3D平视视频系统在外伤性玻璃体视网膜手术中的应用  

The application of three-dimensional heads-up display viewing system in traumatic vitreoretinal surgery

作　　者：李亮[1] 李松峰[1] 刘敬花[1] 邓光达[1] 麻婧[1] 原铭贞 卢海[1] Li Liang;Li Songfeng;Liu Jinghua;Deng Guangda;Ma Jing;Yuan Mingzhen;Lu Hai(Department of Ophthalmology,Beijing Tongren Eye Center,Beijing Tongren Hospital,Capital Medical University,Beijing Key Laboratory of Ophthalmology&Visual Sciences,Beijing 100730,China)

机构地区：[1]首都医科大学附属北京同仁医院眼科、北京同仁眼科中心、北京市眼科学与视觉科学重点实验室,北京100730

出　　处：《中华眼外伤职业眼病杂志》2024年第10期721-728,共8页Chinese Journal of Ocular Trauma and Occupational Eye Disease

基　　金：首都医科大学附属北京同仁医院院基金(2023-YJJ-PY-009)。

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C 3F 8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�ObjectiveTo observe the clinical safety,efficacy and technical advantages of three-dimensional heads-up display viewing system in traumatic vitreoretinal surgery.MethodsThis 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.ResultsThere 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

关 键 词：成像 三维 玻璃体视网膜手术 外伤 眼 

分 类 号：R47[医药卫生—护理学]