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A 62-year-old female diabetic recovered from COVID-19 pneumonia after receiving a prolonged course of steroids. She presented with a clinical picture of left-eye panuveitis with white cotton ball chorioretinal lesions and RAPD suggesting an optic neuropathy (VA HM). Diagnostic vitrectomy was performed to take samples for infective screen and to give intravitreal voriconazole empirically. Smear, culture, and PCR for viral DNA confirmed mixed infection of endogenous Candida endophthalmitis and incidental CMV infection. With further treatment, her corrected vision improved to 6/18 with regressing fungal lesions in serial fundus photographs. Prompt diagnosis and intervention preserved her vision and prevented potential life-threatening complications
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@#AIM: To explore the clinical value of oral administration of Tongmai Tangyanming Capsule after 23-gauge(23G)pars plana vitrectomy(PPV)in patients with proliferative diabetic retinopathy(PDR).<p>METHODS: This prospective study included 98 patients(109 eyes)with PDR admitted to the hospital between February 2018 and October 2019. The patients were randomly divided into control group(49 cases, 54 eyes, 23G PPV)and observation group(49 cases, 55 eyes, oral administration of Tongmai Tangyanming Capsule, 750 mg/time, 3 times/d, for 12wk). The best corrected visual acuity(BCVA), intraocular pressure, visual field sensitivity and central macular thickness(CMT)were measured before and 12wk after surgery. Changes in insulin-like growth factor-1(IGF-1)and vascular endothelial growth factor(VEGF)were determined, and insulin resistance index(HOMA-IR)was calculated. The surgical complications and recurrence rate during 12wk of follow-up were observed.<p>RESULTS: At 12wk after surgery, the BCVA(LogMAR)and visual field sensitivity of the two groups were improved(<i>P</i><0.001), and CMT was decreased(<i>P</i><0.001), but there was no significant change in intraocular pressure(<i>P</i>>0.05). Meanwhile, the BCVA and visual field sensitivity of the observation group were higher than those of the control group(<i>P</i><0.05), and CMT was smaller than that of the control group(<i>P</i><0.05). At 12wk after surgery, serum IGF-1, VEGF and HOMA-IR were decreased in the two groups(<i>P</i><0.001), and these indicators in the observation group were lower than those in the control group(<i>P</i><0.001). The incidence of complications and recurrence rate were similar in the two groups(<i>P</i> >0.05).<p>CONCLUSION: Oral administration of Tongmai Tangyanming Capsule after 23G PPV can better promote postoperative visual recovery, improve visual sensitivity, reduce insulin resistance and lower the levels of IGF-1 and VEGF, inhibit retinal neovascularization and proliferation, and reduce the risk of recurrence.
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@#AIM: To investigate the therapeutic effect of 23G vitrectomy system used in children with congenital cataracts.<p>METHODS: From November 2017 to December 2018, 11 children(19 eyes)aged 3-8 years old with congenital cataract were recruited in the Department of Ophthalmology, the First Affiliated Hospital of Hainan Medical University. 23G vitrectomy instruments were used to enter the anterior chamber through the incision at the corneal limbus, and complete ring resection of anterior capsule, cataract aspiration, intraocular lens implantation, and ring resection of posterior capsule combined with anterior vitrectomy. The visual acuity, intraocular pressure and ocular conditions of the children were observed during 3-24mo of follow-up.<p>RESULTS: All the surgeries were uneventful. During the surgeries, the anterior chambers were stable, the ring resections of lens capsules were accurate, and the IOLs were implanted at the 1<sup>st</sup> phase. The postoperative visual acuity was significantly improved compared with that before surgery. Only 1 patient had intraocular pressure higher than 25mmHg after surgery, which was controlled within the normal range after medication was given. During the follow-up period, all the children had clear corneas, no anterior chamber hemorrhage, no pupil deformation, the intraocular lens was in the center and the right position, the optic axis was transparent, and no obvious complications occurred.<p>CONCLUSION: The 23G vitrectomy system is safe and effective for the surgery of congenital cataract, it can achieve little trauma, accurate lens capsule resection, little postoperative reaction and few complications.
