中國人之玻璃體切除術

Pars Plana Closed Vitrectomy among Chinese

蔡武甫(Wu-Fu Tsai)

《中華民國眼科醫學會會刊》 19卷 (1980/05) Pp. 50-57

https://doi.org/10.30048/ACTASOS.198005.0007

摘要

報告連續七十例密閉式玻璃體切除術病例，手術後繼續追踪觀察半年以上。其成功率為糖尿病性出血17例中59%成功；非糖尿病性出血42例中67%成功；玻璃體混濁11例則82%成功。全部七十例，手術後視力在0.05以上老有44例(62.8%)。手術中及手術後之併發症以出血，外傷性網膜裂孔、再出血、眼球萎縮等較多，但籠統言之。本報告併發症之發生率偏低。

並列摘要

Seventy consecutive pars plana closed vitrectomies were performed from Nov. 1978 to Dec. 1979. All of them had a minumum follow-up for six months. They included 52 cases of male and 18 cases of female. The age ranged from 6 to 72 years with 31% between 20 and 40. Of these seventy cases, 17 were diabetic vitreous hemorrhage, 42 were nondiabetic vitreous hemorrhage (including various origins such as trauma, Eales' disease, hypertensive retinopathy, macular degeneration, central retinal veins occlusion, retinal tear or detachment, irradiation retinopathy and those with unknown cause) and 11 were vitreous opacities caused by uveitis.
The machine the author used was Banko-Tolentino's M6 with a standard nibbler. The surgical technique was essentially same with that originally described by Dr. Machemer with a few modifications. All except the first seven cases were operated on without aid of an operating microscope. Its reasons and advantages have been discussed. The infusion fluid used was lactated Ringer's solution. This has been proved to be a very sartifactory infusion fluid in each case.
Preoperative evaluation included a complete eye examination especially with an attempt to assess retinal function. Light projection, vitreous study with a three mirrors contact lens under slit lamp biomicroscopy and indirect ophthalmoscopy were helpful in evaluating the patient before surgery. By performing these examinations carefully, it almost could substitute for more delicate yet expensive facilities such as a bright flash ERG and ultrasonography.
The major intraoperative complications were bleeding (3 cases), iatrogenic tear (3 cases) lens injury (1 case) etc. Postoperative complications included recurrent hemorrhage (5 cases) hyphema (5 cases) glaucoma (3 cases) retinal detachment (3 cases) phthsis or atrophic eyeball (6 cases) persistent corneal edema (2 cases) rubeosis iridis (4 cases) complicated cataract (2 cases) and recurent vitreous opacity (2 cases). These complications were considerablly less frequent than those reported by other surgeons. The short duration of each surgery was considered to be the most contributing factor.
The author defined the surgery to be successful when visual acuity was improved for at least six months & posterior pole of the fundus was visualized. According to this standard, 59% of 17 cases of diabetic vitreous hemorrhage was successful, 67% of 42 cases of nondiabetic vitreous hemorrhage was successful and 82% of 11 cases of vitreous opacities caused by uveitis was successful. 62.8% of total cases obtained vision better than 0.05.
In conclusion, pars plana closed vitrectomy is a very effective surgery to restore vision of the eyes with chronic vitreous opacity. It can also be used in a clinic where facility is not advanced enough. Becuase of high successful rate and less complications, it ts highly recommeded in clinical use.

並列關鍵字

Pars plana closed vitrectomy