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Long-Term Visual Outcomes and Safety Profile of 27-Gauge Pars Plana Vitrectomy for Posterior Segment Disease
Ophthalmology ( IF 13.7 ) Pub Date : 2017-11-13 , DOI: 10.1016/j.ophtha.2017.09.013
M. Ali Khan , Alexander Kuley , Christopher D. Riemann , Maria H. Berrocal , Rohit R. Lakhanpal , Jason Hsu , Arunan Sivalingam , Allen C. Ho , Carl D. Regillo

Purpose

To report longer-term outcomes of 27-gauge pars plana vitrectomy (PPV) in eyes with posterior segment disease.

Design

Multicenter, retrospective, interventional case series.

Participants

A total of 390 eyes of 360 patients undergoing 27-gauge PPV for a vitreoretinal surgery indication.

Intervention

Three-port, transconjunctival, 27-gauge PPV.

Main Outcome Measures

Change in visual acuity (VA) and occurrence of intraoperative and postoperative complications with a minimum follow-up of 365 days.

Results

Mean follow-up was 715±332 days (median, 514; range, 365–1440 days). Surgical indications included epiretinal membrane (ERM) (n = 121), vitreous floaters (n = 69), diabetic tractional retinal detachment (n = 49), vitreous hemorrhage (n = 40), full-thickness macular hole (n = 33), recurrent proliferative vitreoretinopathy (PVR)–related retinal detachment (n = 18), primary rhegmatogenous retinal detachment (RRD) (n = 17), silicone oil removal (n = 16), dislocated intraocular lens (n = 10), submacular hemorrhage (n = 7), endophthalmitis (n = 6), and retained lens material (n = 4). Mean logarithm of the minimum angle of resolution (logMAR) VA improved from 0.72±0.62 (20/105 Snellen equivalent) preoperatively to 0.40±0.55 (20/50 Snellen equivalent) postoperatively (P < 0.001). No case required conversion to 23- or 25-gauge instrumentation. Postoperative complications included transient ocular hypertension in 44 eyes (11.3%), vitreous hemorrhage in 31 eyes (7.9%), and transient hypotony in 22 eyes (5.6%). Acute postoperative endophthalmitis occurred in 1 case (0.26%). Overall, 82 of 390 eyes (21.0%) underwent at least 1 additional intraocular surgery in the follow-up period, most commonly for cataract extraction (n = 40/82 eyes, 48.8%). Of the 18 eyes undergoing surgery for primary RRD, recurrent detachment due to PVR occurred in 2 eyes (11.1%).

Conclusions

At a minimum follow-up of 1 year, 27-gauge PPV was well tolerated with low rates of postoperative complications across varied surgical indications, including primary and complex retinal detachment.



中文翻译:

27口径帕斯玻璃体切除术治疗后段疾病的长期视觉结果和安全性

目的

要报告患有后段疾病的眼睛的27英寸标准尺玻璃体切除术(PPV)的长期结果。

设计

多中心,回顾性,介入病例系列。

参加者

360位患者的总共390只眼睛接受了27规格PPV的玻璃体视网膜手术指征。

干涉

三端口经结膜27规PPV

主要观察指标

视力(VA)的变化以及术中和术后并发症的发生,至少需要365天的随访。

结果

平均随访时间为715±332天(中位数为514天;范围为365–1440天)。外科手术适应症包括视网膜前膜(ERM)(n = 121),玻璃体漂浮物(n = 69),糖尿病性视网膜牵引脱离(n = 49),玻璃体出血(n = 40),全层黄斑裂孔(n = 33) ,复发性增殖性玻璃体视网膜病变(PVR)相关的视网膜脱离(n = 18),原发性血源性视网膜脱离(RRD)(n = 17),硅油去除(n = 16),人工晶状体脱位(n = 10),黄斑下出血(n = 7),眼内炎(n = 6)和保留的晶状体材料(n = 4)。最小分辨角(logMAR)VA的平均对数从术前的0.72±0.62(20/105 Snellen当量)提高到术后的0.40±0.55(20/50 Snellen当量)(P<0.001)。无需将案例转换为23或25规格的仪器。术后并发症包括短暂性高眼压症44眼(11.3%),玻璃体出血31眼(7.9%)和短暂性低眼压22眼(5.6%)。术后发生急性眼内炎1例(0.26%)。总体而言,在随访期间,390眼中的82眼(占21.0%)至少进行了1次眼内手术,最常见的是白内障摘除术(n = 40/82眼,占48.8%)。在接受原发性RRD手术的18眼中,有2眼(11.1%)发生了因PVR引起的复发性脱离。

结论

在至少1年的随访中,对27种PPV的耐受性良好,并且在各种手术适应症(包括原发性和复杂性视网膜脱离)中的术后并发症发生率均较低。

更新日期:2017-11-13
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