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@#AIM: To observe the clinical effects of 23G micro-invasive vitrectomy combined with intravitreal injection of ranibizumab in the treatment of proliferative diabetic retinopathy(PDR).<p>METHODS: A retrospective review was performed on 78 patients with PDR who were seen between January 2016 and January 2020. Those treated with 23G micro-invasive vitrectomy alone were included in the surgery group(<i>n</i>=35, 41 eyes), while those treated with 23G micro-invasive vitrectomy and preoperative intravitreal injection of ranibizumab were included in the combined group(<i>n</i>=43, 48 eyes). The operation time, intraoperative blood loss, frequency of electric coagulation hemostasis during surgery, intraocular tamponade, occurrence of retinal tear, changes in the best corrected visual acuity(BCVA), intraocular pressure, central macular thickness(CMT)and fluorescein leakage area of retinal neovascularization before treatment, at 1d and 3mo were compared between the 2 groups. Aqueous humor samples were collected before treatment and at 1wk to determine changes in vascular endothelial growth factor(VEGF)-A, human stromal cell-derived factor-1(SDF-1)and pigment epithelial-derived factor(PEDF)levels. The incidence of surgical complications within 3mo of follow-up was counted.<p>RESULTS: Operation time for the combined group was shorter than that for the surgery group, the frequency of electric coagulation hemostasis, the number of eyes filled with silica-gel and the total number of intraoperative bleeding eyes were lower and smaller than those in the surgery group(<i>P</i><0.05). At 1d and 3mo, the improvement of BCVA was better in the combined group than in the surgery group(<i>P</i><0.05), CMT and retinal neovascularization leakage area were smaller than the surgery group(<i>P</i><0.05), but no significant difference was found in intraocular pressure between the 2 groups(<i>P</i>>0.05). At 1wk, VEGF-A, SDF-1 and PEDF decreased in both groups(<i>P</i><0.001), lower in the combined group than in the surgery group(<i>P</i><0.001). The incidences of iatrogenic tear and vitreous re-hemorrhage were lower in the combined group than in the surgery group(<i>P</i><0.05). There was no significant difference in the incidence of the other complications between the 2 groups(<i>P</i>>0.05).<p>CONCLUSION: 23G micro-invasive vitrectomy combined with intravitreal injection of ranibizumab is superior to 23G micro-invasive vitrectomy alone in the treatment of PDR since the combined treatment can reduce surgical difficulty, shorten the operation time, reduce intraoperative blood loss and instrument operation, promote postoperative recovery of visual acuity, inhibit retinal neovascularization, and reduce the risks of iatrogenic injury, with fewer complications. Also, it is safer and more effective.
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@#AIM: To observe the effect of modified minimally invasive 23G combined with standard 20G three-channel vitrectomy for silicone oil removal. <p>METHODS: The objects of study were 32 patients with silicone oil eyes hospitalized in Jingliang Eye Hospital from March 2018 to September 2019. Enrolled patients were provided with standard three-channel incision for vitrectomy, with 23G perfusion and lighting as well as 20G suction incision at 10 o'clock. Silicone oil removal was then conducted by using minimally invasive 23G vitrectomy instrument and modified 18G needle. Further examination was performed to observe the best corrected visual acuity(BCVA), intraocular pressure, pain comfort, silicone oil residue, choroidal detachment, retinal detachment 1d, 1wk, 1mo and 3mo after operation. <p>RESULTS: All the 32 patients underwent operation successfully, and there was stable intraocular pressure and no fluctuation during operation. The removal time of silicone oil was about 10-15min, and no complications occurred intraoperatively. Postoperative 3-month follow-up 3 revealed no vitreous hemorrhage, choroidal detachment and retinal reattachment. <p>CONCLUSION: The modified minimally invasive 23G combined with standard 20G three-channel vitrectomy is simple, safe, stable and effective for silicone oil removal.
