摘要
目的探讨巩膜穿刺孔玻璃体嵌顿与玻璃体手术失败的关系。方法对连续49例(49只眼)玻璃体手术后视网膜脱离患者,根据术中探查,将巩膜穿刺孔内口玻璃体嵌顿分为5级:0级:无任何玻璃体嵌顿;Ⅰ级:穿刺孔内口玻璃体嵌顿,但对视网膜无牵拉;Ⅱ级:玻璃体嵌顿,对视网膜产生牵拉,表现向前移位;Ⅲ级:视网膜嵌顿在穿刺孔内口处;Ⅳ级:玻璃体嵌顿牵拉形成视网膜裂孔。Ⅲ和Ⅳ级定为是手术失败的主要原因,Ⅱ级判为手术失败的次要原因,0和Ⅰ级为非巩膜穿刺孔并发症引起的手术失败。结果患者原发疾病为裂孔性视网膜脱离22例,眼外伤21例(包括取眼内异物8例);分支静脉阻塞和化脓性眼内炎各2例;糖尿病性视网膜病变和急性视网膜坏死综合症各1例。做过1次玻璃体手术37例,2次以上12例。前段增生性玻璃体视网膜病变分级:单纯视网膜环形收缩2例;视网膜前移位31例(合并环形收缩11例)。主要因巩膜穿刺孔并发症引起的手术失败占57.2%(28例),巩膜穿刺孔并发症为次要原因占20.4%(10例),二者占77.6%。非巩膜穿刺孔并发症引起的手术失败占22.4%(11例)。结论巩膜穿刺孔玻璃体嵌顿的并发症是玻璃体手术失败的首要原因。
Objective To investigate whether the failing causes of vitreous surgery were related to the vitreous incarceration of the sclerotomy sites. Methods A series of 49 patients （49 eyes）, who had undergone unsuccessful vitreous surgery and occurred retinal detachment, were enrolled for this study. Based on the intraoperative observation, the vitreous incarceration at inner aspects of sclerotomies （IAS） was classified into five grades. Grade 0 was no vitreous incarceration; Grade Ⅰ had vitreous incarceration in IAS without drawing retina; Grade Ⅱ had the incarcerated vitreous draw the retinal anterior displacement; Grade Ⅲ had caused retinal incarceration in IAS; Grade IV was the traction of the incarcerated vitreous leading to retinal breaks. Grade Ⅲ and Grade Ⅳ were recognized as a chief causation of surgery failure, Grade Ⅱ was secondary causation, but Grade I and Grade 0 were not related to the vitreous surgery failure caused by the complications of the sclerotomy sites. Results the causal diseases were retinal detachment in 22 eyes, ocular trauma in 21 eyes （intraocular foreign body removal in 8 eyes）, branch retinal vein occlusion and suppurative endophthalmitis in 2 eyes respectively, diabetic retinopathy and acute retinal necrosis syndrome in 1 eye respectively. Thirty-seven patients had one vitreous surgery and twelve patients had twice or more vitrectomies. Anterior proliferative vitreoretinopathy was found in 33 eyes, including circumferential contraction in 2 eyes, anterior displacement in 31 eyes （combined with circumferential contraction in 11 eyes）. The vitreous incarceration was the chief cause of vitreous surgery failing in 57.2% （28eyes）, the secondary one in 20.4%（10 eyes）, and both counted 77.6%. The failing causes were not related with sclectomies in 22.4%（11 eyes）. Conclusion The complications of vitreous incarceration in sclerotomy sites were the primary cause of vitreous surgery failure.
出处
《中国实用眼科杂志》
CSCD
北大核心
2006年第6期577-580,共4页
Chinese Journal of Practical Ophthalmology
