgery） in PPV included secondary glaucoma occurred in 5 eyes （4.46%, 5/112）, forma-tion of posterior synechia and discoria was observed in 5 eyes （4.46%, 5/112）, posterior capsual opacification occurred in 7 eyes （6.25%, 7/112）, recurrent retinal detachment occurred in 3 eyes （2.68%, 3/112）.And in PPVCE included secondary glaucoma occurred in 2 eyes （3.28%, 2/61）, formation of posterior synechia and discoria was observed in 3 eyes （4.92%, 3/61）, recurrent retinal detachment occurred in 2 eyes （3.28%, 2/61）.There were no significant differences comparing secondary glaucoma （x2=0.143, P =0.705）, formation of posterior synechia （x2=0.081, P =0.892）, recurrent retinal detachment （x2=0.189, P =0.664） between PPV eyes and PPVCE eyes.Conclusions Combined 23-gauge sutureless pars plana vitrectomy surgery and phacoemulsification is safe and effective in treating rhegmatogenous retinal detachment co-existing with cataract.Combined surgery may prevent a second operation for postvitrectomy cataract, and facilitate postoperative retinal follow-up observation.

作者梁雪梅秦斌

机构地区南宁爱尔眼科医院

出处《中国实用眼科杂志》 2015年第9期975-979,共5页 Chinese Journal of Practical Ophthalmology

关键词孔源性视网膜脱离 23G微创玻璃体切除术超声乳化白内障摘除术视力并发症 Rhegmatogenous retinal detachment 23-gauge microincisional vitrectomy Phacoemulsification Visual acuity outcomes Complications

分类号 R779.66 [医药卫生—眼科]

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