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@#AIM: To investigate the clinical effect of scleral buckling surgery combined with 23G vitrectomy in treatment of intraocular foreign body with retinal detachment.<p>METHODS: Totally 72 cases of patients with intraocular foreign bodies and retinal detachment admitted from January 2014 to January 2018 were selected and divided into the control group(36 cases)and the observation group(36 cases)by random number table method. The patients in the control group were treated with 23G vitrectomy surgery while patients in the observation group were treated with scleral buckling surgery on the basis of the treatment in the control group. The changes of intraocular pressure(IOP)and visual acuity, successful reset, recurrence and complications were observed before operation and 3mo after silicone oil was removed.<p>RESULTS: There was no difference in IOP and BCVA between the two groups before operation(<i>P</i>>0.05). Three months after silicone oil was removed, IOP and BCVA in two groups were significantly improved compared with those before operation(<i>P</i><0.05). There was no difference between the two groups(<i>P</i>>0.05). The success rates of one-time anatomical reduction in the observation group and the control group were respectively 97% and 81%(<i>P</i><0.05). The recurrence rates of the observation group and the control group were respectively 6% and 25%(<i>P</i><0.05). The incidence of complications was 22% in the observation group and 31% in the control group(<i>P</i>>0.05).<p>CONCLUSION: The treatment of scleral buckling combined with 23G vitrectomy in the treatment of intraocular foreign body with retinal detachment can significantly improve the IOP and visual acuity of patients, improve the success rate of reduction, reduce recurrence, and have high safety.
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@#AIM:The repair of macular structure after 23G vitrectomy was performed in patients with idiopathic macular hole, and the changes of retinal thickness in vision and macular area were analyzed.<p>METHODS: A total of 85 patients(85 eyes)with monocular idiopathic macular hole who underwent elective surgery in our hospital from June 2016 to December 2017 were included in the study, of which 37 were male and 48 were female, with an average age of(64.7±10.1)years. All subjects underwent 23G vitrectomy were observed the closure of macular hole after operation, and the changes of retinal thickness in macular forea were observed preoperatively and postoperatively by optical coherence tomography(OCT). To observe the changes of the best corrected visual acuity(BCVA)in preoperative, 1mo, 3mo and 6mo after operation.<p>RESULTS: All subjects underwent postoperative examinations had good macular hole closure. The average BCVA of 3mo and 6mo after operation were significantly higher than that of preoperative and 1mo after operation(<i>P</i><0.05); the average BCVA in 6mo after operation was significantly higher than the average BCVA of 6mo after operation, with statistically significant differences(<i>t</i>=7.983, <i>P</i>=0.037). The macular central fovea thickness in 1mo after operation was significantly higher than preoperative and 3mo, 6mo after operation(<i>P</i><0.05); The retinal thickness of the macular fovea thickness in 3mo and 6mo after operation were significantly lower than that of preoperative.<p>CONCLUSION:The treatment of idiopathic macular hole with 23G vitrectomy had a high degree of successful closure rate of fracture hole and the visual acuity of patients was obviously improved.
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@#AIM: To explore the safe movement angle of a 23-gauge(G)cannula in double-channel silicone oil(SO)removal surgery.<p>METHODS: From March 2017 to September 2017, 15 patients with SO filled eyes were enrolled in this retrospective analysis. Based on ultrasound biomicroscopy(UBM), the distance from the front surface of the sclera at the 2 o'clock and the 10 o'clock positions to the SO bubble at 4 mm behind the corneal limbus was measured and defined as “A”. The length of the 23G cannula(4 mm)was defined as “C”. The width of the scleral inner wall at the maximum operating angle of the scleral trocar was defined as “B”. The safe movement angle of the 23G cannula was determined according to the trigonometric function table. Using the self-made SO removal device connected to the 23G puncture cannula, the SO was successfully removed from all patients.<p>RESULTS: The average SO removal time for all patients was 4.78±0.13min. The trigonometric function was used to work out the distance from the scleral front surface to the SO bubble, which was 0.82-2.81(1.62±0.41)mm at the 2 o'clock position, and 0.98-2.19(1.71±0.34)mm at the 10 o'clock position. Finally, the verification analysis using geometric model calculation showed that the optimal movement angle of the cannula was 52°.<p>CONCLUSION:Combining the trigonometric function and UBM measurement to calculate the safe movement angle of a 23G cannula can effectively guide the moving range of the trocar during SO removal. A movement angle of the cannula larger than 50° may avoid the occurrence of a retinal tear.
