摘要
目的 观察 3D平视视频系统在外伤性玻璃体视网膜手术中应用的安全性、有效性及技术优势.方法 回顾性队列研究.纳入首都医科大学附属北京同仁医院眼科 2021 年 2 月至 2023年 1 月行玻璃体视网膜手术的累及眼后节的眼外伤患者 83 例(83 只眼).按照手术方式,将患者分为 3D平视视频系统组(A组)41 例(41 只眼)和传统显微镜目镜组(B组)42 例(42 只眼).A组和B组术后随访时间分别为 14.00(13.00,15.00)、17.00(13.00,22.00)个月.比较两组患者总手术时间、清除玻璃体积血时间、人工玻璃体后脱离时间、剥除视网膜前增生膜和内界膜时间、玻璃体替代物填充率、最佳矫正视力(BCVA,logMAR)、视网膜解剖学复位成功率、黄斑孔闭合率、并发症发生率以及手术医师和观摩者的主观感受.结果 两组患者年龄、性别、外伤类型、主要诊断和手术方式差异均无统计学意义(均P>0.05).A组清除玻璃体积血时间较B组短[13.50(8.00,25.00)比 20.00(15.75,38.75)min,Z=-2.17,P=0.030];A组和B组总手术时间、人工玻璃体后脱离时间、剥除视网膜内界膜和视网膜前增生膜时间差异均无统计学意义(t=0.21、-1.25、0.84,Z=-1.30,P=0.838、0.247、0.442、0.192).按照挫伤、破裂伤和裂伤分组,A组和B组总手术时间差异亦无统计学意义(t=-0.02、0.10、-0.10,P=0.981、0.925、0.918).末次随访时,A组可配合视力检查 32 例(32 只眼),BCVA较手术前提高[2.30(1.08,2.60)比 2.60(2.30,2.90),Z=-2.01,P=0.044];B组可配合视力检查 35 例(35 只眼),BCVA亦较手术前提高[2.30(1.30,2.60)比 2.60(2.00,2.90),Z=-2.09,P=0.037].手术前后同一时间点两组BCVA差异均无统计学意义(Z=-0.47、-0.27,P=0.636、0.789).两组患者C3 F8 或硅油填充率、视网膜解剖学复位成功率、黄斑孔闭合率差异均无统计学意义(均P>0.05),均未出现手术相关并发症.术者可倚靠手术椅,在坐姿舒适、肩颈背部放松下进行手术.3D平视外伤性玻璃体视网膜手术视频清晰度和立体感均优于传统显微镜手术视频.结论 3D平视视频系统下外伤性玻璃体视网膜手术可以达到显微镜目镜下相同的安全性和治疗效果,并可优化手术姿势,提升手术效率,具有良好的示教作用.
Abstract
Objective To observe the clinical safety,efficacy and technical advantages of three-dimensional heads-up display viewing system in traumatic vitreoretinal surgery.Methods This was a retrospective cohort study.From Feb.2021 to Jan.2023,83 eyes of 83 patients with ocular trauma involving the posterior segment diagnosed in the Department of Ophthalmology,Beijing Tongren Hospital Affiliated to Capital Medical University who underwent vitreoretinal surgeries were included in this study.Based on the surgical observation system,patients were divided into a 3D display viewing system group(group A)with 41 eyes of 41 cases and a traditional microscope eyepiece group(group B)with 42 eyes of 42 cases.The follow-up time of group A and group B was 14.00(13.00,15.00)and 17.00(13.00,22.00)months,respectively.General surgical duration,duration of vitreous hemorrhage removal,posterior vitreous detachment creating,proliferating epiretinal membranes and inner limiting membrane(ILM)peeling,vitreous substitutes injection rates,best corrected visual acuity(BCVA,logMAR),retinal reattachment rate,macular hole closure and postoperative complication,and subjective feelings of the surgeon and observers were compared between the two groups.Results There were no statistically significant differences in age,gender,trauma type,major diagnosis or surgical procedures between the two groups(all P>0.05).The duration of vitreous hemorrhage removal in group A was less than that in group B[13.50(8.00,25.00)vs 20.00(15.75,38.75)min,Z=-2.17,P=0.030].There were no statistically significant differences in general surgical duration,the duration of posterior vitreous detachment creating,or ILM peeling and proliferating epiretinal membranes peeling between group A and group B(t=0.21,-1.25,0.84;Z=-1.30;P=0.838,0.247,0.442,0.192).There were also no statistically significant differences in general surgical duration between group A and group B categorised under contusion,rupture and laceration(t=-0.02,0.10,-0.10;P=0.981,0.925,0.918).In group A,postoperative BCVA of 32 cases compliable with visual examination improved from before surgery at the last follow-up[2.30(1.08,2.60)vs 2.60(2.30,2.90);Z=-2.01,P=0.044].In group B,postoperative BCVA of 35 cases compliable with visual examination improved from before surgery at the last follow-up[2.30(1.30,2.60)vs 2.60(2.00,2.90);Z=-2.09,P=0.037].There were no statistically significant differences in BCVA between the two groups at the same time points before and after surgery(Z=-0.47,-0.27;P=0.636,0.789).There were no statistically significant differences in the rate of C3 F8 or silicone oil injection,retinal reattachment,or macular hole closure between the two groups(all P>0.05).None had postoperative complications in either groups.During operation,the surgeon leaned back in the operating chair and performed the operation in a comfortable sitting position with shoulders,neck and back relaxed.Heads-up 3D video of traumatic vitreoretinal surgery was superior to standard operating microscope video in terms of clarity and stereoscopy.Conclusion Traumatic vitreoretinal surgery under 3D heads-up display viewing system may achieve the same clinical safety and efficacy as under microscope eyepieces.It also optimizes operative position,improves surgical efficiency and has a good teaching effect.
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