دراسة تقنية قطع الزجاجي عبر المنطقة الملساء باستخدام شقوق 23-gauge وتأثيرها المبكر على الضغط داخل المقلة والاختلاطات أثناء وبعد العمل الجراحي

الموضوعات

طب

روابط وملفات

التعريف والنوع

رقم الوثيقة

fc7e406c-ddd9-4f29-a69b-a65e172e81bf

رقم العقد

0

نوع الوسائط

Crawler

نوع المحتوى

الرسائل العلمية

صيغة المصدر

رسائل دكتوراة

نوع الملف

pdf text

أسماء الملفات

1961000_1.pdf

بيانات النشر

ترجمة العنوان

The technique of 23-guage pars plana vitrectomy , and its early influences on intraocular pressure and intraoperative and postoperative complications

ألقاب المؤلفين

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اللغة

Arabic

المصدر والدورية

اسم المصدر

دراسة تقنية قطع الزجاجي عبر المنطقة الملساء باستخدام شقوق 23-gauge وتأثيرها المبكر على الضغط داخل المقلة والاختلاطات أثناء وبعد العمل الجراحي

المحتوى والصفحات

عدد الصفحات

0

ترجمة الملخص

The technique of 23-guage pars plana vitrectomy , and its early influences on intraocular pressure and intraoperative and postoperative complications Background: Developing Microincisional pars plana vitrectomy systems was one of the most important achievements added to vitreo-retinal surgery. This study evaluates 23-guage pars plana vitrectomy in challenging surgical cases such as proliferative diabetic retinopathy causing tractional retinal detachment (involving or threatening the macula) or rhegmatogenous retinal detachment associated with proliferative vitreoretinopathy PVR. Purpose: to evaluate the technique of 23-gauge pars plana vitrecotmy and its early influences on intraocular pressure, and intraoperative and postoperative complications. Materials and Methods: the study included 191 cases divided into (Study Group: 51 eyes), and (comparative Group: 140 eyes). The (study group) contained 51 eyes that underwent 23-gauge pars plana vitrectomy , due to proliferative diabetic retinopathy and rhegmatogenous retinal detachment with proliferative vitreoretinopathy. Silicon oil was the intraocular tamponade used in the Study group. Cases with glaucoma, intraocular foreign body, ocular trauma affecting corneal transparency or topography, or associated with scleral or optic nerve or iris or trabecualr meshwork injury , high myopia, endophthalmitis , previous vitrectomy, corneal scars affecting fundus exam, and the cases that didn’t require the use of silicon oil as an internal tamponade were excluded. the complications were observed intra- and postoperatively. The macula was evaluated using optical coherence tomography OCT during the study period. Surgically inducedastigmatism SIA was measured using both polar and vector analysis. The comparative group contained 140 eyes that underwent 23-gauge PPV to treat primary uncomplicated rhegmatogenous retinal detachment. Cases with traumatic retinal detachment, endophthalmitis, previous vitrectomy or previous filtrating or strabismus surgeries, corneal scars affecting the evaluation of ocular fundus, proliferative diabetic retinopathy, proliferative vitreoretinopathy were excluded. Intraoperative and 2 days- postoperative Complications were observed, as well as intraocular pressure changes in the 2 days following the surgery .Results: Surgery duration was longer in the study group(117.25+32.914 minutes) than that of the comparative group( 37.76+13.756 minutes) respectively. Scleral incisions were sutured in 54.9% of cases in the study group, and in 10% from the 23-gauge comparative group. central corneal thickness changes (study group) were statistically significant a day and a week postoperatively. Anterior chamber depth increased a week, a month, and 3months postoperatively (study group). No cases of hypotony were recorded in both study and control groups using non-modified intraocular pressure measurements. In the study group: elevated intraocular pressure >30 mmHg was found in 2%, 3.9%, 2%, 2% of cases after a day, week, month, and 3months respectively. elevated intraocular pressure >30 mmHg occurred in 2.9% of the comparative group, and all cases responded well to topical medications. At graduation, 5.7% of cases showed intraocular pressure elevation ranged from (20-30 mmHg) in the comparative group. In the study group: 5,3,1 cases of hypotony (using modified intraocular pressure due to central corneal thickness) were recorded a day ,a week, a month after surgery respectively. 2,1,2 cases of modified intraocular pressure >30 mmHg were recorded a week, moth, 3 months respectively after vitrectomy. SIA centroid was :0.51/104, 0.42/87, 0.43/104 at week, month, 3months respectively .SIA was higher in eyes that underwent suturing the scleral incisions than eyes that underwent suture less vitrectomy. Post-operative Corneal steepening occurred in 45.1%, 37.3%, 52.4% of eyes after a week, month ,and 3months respectively. Post-operativeAnti-clockwise torsion occured in 58.8% , 39.2%, 66.7% of eyes after a week, a month, and 3months respectively. visual acuity was improved significantly. Central macular thickness CMT was 275.63+71.065 microns, 259.82+40.898 microns, 260.27+33.897 microns at the post-operative week, month, 3months respectively. Difference between CMT measured at week and month postoperatively was statistically significant. one months’ CMT was higher in patients underwent combined phacoimulsification and vitreoretinal surgery. A significant correlation was found between CMT(month) and combined surgery. CMT (week) , CMT(month) were significantly different between eyes with RRD and eyes with PDR. A significant correlation was found between CMT(week) and Diabetes Mellitus. Macular re-attachment and tractional release were achieved in 100% of cases. OCT images revealed Macular edema in 23.5%, 9.8%, 3.9% at postoperative week, month , 3months respectively, and Epiretinal membrane in 3.9%, 7.8% of cases in the postoperative month, 3months respectively. Main intraoperative complications were iatrogenic retinal breaks 7.8% (study group) and 2.1%(comparative group), small cannula dislocation in 7.8%(study group) and 0.7%(comparative group), and choroidal effusion in 2% of cases(study group) and 0.7%(comparative group).Conclusion: 23-gauge pars plana vitrectomy system is safe and effective in complicated cases requiring extensive membrane peeling. It is accompanied with a slight surgically induced astigmatism SIA and a low incidence of conjuctival scarring. The development of surgical instruments, vitrectomy fluidics, illumination equipments and wide-angle viewing systems helps the surgeon to achieve different steps of vitreoretinal surgery easily and effectively

كلمات الباحثين

23-gauge vitrectomy, combined retinal detachment, combined surgery, intraocular pressure, Microincisional Vitrectomy, proliferative diabetic retinopathy PDR, proliferative vitreoretinopathy, rhegmatogeneous retinal detachment RRD, vitrectomy fluidics, Wide Angle viewing systems, اعتلال الشبكیة السكري المنمي, الجراحة المشتركة, الضغط داخل المقلة, انفصال الشبكیة الشدي, انفصال الشبكیة الشقي, انفصال الشبكیة المشترك، اعتلال, حركیة السوائل في قطع الزجاجي, زجاجي شبكي منمي, قطع الزجاجي باستخدام شقوق 23-gauge, قطع الزجاجي عبر شقوق فائقة في الصغر

إشراف وإعداد

الإشراف

أحمد باسم البریدي , یسرى حدة

الإعداد

عفراء هیثم سلمان

الاقتباسات الببليوغرافية