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目的 探讨 2 5G经结膜无缝线微创玻璃体手术 ( 2 5GTSV)治疗特发性黄斑裂孔的疗效及并发症。方法 采用 2 5GTSV手术系统 ,对IMH1 5例 1 5眼 ,行玻璃体切除术。术后随访 1～ 1 3个月 ,平均 7个月。结果 1 5眼均顺利完成手术 ,手术时间 2 0～ 2 5分钟 ,平均约 2 1 . 4分钟。 1 5眼中 9眼采用表面麻醉 ,6眼采用球后麻醉。 1 4眼可顺利剥除黄斑裂孔旁内界膜 ,1眼未能完整的撕除。术后 1～ 6个月行OCT检查 ,显示 1 5眼中 1 4眼裂孔闭合 ,1眼裂孔缩小但未闭合 ,裂孔闭合率为93 3%。术后随访期间未发生裂孔再裂开现象。最后一次随访 ,术后最佳矫正视力 0 . 1～ 1 .0 ,平均0 . 35。 9眼 ( 6 0 % )的病人视力至少提高两行。手术并发症包括一过性眼压升高 ( 2眼 )、结膜下气泡( 2眼 )、晶状体后囊下羽毛状混浊 ( 5眼 ) ,晶状体核硬化 ( 2眼 ) ,未发生感染性眼内炎、医源性视网膜裂孔及视网膜脱离、脉络膜脱离以及切口持续性渗漏等并发症。结论 采用 2 5G经结膜无缝线微创玻璃体手术治疗IMH ,具有手术时间短、创伤小、并发症少、术后恢复快 ,手术疗效确切的优点 ,特别是可在表面麻醉下手术 ,避免了球后麻醉所引起的并发症 ,可用于门诊开展IMH的手术治疗。
Objective To investigate the curative effect and complications of 25G TSG (25GTSV) in the treatment of idiopathic macular hole. Methods Twenty-five GTSV surgical systems were used. Fifteen (15) cases of IMH1 underwent vitrectomy. Follow-up 1 ~ 13 months, an average of 7 months. Results All 15 patients successfully completed the operation, the operative time was 20 to 25 minutes, an average of about 21.4 minutes. Nine of the 15 eyes had surface anesthesia and 6 eyes had retrobulbar anesthesia. 14 eyes can be successfully removed macular hole next to the inner limiting membrane, a failed to complete tear. 1 to 6 months after operation underwent OCT examination, 14 eyes were closed in 15 eyes, 1 eyes closed but not closed, the hole closure rate of 93 3%. There was no reoperation of the hole during follow-up. The last follow-up, postoperative best corrected visual acuity 0.1-1.0, an average of 0.35. 9 eyes (60%) of patients with visual acuity increased by at least two lines. Surgical complications included transient elevated intraocular pressure (2 eyes), subconjunctival air bubble (2 eyes), posterior subcapsular feathery opacity (5 eyes), lens nucleus sclerosis (2 eyes), and no infectious intraocular Inflammation, iatrogenic retinal tears and retinal detachment, choroidal detachment and incision persistent leakage and other complications. CONCLUSIONS: 25G IMT with minimally invasive vitrectomy is a safe and effective method for the treatment of IMH. It has the advantages of short operation time, less trauma, less complications, quick recovery after operation, and definite curative effect. Especially under surface anesthesia, it avoids Anesthesia caused by complications after the ball, can be used for outpatient surgery for IMH.