确定小儿患者双侧同期玻璃体视网膜手术的可行性和安全性。
国际,多中心,介入,回顾性病例系列。
来自全球24个中心的17岁或以下的患者,接受了立即序贯双侧玻璃体视网膜手术(ISBVS)-定义为玻璃体切除术,巩膜带扣,或使用玻璃体切割器进行晶状体切除术-在同一麻醉期间连续进行双眼。
临床病史,手术细节和适应症,麻醉下的时间,并回顾了术中和术后眼科和全身不良事件。
眼部和全身不良事件。
本研究共纳入167例患者的172例ISBVS手术中的344例手术。该队列的平均年龄为1.3±2.6岁。ISBVS的非排他性适应症是快速进行性疾病(74.6%),全身发病率使儿童处于高麻醉风险(76.0%),和远离手术地点的住所(30.2%)。最常见的诊断是早产儿视网膜病变(ROP;72.7%[P<0.01];3期,4.8%;4A期,44.4%;4B阶段,22.4%;第五阶段,26.4%),家族性渗出性玻璃体视网膜病变(7.0%),虐待性头部外伤(4.1%),持续的胎儿脉管系统(3.5%),先天性白内障(1.7%),后囊混浊(1.7%),孔源性视网膜脱离(1.7%),先天性X连锁视网膜劈裂(1.2%),诺里病(2.3%),和病毒性视网膜炎(1.2%)。双眼的平均手术时间为143±59分钟。ROP分期越高,手术时间越长(P=0.02)。没有报告术中眼部并发症。在术后即刻,来自不同患者的2只眼显示单侧玻璃体出血(0.6%)。没有眼内炎的病例,脉络膜出血,或者发生了低血压。平均总麻醉时间为203±87分钟。没有麻醉相关死亡病例,恶性高热,过敏反应,或心脏事件。再插管1例(0.6%),氧饱和度延长1例(0.6%)。手术后平均随访103周,解剖成功率和全球抢救率为89.8%和98.0%,分别。
本研究发现,对于具有双侧玻璃体视网膜病理特征的儿科患者,当反复全身麻醉是不可取的或不切实际的时,ISBVS是一种可行且安全的治疗模式。
To determine the feasibility and safety of bilateral simultaneous vitreoretinal surgery in pediatric patients.
International, multicenter, interventional, retrospective case series.
Patients 17 years of age or younger from 24 centers worldwide who underwent immediate sequential bilateral vitreoretinal surgery (ISBVS)-defined as vitrectomy, scleral buckle, or lensectomy using the vitreous cutter-performed in both eyes sequentially during the same anesthesia session.
Clinical history, surgical details and indications, time under anesthesia, and intraoperative and postoperative ophthalmic and systemic adverse events were reviewed.
Ocular and systemic adverse events.
A total of 344 surgeries from 172 ISBVS procedures in 167 patients were included in the
study. The mean age of the cohort was 1.3±2.6 years. Nonexclusive indications for ISBVS were rapidly progressive disease (74.6%), systemic morbidity placing the child at high anesthesia risk (76.0%), and residence remote from surgery location (30.2%). The most common diagnoses were retinopathy of prematurity (ROP; 72.7% [P < 0.01]; stage 3, 4.8%; stage 4A, 44.4%; stage 4B, 22.4%; stage 5, 26.4%), familial exudative vitreoretinopathy (7.0%), abusive head trauma (4.1%), persistent fetal vasculature (3.5%), congenital cataract (1.7%), posterior capsular opacification (1.7%), rhegmatogenous retinal detachment (1.7%), congenital X-linked retinoschisis (1.2%), Norrie disease (2.3%), and viral retinitis (1.2%). Mean surgical time was 143±59 minutes for both eyes. Higher ROP stage correlated with longer surgical time (P = 0.02). There were no reported intraoperative ocular complications. During the immediate postoperative period, 2 eyes from different patients demonstrated unilateral vitreous hemorrhage (0.6%). No cases of endophthalmitis, choroidal hemorrhage, or hypotony occurred. Mean total anesthesia time was 203±87 minutes. There were no cases of anesthesia-related death, malignant hyperthermia, anaphylaxis, or cardiac event. There was 1 case of reintubation (0.6%) and 1 case of prolonged oxygen desaturation (0.6%). Mean follow-up after surgery was 103 weeks, and anatomic success and globe salvage rates were 89.8% and 98.0%, respectively.
This
study found ISBVS to be a feasible and safe treatment paradigm for pediatric patients with bilateral vitreoretinal pathologic features when repeated general anesthesia is undesirable or impractical.