Application of 23G vitrectomy system in pediatric congenital cataract surgery / 国际眼科杂志(Guoji Yanke Zazhi)

@#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^st 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.

Scleral buckling combined with 23G vitrectomy in treatment of intraocular foreign body with retinal detachment / 国际眼科杂志(Guoji Yanke Zazhi)

@#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.

Analysis on risk factors of early bleeding after 23G bead resection for PDR / 国际眼科杂志(Guoji Yanke Zazhi)

@#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.

Modified scleral puncture drainage in 23G vitrectomy for patients with coexisting rhegmatogenous retinal detachment and choroidal detachment / 国际眼科杂志(Guoji Yanke Zazhi)

@#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.

Efficacy comparison between two kinds of vitrectomy in proliferative diabetic retinopathy / 国际眼科杂志(Guoji Yanke Zazhi)

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.

Clinical study on the treatment of vitreoretinal diseases complicated with cataract with micro-micro surgery / 国际眼科杂志(Guoji Yanke Zazhi)

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.

23G vitrectomy outcomes of macular edema in retinal vein occlusion combined with vitreomacular traction or epiretinal membrane / 国际眼科杂志(Guoji Yanke Zazhi)

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.

Preoperative and intraoperative adjunctive intravitreal conbercept in 23G vitrectomy for proliferative diabetic retinopathy / 眼科新进展

Objective To discuss the effects and influence of preoperative and postoperative adjunctive intravitreal conbercept in 23G vitrectomy for proliferative diabetic retinopathy (PDR).Methods A retrospective research was performed on 42 PDR eyes from January 2015 to February 2016 in the Second Affiliated Hospital of Nanchang University,who received either intravitreal 0.05 mL conbercept injection 7 days before 23G vitrectomy (group A,n =22) or intravitreal 0.05 mL conbercept injection at the end of 23 G vitrectomy (group B,n =20).The operative time,postoperative vitreous hemorrhage (VH),intraoperative and postoperative other differences of clinical indicators and postoperative best-corrected visual acuity (BCVA) between the two groups were compared.Results The average operation time,intraoperative electric coagulation hemostasis rate,iatrogenic hiatal incidence and intraoperative hemorrhage rate of group A were lower than those of group B (all P ＜ 0.05).BCVA at 6 months after surgery did not differ significantly between two groups (P ＞ 0.05),but the difference was statistically significant between pre-operation and post-operation (P ＜ 0.05).The incidences of early (≤ 1 month) postoperative VH were 18.2％ (4 eyes) and 15.0％ (3 eyes) in group A and B,respectively (P ＞ 0.05).The incidences of later (＞ 1 month) postoperative VH were 27.3％ (6 eyes) and 0 in group A and B,respectively,the difference was statistically significant (P ＜0.05).The percentages of reoperation were 13.6％ (3eyes with postoperative VH) and 10.0％ (2 eyes with traction retinal detachment) respectively in group A and B.The average times of supplementary laser photocoagulation were (2.3 ± 1.0) times and (1.4 ±0.6) times in group A and B,respectively in follow-up period (P ＜ 0.05).Conclusion The adjunctive use of intraoperative intravitreal injection of conbercept can prevent effectively postoperative VH and decrease conveniently the time of supplementary laser photocoagulation in 23G vitrectomy for PDR,as well as the preoperative adjunctive use can decrease the operation time,intraoperative complications and incidences of early postoperative VH.

Analysis of 23 G and 25 G+vitrectomy for retinal detachment / 国际眼科杂志(Guoji Yanke Zazhi)

?AIM: To compare the clinical effect of 23G and 25G+vitrectomy for retinal detachment.?METHODS:Forty seven patients with retinal detachment were treated with 23G vitrectomy (27 eyes in 27 cases as group A) and 25G+ vitrectomy (20 eyes in 20 cases as group B ) . The operation time and the incidence of intraoperative complications were recorded. The occurrence of retinal reposition, visual acuity, intraocular pressure ( IOP ) and complications were observed. Postoperative follow-up time of the two groups were 3d, 1wk, 3mo. The relevant records were statistically analyzed and compared.?RESULTS: The operation time of 23G group and 25G+group were 50. 21+4. 52min, 49. 15+5. 14min,respectively and there was no significant difference between the two groups (P>0. 05). The main complications were retinal hemorrhage and iatrogenic retinal hole. There were 3 eyes with retinal hemorrhage, 2 eyes with iatrogenic retinal hole in 23G group, and 1 eye with retinal hemorrhage, 1 eye with iatrogenic retinal hole in the 25G+group, and the difference was statistically significant ( P0. 05). The number of eyes with hypotonia in 23G and 25G+group were 3 and 1 eyes respectively, the difference was statistically significant ( P 0. 05). At the last follow-up, the results showed that 26 eyes ( 96%) with retinal reposition in 23G group, 19 eyes (95%) in 25G+ group, the difference was not statistically significant (P>0. 05).?CONCLUSION: The clinical effect of 23G and 25G+vitrectomy for retinal detachment is similar, but 25G+vitrectomy can reduce incidence of complications and early postoperative low IOP.

Comparisons of Corneal Topographic Change Between 20-Gauge and 23-Gauge Pars Plana Vitrectomy

PURPOSE: To compare the changes in corneal topography between 23 gauge (G) pars plana vitrectomy (PPV) and 20 G PPV. METHODS: Forty-three eyes of 42 patients who underwent PPV were divided into 2 groups: 20G PPV (Group I, n=18) and 23 G PPV (Group II, n=25). Both groups were followed up over 3 months postoperatively. ORBSCAN II was performed to compare the corneal topographic change of 20 G PPV and 23 G PPV. RESULTS: In a 5 mm zone, significant postoperative change in the mean corneal surface cylinder was found between the 1st day and the 1st month in Group I, while no significant change was found in Group II. Postoperatively, the increase in the mean corneal surface cylinder in Group I was significantly higher than in Group II between the 1st day and the 1st month. Clinically significant astigmatism, induced by surgery, was found only in Group I one week after the operation. In a 3 mm zone, there was no significant change in the mean corneal surface cylinder in both groups postoperatively. The difference in the mean corneal surface cylinder between the 2 groups at the postoperative periods showed no significant change. Surgically induced astigmatism was significantly higher in Group I than in Group II between the 1st day and the 1st month postoperatively. CONCLUSIONS: PPV with the 23 G system is a sutureless transconjunctival surgery, which appears to be more effective due to insignificant corneal surface and astigmatic changes in the early postoperative period.