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@#AIM: To analyze the risk factors of early bleeding after 23G vitrectomy for proliferative diabetic retinopathy(PDR).<p>METHODS: A retrospective analysis was made on the clinical data of 100(100 eyes)PDR patients who were underwent 23G vitrectomy from June 2016 to January 2018. According to whether vitreous hemorrhage occurred in the early stage of operation(within 1mo), the patients were divided into early vitreous hemorrhage group(27 cases)and non vitreous hemorrhage group(73 cases). The risk factors of early vitreous hemorrhage were analyzed.<p>RESULTS: There were significant differences in age, preoperative anti-vascular therapy, preoperative fibrovascular membrane proliferation, intraoperative optic disc neovascularization hemorrhage and intraoperative gas injection between the two groups(<i>P</i><0.01). Preoperative fibrovascular membrane proliferation and intraoperative optic disc neovascularization hemorrhage were independent risk factors for early postoperative hemorrhage.<p>CONCLUSION: Early vitreous hemorrhage after 23G vitrectomy for PDR mainly occurs in patients with severe fundus lesions. Preoperative fibrovascular membrane proliferation and intraoperative optic disc neovascularization hemorrhage increase the risk of vitreous hemorrhage.
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@#AIM: To observe and analyze the safety and clinical efficacy of full-thickness scleral incision and <i>in situ</i> paracentesis in the treatment of patients with coexisting rhegmatogenous retinal detachment and choroidal detachment using minimally invasive vitrectomy. <p>METHODS: From April 2015 to April 2017, 20 patients(20 eyes)with coexisting rhegmatogenous retinal detachment and choroidal detachment who were treated in Department of Ophthalmology, Jiangsu Province Hospital were enrolled in this retrospective analysis. All patients received modified scleral puncture drainage combined with 23G minimally invasive vitrectomy. This study analyzed and compared intraoperative paracentesis success rate, the incidence of intraoperative, postoperative visual acuity, intraocular pressure, and postoperative retinal reattachment rate. <p>RESULTS: Suprachoroidal fluid from all patients were drainaged successfully. Compared with preoperative conditions, the postoperative visual acuity was significantly improved(<i>P</i><0.01). There was a significant difference in average intraocular pressure(IOP)between preoperative one and postoperative one(7.00±2.05mmHg and 15.38±2.66mmHg respectively, <i>P</i><0.01). The origin retinal reattachment rate was 90%(18/20), and the final retinal reattachment rate was 95%(19/20). <p>CONCLUSION: The modified scleral puncture surgery in the treatment of patients with coexisting rhegmatogenous retinal detachment and choroidal detachment in 23G vitrectomy has great clinical effects. It not only simplifies the procedure of operation, but also reduces the difficulty and complication of operation.
