Efficacy of 20G or 25G three-channel vitrectomy for idiopathic macular epiretinal membrane / 国际眼科杂志(Guoji Yanke Zazhi)

AIM:To explore the curative effect of 20G and 25G three-channel pars plana vitrectomy in the treatment of idiopathic macular epiretinal membrane,and to provide a theoretical basis for the minimally invasive treatment of idiopathic macular epiretinal membrane.METHODS:Medical records were retrospectively analyzed to explore curative effect.From January 2014 to December 2016,60 patients (60 eyes) with idiopathic macular pucker in our hospital for eye treatment were selected.They were grouped according to different operation way,in 28 patients (28 eyes) using three-channel 20G pars plana vitrectomy as the control group,32 patients (32 eyes) with 25G no-suture conjunctival vitrectomy as observation group.Two groups of patients were evaluated at 3mo after treatment for visual acuity,OCT examination,comfort,and we recorded the operation time,complications and recurrence.RESULTS:The operating time of observation group was 18-25min,average 20±2.15min,the control group was 22-35min,28 ± 2.07min on average,the difference was statistically significant (P＜0.05).At the time of the last follow-up,visual acuity of two groups improved compared with preoperative,without vision decrease.In observation group vision improved in 69％,significantly higher than that of control group (50％),difference was statistically significant (x2 =7.287,P＜ 0.05).Preoperative intraocular pressure of two groups was not significantly different.intraocular pressure of two group at postoperative 1d reduced compared with preoperative (Ftime =31.34,P＜0.01;Fgr.up =17.43,P＜0.01).There was no statistically significant difference at 7d and 1mo compared with preoperative (P＞0.05).Preoperative OCT on macular thickness of the two groups had no statistically significant difference.At 7d,1 and 3mo after treatment,epiretinal membranes disappeared in all patients,and the macular thickness reduced,the macular edema relieved (P＜ 0.05).At postoperative 3mo,two groups of patients were found no recurrence of epiretinal membranes.At 7d,1 and 3mo after treatment,differences between the two groups on macular thickness had no statistical significance.At postoperative 1d,in the control group there were foreign body sensation,swelling,and tears,pain and discomfort,20 patients with eye conjunctival congestion,edema,conjunctival suture to cause discomfort,the symptoms relieved after treatment.In observation group,12 patients with mild conjunctival congestion and edema,dotted hemorrhage at the wound in 4 eyes,5 eyes appeared lower intraocular pressure (6-8mmHg).without special treatment,Postoperative bleeding and edema stopped at 7d,intraocular pressure returned to normal.Patients of observation group did not have foreign body sensation,swelling and discomfort symptoms.At the time of the last follow-up,in the two groups,no iatrogenic retinal detachment,cataract,endophthalmitis and other serious complications occurred.CONCLUSION:The 20G of three-channel pars plana vitrectomy and 25G the no-suture conjunctival vitrectomy are equal for idiopathic macular epiretinal membrane,25G vitrectomy operation time is short with better patient comfort.

Astigmatism after Cataract Surgery using Various Wound Sizes, Configurations, and Suture Techniques

We performed a retrospective review of three hundred and twelve consecutive patients who underwent phacoemulsification and posterior chamber lens implantation between January 1, 1990 and December 31, 1990. Patients were divided into three groups according to the wound size: 3.5 - 4.0 mm(95 patients); 5.0 - 5.5mm(74 patients) and 6.5 - 7.0mm(143 patients). The patients in the 3.5 to 4.0mm did not receive suture and the patients in the 5.0 to 5.5mm wound size received one horizontal suture. The patients in the 6.5 to 7.0mm group were further evaluated by comparing those who received two horizontal sutures with those who received a running shoelace suture. At one day, one week, one month, and one year after surgery, astigmatic error was measured and a vector analysis calculation of diopters of mean induced keratometric astigmatism was performed. There was a statistically significant increase in astigmatism following 6.5 to 7.0mm incision as compared to 3.5 to 5.5mm incision at each time interval. There was no significant difference in astigmatism at any time period between the 5.0 to 5.5mm and 3.5 to 4.0mm incision groups. The longer the incision, the greater the postoperative against-the-rule astigmatic shift at the last follow up. Among those of 6.5 - 7.0 wound size, the shoelace suture technique induced greater with-the-rule astigmatic change than two horisontal sutures at postoperative day one but the difference did no longer persist at one year.

Effect of Incision Length on Visual Recovery and Astigmatism in No-Suture Cataract Surgery

To evaluate the effect of incision length on visual recovery and astigmatism in sutureless cataract surgery, three different lengths of incision were applied to 69 eyes. Soft intraocular lens (IOL) was inserted through 4mm incision in group 1 (16 eyes), ovoid polymethylmethacrylate (PMMA)IOL was inserted through 5mm incision in group 2 (31 eyes), and 7mm optic sized PMMA IOL was inserted through 7mm incision in group 3 (22 eyes). Average uncorrected visual acuity was 0.69, 0.52 and 0.57 at one week and 0.79, 0.68 and 0.66 at eight weeks in the group 1, group 2, and group 3 respectively. There was no statistically significant difference among the three groups (p>0.05). Keratometric astigmatism was 0.26 diopter (D), - O.1OD and -O.12D in the group 1, group 2, and group 3 respectively. There was no statistically significnt difference among the three groups (p>0.05). Keratometric astigmatism was 0.26 diopter (D), -O.1OD and O.12D in the group 1, group 2, and group 3 respectively at one week postoperatively. The change of mean keratometric astigmatism from 1 to 8 weeks postoperatively was 0.73D in group 1 ,0.60D in group 2 and 0.79D in group 3 and there was no statistically significant difference among the three groups (p>0.05). As postoperative problems, microleakage of aqueous humor at incision site and cystoid macular edema were shown in 6% of the group 1. Microhyphema was shown in 6% of group 1, 6% of group 2 and 18% of group 3 at one day postoperatively. Early clinical observations indicate that sutureless cataract surgery shows early visual recovery and minimizes surgically induced astigmatism without serious complications, regardless of length of incision.