长轴玻璃体切除术探头治疗高度近视眼玻璃体视网膜疾病的随机对照试验

IF 3.2 Q1 OPHTHALMOLOGY

Ophthalmology science Pub Date : 2025-06-16 DOI:10.1016/j.xops.2025.100824

Yun Hsia MD, MS , Cheng-Yung Lee MD , Mei-Chi Tsui MD , Shih-Wen Wang MD , Chien-Jung Huang MD , I-Hsin Ma MD, MS , Kuo-Chi Hung MD , Muh-Shy Chen MD, PhD , Zih-Wei Yang MD , Bo-Da Huang MD , Ting-Chieh Ko MD , Tzyy-Chang Ho MD

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引用次数: 0

摘要

目的评价长轴玻璃体切割探头在高度近视玻璃体切割手术中的安全性和有效性。设计随机对照试验。对象高度近视（眼轴长[AL] >；26 mm）伴视网膜前膜（ERM），近视牵引性黄斑病变，视网膜脱离。方法将入组眼睛随机分为研究组（紫外线25 Ga， 31.75 mm，爱尔康）和对照组（紫外线25 Ga+， 27 mm，爱尔康）。进行分层随机化，以平衡各组间AL >；28 mm眼的比例。主要观察指标：玻璃体摘除率和玻璃体核心切除术时间为主要观察指标，器械弯曲为次要观察指标。解剖和视觉结果及并发症记录了6个月。进行亚组分析，比较AL >；28 mm与非AL >；28 mm的眼睛。结果86例患者，平均年龄60.7±9.6岁，AL为29.15±2.14 mm。两组玻璃体核心切除术时间相当（- 0.5分钟，P = 0.172）。研究组套管针拔除率较低(5% vs. 67%, P <；0.001)，但器械弯曲率较高（36% vs. 14%, P = 0.036），特别是AL >； 28mm的眼睛。在AL >；28 mm眼中，标准玻璃体切割探头在皮质玻璃体去除、内限制膜（ILM）切边或诱导玻璃体后脱离方面比长轴玻璃体切割(P <；0.001)。6个月时，视力显著改善（最小分辨角的对数），解剖成功(研究：- 0.22,95%；对照组：−0.24,88%)。研究组有ERM的眼睛有显著的视力改善（- 0.21,P = 0.02 vs. - 0.09, P = 0.34）。结论长柄玻璃体切割探头安全、有效，尤其适用于高度近视眼（AL > 28mm），但器械弯曲率较高。它提供了更好的后极通道，允许精细地去除附着的皮质玻璃体和修剪ILM皮瓣。解决由于无袖设计而增加的仪器弯曲对未来的设计很重要。财务披露作者在本文中讨论的任何材料中没有专有或商业利益。

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Long-Shaft Vitrectomy Probe for Vitreoretinal Diseases in Highly Myopic Eyes: A Randomized Controlled Trial

Objective

To evaluate the safety and efficacy of a long-shaft vitrectomy probe in highly myopic eyes undergoing pars plana vitrectomy.

Design

A randomized controlled trial.

Subjects

Highly myopic eyes (axial length [AL] >26 mm) with epiretinal membrane (ERM), myopic tractional maculopathy, and retinal detachment.

Methods

The enrolled eyes were randomly assigned to a study group (UltraVit 25 Ga, 31.75 mm, Alcon) and a control group (UltraVit 25 Ga+, 27 mm, Alcon). Stratified randomization was performed to balance the proportion of eyes with AL >28 mm between groups.

Main Outcome Measures

Trocar removal rate and core vitrectomy time were assessed as primary outcomes, and instrument bending as a secondary outcome. Anatomical and visual outcomes and complications were documented for 6 months. Subgroup analysis was performed to compare the eyes with AL >28 mm to those without.

Results

We included 86 patients with a mean age of 60.7 ± 9.6 years and an AL of 29.15 ± 2.14 mm. Two groups had comparable core vitrectomy times (−0.5 minutes, P = 0.172). The study group had a lower trocar removal rate (5% vs. 67%, P < 0.001) but a higher instrument bending rate (36% vs. 14%, P = 0.036), particularly in eyes with AL >28 mm. In eyes with AL >28 mm, the standard vitrectomy probe faced a significantly greater difficulty in cortical vitreous removal, internal limiting membrane (ILM) trimming, or posterior vitreous detachment induction compared with the long-shaft vitrectomy (P < 0.001). At 6 months, significant visual improvement (logarithm of the minimum angle of resolution) and anatomical success were achieved (study: −0.22, 95%; control: −0.24, 88%). Eyes with ERM in the study group, not the controls, had significant visual improvement (−0.21, P = 0.02 vs. −0.09, P = 0.34).

Conclusions

The long-shaft vitrectomy probe is safe and efficient, especially in highly myopic eyes with AL >28 mm, despite a higher instrument bending rate. It provides improved access to the posterior pole, allowing for delicate removal of adherent cortical vitreous and trimming of ILM flaps. Addressing increased instrument bending due to the sleeveless design is important for future design.