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@#AIM: To observe the treatment effect and discuss availability of spherical retinal detachment by 23G intra-infusion-assisted scleral buckling. <p>METHODS: Twenty-one eyes were randomly selected from in-patients with rhegmatogenous retinal detachment with much subretinal fluid and spherical appearance between February 2017 and February 2018, which were suitable for scleral buckling. The 23G intra-infusion was placed in the pars plana of ciliary body before the surgery. Retinal hole was not solidified during operation. Laser photocoagulation was performed around the retinal hole after surgery. Retinal reattachment state and the complications were evaluated by 3 to 10mo follow up. <p>RESULTS: All patients have undergone operations smoothly. Subretinal fluid was drainage, chroidal bleeding and retinal incarceration did not appear during the operation. Eighteen eyes achieved retinal reattachment on the first postoperative day; Subretinal fluid of two eyes was asorbed fully; One eyes achieved retinal reattachment after the adjustment by the external pressure block. One eyes with recurrence achieved retinal reattachment after vitreoretinal surgery. One eye developed complication with subretinal hemorrhage and the range of bleeding was less than 1PD, which was absorbed after 3mo. There were no eyes found abnormal intraocular pressure, anterior segment ischemia or other sever complications.<p>CONCLUSION: The 23G intra-infusion was pre-placed before relieving fluid in the scleral buckling of retinal detachment, which can effective keep intraocular pressure stably and reduce the possibilities of explosive suprachoroidal hemorrhage and postoperative choroidal amotio triggered by fast decrease of intraocular pressure. The retina is flat basically and the hole location is relatively accurate, which improve the success of the surgery.
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@#AIM: To observe the efficacy of 23G minimally invasive system combined with phacoemulsification in the treatment of cataract complicated with vitreoretinopathy. <p>METHODS: Totally 96 cases(103 eyes)of patients with cataract and vitreoretinopathy were divided into observation group(48 cases 51 eyes)and control group(48 cases 52 eyes)by computer random number method. Observation group was given 23G minimally invasive system combined with phacoemulsification and vitrectomy, and control group was given conventional phacoemulsification and vitrectomy. The changes of best corrected visual acuity(LogMAR visual acuity), intraocular pressure and corneal astigmatism degree were observed before operation and at 1, 3 and 6mo after operation, and the complications were observed as well. <p>RESULTS:At 1, 3 and 6mo after operation, the LogMAR visual acuity in the two groups were lower than those before operation, and they were gradually decreased(<i>P</i><0.05), and the LogMAR visual acuity in observation group at the same time point were lower than those in control group(<i>P</i><0.05). The intraocular pressure in the two groups was lower than that before operation, and it was with a gradual decrease trend(<i>P</i><0.05), and the intraocular pressure in observation group was lower than that in control group at the same time(<i>P</i><0.05). Compared with before operation, the corneal astigmatism degree was increased significantly in the two groups at 1mo after operation(<i>P</i><0.05), and was decreased gradually to preoperative level at 6mo after operation and the corneal astigmatism degree at 1mo and 3mo after operation in observation group was lower than that in control group(<i>P</i><0.05). The incidence rate of postoperative complications in observation group was lower than that in control group(<i>P</i><0.05). <p>CONCLUSION: The 23G minimally invasive system combined with phacoemulsification has better efficacy than conventional surgery in the treatment of cataract complicated with vitreoretinopathy, and it is beneficial to the restoration of visual acuity, intraocular pressure, and corneal astigmatism degree, and it can reduce postoperative complications.
