網膜硝子体手術における温度管理の展望

Prospects of Temperature Management in Vitreoretinal Surgery.

• Lukyan Anatychuk
• Nataliya Pasyechnikova
• Volodimir Naumenko
• Roman Kobylianskyi
• Rudolf Nazaretyan
• Oleg Zadorozhnyy

抄録

現在のところ、網膜硝子体手術中の眼内構造物の特定の温度条件の安全性、硝子体腔の再保温の安全な速度についての指示、術後の眼球温度モニタリングの有用性についての明確な推奨事項はない。目的は、網膜硝子体手術中の眼球外温度と眼内温度の動態を研究することであった。本研究では，リヘマトゲン性網膜剥離（10 眼）および増殖性糖尿病網膜症に伴う網膜剥離（10 眼）の患者 20 例を対象とした．全患者が網膜硝子体手術を受けた。すべての症例において、手術中に周囲温度、患者の体温、灌流液の温度、前部、中間部、後部硝子体の温度を記録した。術前および術後の眼球外表面の温度測定も行った。常温灌注液を用いた網膜硝子体手術では、硝子体腔の全セグメントにおいて、初期のものに対する温度の低下（<0.001）が認められた。継続的な灌水を行わない場合、硝子体腔の急速な再保温が認められた（平均0.18℃/分）。我々の研究では、術後に多くの患者（25％）で手術眼の局所的な高熱が認められた。現在の研究では、網膜硝子体手術は制御不能な局所眼球低体温症の条件下で行われ、冷却停止後の硝子体腔の急速な制御不能な再温熱が特徴であり、術後期には多数の患者で手術眼の局所高体温症が観察されています。

Currently, there are no clear recommendations about the safety of certain temperature conditions for intraocular structures during vitreoretinal surgery; instructions on the safe rate of rewarming of the vitreous cavity; and the advisability of monitoring ocular temperature in the postoperative period. The purpose was to study the dynamics of epibulbar and intraocular temperature during vitreoretinal surgery. This study included 20 patients with rhegmatogenous retinal detachment (10 eyes) and retinal detachment associated with proliferative diabetic retinopathy (10 eyes). All patients underwent vitreoretinal surgery. In all cases, the ambient temperature, the patient's body temperature, the temperature of the irrigating solution, and temperature in the anterior, mid-, and posterior vitreous were recorded during surgery. Pre- and postoperative thermometry was also performed on the outer ocular surface. During vitreoretinal surgery with room temperature irrigation solution, a decrease in temperature ( < 0.001) versus the initial one was found in all segments of the vitreous cavity. In the absence of continuous irrigation, a rapid rewarming of the vitreous cavity was noted (an average of 0.18°C/min). Our study also demonstrated the presence of regional hyperthermia of the operated eye in a number of patients (25%) in the postoperative period. Current research shows that vitreoretinal surgery is performed under conditions of uncontrolled local ocular hypothermia and is characterized by a rapid uncontrolled rewarming of the vitreous cavity after cessation of cooling, and in the postoperative period local hyperthermia of the operated eye is observed in a number of patients.