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@#AIM: To explore the application effect of fenofibrate combined with 23G minimally invasive vitrectomy in patients with diabetic retinopathy(DR). <p>METHODS: Totally 102 DR patients(102 patients)treated in our hospital from October 2015 to November 2017 were selected and divided into observation group and control group according to random number table, 51 cases in each group. The 23G minimally invasive vitrectomy was performed in all patients. From the 1<sup>st</sup> day after operation, the two groups were treated with related treatment, and the control group was given conventional hypoglycemic, antihypertensive and improved microcirculation treatment. On the basis of the above, the observation group was treated with fenofibrate treatment. Both groups were treated for 3mo. The operation and postoperative basic conditions(operative time, intraoperative blood loss, complication rate, length of stay), the level of blood lipid \〖total cholesterol(TC), triglyceride(TG), low density lipoprotein cholesterol(LDL-C), high density lipoprotein cholesterol(HDL-C)\〗, and the serum levels of related factors \〖lipoprotein associated phospholipase A2(Lp-PLA2), vascular endothelial growth factor(VEGF)\〗 before and after 3mo of operation of two groups were compared. Following up for 6mo after operation, the recurrence rate of two groups of retinopathy was statistically compared. <p>RESULTS: There was no significant difference in operative time, intraoperative blood loss, incidence of complications and length of stay between the two groups(<i>P</i>>0.05). There was no significant difference in the levels of TC, TG, LDL-C and HDL-C between the two groups before operation(<i>P</i>>0.05). After 3mo, the levels of TC, TG and LDL-C in the observation group were lower than those in the control group, and the level of HDL-C was higher than that in the control group, and the difference was statistically significant(<i>P</i><0.05). There was no significant difference in serum levels of Lp-PLA2 and VEGF between the two groups before operation(<i>P</i>>0.05). The serum levels of Lp-PLA2 and VEGF in the observation group were lower than those in the control group 3mo after operation, and the difference was statistically significant(<i>P</i><0.05). There was insignificant difference in visual function and quality of life, sensory adjustment, psychological and social scores and total scores between the two groups before surgery(<i>P</i>>0.05). At 3mo after operation, the scores of visual function and life quality in the observation group were lower than those in the control group, and the difference was statistically significant(<i>P</i><0.05). After follow-up for 6mo, no recurrence occurred in the observation group. The recurrence rate in the control group was 5.9%(3/51), and there was no significant difference between the two groups(<i>P</i>>0.05).<p>CONCLUSION: The combination of fenofibrate and 23G minimally invasive vitrectomy for the treatment of DR can effectively correct the disorder of lipid metabolism, reduce the level of serum Lp-PLA2 and VEGF, so it is beneficial to improve the visual function and quality of life of the patients, but there is no effective data support for reducing the postoperative recurrence rate.
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@#AIM: To summarize the characteristics of ocular perforation caused by metallic foreign body, evaluate the effectiveness and safety of 23G vitrectomy, and analyze the factors that affect the final vision of patients with ocular trauma score. <p>METHODS: Continuous observation and analysis from July 1, 2014 to June 1, 2016, hospitalized in our hospital caused by metallic perforating ocular trauma for 23G vitrectomy in 38 cases(38 eyes). A prospective collection of patient included age, gender, eye, place of occurance of trauma, foreign body size, wound length, foreign body position, initial visual acuity and final visual acuity, macular etc.. The ocular trauma score(OTS)system was used to assess the effectiveness and prognosis of the patients. The follow-up time was over 6mo. <p>RESULTS: There were 38 eyes in 38 patients, including 37 males and 1 females, aged 16y-56y. Ocular trauma mainly occurred in the workplace, 33 cases accounted for 87%, followed by sports venues, 3 cases accounting for 8%. Corrected visual acuity more than 0.1 in eyes with intraocular foreign bodies underwent 23G vitrectomy were 21 cases, accounting for 55%. Preoperative retinal detachment, large foreign body(more than 5.0mm), damage of lens were important factors of poor prognosis. Foreign bodies were located in the vitreous body in 23 cases, accounting for 61%, located in the retina in 15 cases, accounting for 39%. When admitted to hospital, the patients suffered from retinal detachment in 21 cases(55%), endophthalmitis in 7 cases(18%), the size of intraocular foreign bodies(IFOB)was larger than 5.0mm in 7 cases(18%), severe postoperative proliferative vitreoretinopathy(PVR)was in 6 cases(16%), epiretinal membrance of macula in 5 cases(13%). Of the same OTS scores, visual acuity in 6mo was significantly better than preoperative; no matter preoperative vision or postoperative vision in 6mo, the higher the OTS scores, the better the visual acuity. <p>CONCLUSION: The ocular perforation caused by metallic foreign body mostly occurs in young men under 40y, and the main reason is injury in the workplace. No protective measures are adopted. The main factors affecting the final visual acuity are retinal detachment, foreign body greater than 5.0mm and postoperative PVR appearance after the injury, vitrectomy time has little effect. The 23G vitrectomy is safe, reliable and effective in the treatment of ocular penetrating injuries due to metallic foreign bodies. OTS score can be used effectively in patients with ocular perforation caused by metallic foreign bodies and make reasonable and useful postoperative visual acuity prediction.
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Objective To evaluate the outcome of 23G minimally vitrectomy trocar on eyes with acute angle closure glaucoma.Methods A retrospective review was performed of patients with acute angle closure glaucoma who underwent combined compound trabeculectomy from September,2014 to June,2015 in Beijing MEM care system.Intraoperative 23G minimally vitrectomy trocar was used in all of the patients.30 eyes of 30 patients were enrolled in the study.All patients were followed up for 12 months.Visual acuity,intraocular pressure and complications were observed.Results No serious complications such as explosive choroid hemorrhage and retinal hemorrhage occurred during operation.All of 30 eyes maintained adequate pressure control.The average postoperative IOP was (15.93 ± 1.35) mmHg (1 kPa =7.5 mmHg),was less than the preoperative (56.34 ± 6.96) mmHg (P =0.00).And the visual acuity in 23 eyes were improved.Conclusion Combined trabeculectomy with 23G minimally vitrectomy trocar in acute angle closure glaucoma patients is a kind of safe and effective operation method,can obviously reduce the intraoperative explosive choroid hemorrhage.
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@#AIM: To observe the efficacy and safety of cyclophoto-coagulation through 23G minimally invasive scleral incision in the treatment of refractory glaucoma. <p>METHODS: Totally 23 patients(23 eyes)were taken the surgery-the cyclophotocoagulation-through 23G minimally invasive scleral incision. We observed the changes of intraocular pressure(IOP), the best corrected visual acuity(BCVA), the quantity of drugs reducing intraocular pressure and complications in the pre-and post-operation. <p>RESLUTS: Comparing with preoperative, the postopera-tive IOP, BCVA and the number of IOP-decreased drugs were statistically significant(<i>P</i><0.05); the complication was fewer. <p>CONCLUSION: The 23G minimally invasive scleral incision cyclophotocoagulation is a new type of safe and effective surgical method for the treatment of refractory glaucoma.
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@#AIM: To investigate the clinical effect of 23G transconjunctival sutureless vitrectomy(23G TSV)in the treatment of idiopathic macular hole. <p>METHODS: Totally 80 cases with macular hole treated in ophthalmology department of our hospital from January 2013 to June 2015 were selected as the research objects, in which 40 cases were treated with 23G TSV after admission, the other 40 cases were treated with 20G vitrectomy. The surgery time, length of hospital stay, changes of visual acuity, macular hole closure, macular thickness and complications were observed in two groups. <p>RESULTS: The surgery time, length of hospital stay and the complication rate of observation group were less than those of control group with significant difference(<i>P</i><0.05). The corrected visual acuity was significantly improved in both groups at 3, 6, 12mo after operations compared to before operations, but no significant difference were found between the two groups(<i>P</i>>0.05). Macular hole closure rate of observation group was 98%(39/40), that of control group was 95%(38/40), there was no significant difference between the two groups(<i>χ</i>2=0.346, <i>P</i>=0.553). The macular thickness significantly decreased in both groups at 3, 6, 12mo after operations compared to before operations, but no significant difference were found between the two groups(<i>P</i>>0.05).<p>CONCLUSION: 23G TSV is effective in the treatment of idiopathic macular hole with low complication rate, which is beneficial to improve the postoperative visual acuity and improve the prognosis.
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AIM:To evaluate 23G vitrectomy for macular edema in eyes with retinal vein occlusion (RVO) combined with vitreoretinal traction (VMT) or epiretinal membrane (ERM).METHODS:Totally 22 patients (22 eyes) diagnosed with macular edema of RVO combined with VMT or ERM were retrospectively analyzed.Twelve cases performed with 23G vitrectomy together with peeling of inner limiting membrane (ILM) and/or ERM were considered as the observation group or intervention group.Ten cases without vitrectomy were recruited as control group.The best corrected visual acuity (BCVA) and central retinal thickness (CRT) at baseline, 1, 3 and 6mo were recorded and compared.RESULTS:At baseline, the difference of BCVA and CRT between observation group and control group was not statistically significant (P=0.645, 0.206).After vitrectomy, the BCVA and CRT of RVO patients in observation group were significantly improved compared with baseline at each follow-up (F=2.895, P=0.048;F=16.431, P<0.01).However, the BCVA and CRT in control group remained the same as baseline at every follow-up.Moreover, the BCVA and CRT in observation group were much better than that in control group at both 3 and 6mo after vitrectomy.However, the BCVA and CRT between two groups were not significantly different at 1mo postoperatively.CONCLUSION:The 23G vitrectomy could markedly improve BCVA and reduce CRT in RVO patients with macular edema combined with VMT and/or ERM.
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AIM: To study the clinical curative effect of 2mm micro incision phacoemulsification combined with 23G minimally invasive vitrectomy for cataract and vitreoretinal diseases.METHODS: Retrospective analysis of 92 patients (99 eyes),including 49 male (53 eyes),43 female (46 eyes) with mean age was 57.1±1.9 years,in our hospital for cataract and vitreoretinal treatment of the disease from February 2013 to February 2016.All patients underwent 2mm micro incision phacoemulsification combined with 23G minimally invasive vitrectomy.Curative effect and complications were observed.RESULTS: Combined surgical procedures were carried out smoothly.posterior capsule rupture did not occurred.seven eyes were filled with BSS fluid,46 eyes with C3F8,49 eyes with intraocular lens at phase Ⅰ,21 eyes placed intraocular lens when silicone oil was removed.The visual acuity improved in 84 eyes (85%),unchaged in 15 eyes (15%).Postoperative complications included transient high intraocular pressure in 18 eyes (18%),anterior chamber reaction in 7 eyes (7%) and corneal edema in 8 eyes (8%).CONCLUSION: The 2mm micro incision phacoemulsification combined with 23G minimally invasive vitrectomy is a safe and effective surgical method with less injury,fewer complications.
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AIM:To compare the clinical effect of 23G and 25G+ vitrectomy for treatment of proliferative diabetic retinopathy (PDR).METHODS: A total of 128 PDR patients (195 eyes) requiring vitrectomy in our hospital from November 2013 to May 2016 were randomly divided into 25G+ group and 23G group, 64 cases (97 eyes) in 25G+ group and 64 cases (98 eyes) in 23G group.In 25G+ group, patients were treated by 25G+ vitrectomy.In 23G group, patients were treated by 23G vitrectomy.The visual acuity, as well as intraocular pressure (IOP), iatrogenic injury and complications in two groups were recorded before and 1d, 1wk, 1mo after treatment.The operation time was compared between two groups.RESULTS: The operation time in 25G+ group was lower than that in 23G group (P0.05).IOP in 25G+ group before surgery had no significant difference compared with those after surgery at 1d,1wk, and 1mo(P>0.05), which it was the same in 23G group.IOP of two groups in the same period had no significant difference (P>0.05).The incidence rate of iatrogenic injury in 25G+ group was 4.1%, which was significant lower than that of 23G group (13.3%) (P<0.05).The incidence rate of complication in 25G+ group was 3.1%, which was significant lower than that of 23G group (11.2%) (P<0.05).CONCLUSION: Both 23G and 25G+ vitrectomy are safe and effective treatment for PDR.However, 25G+ vitrectomy is the better choice for PDR for the shorter operation time, lower incidence rate of iatrogenic injury and fewer surgical complications.