无灌注25-G玻璃体手术系统在白内障超声乳化玻璃体脱出中的应用  

Dry 25-gauge vitrectomy to manage vitreous loss in phacoemulsification

作　　者：吴晓明[1] 由彩云[1] 黄钰森[1] 

机构地区：[1]山东省眼科研究所,山东青岛266071

出　　处：《中华眼视光学与视觉科学杂志》2011年第1期60-63,共4页Chinese Journal Of Optometry Ophthalmology And Visual Science

基　　金：国家自然科学基金资助项目（30600698）;国家“十一五”科技支撑计划资助项目（2006BA102804）

摘　　要：目的 探讨无灌注25-G玻璃体手术系统在白内障超声乳化吸除术中处理玻璃体脱出的有效性和安全性.方法 回顾性病例系列研究.收集山东省眼科研究所2007年9月至2009年9月期间收治的白内障超声乳化术中后囊膜破裂的病例18例（18眼）,其中年龄相关性白内障13例,糖尿病性白内障2例,并发性白内障3例,年龄41～86岁,平均（64.8±11.6）岁.所有患者均行白内障超声乳化吸除术,术中发现后囊膜破裂、玻璃体脱出后,即以无灌注25-G玻璃体切除头通过透明角膜切口进入前房,切除残余晶状体皮质和脱出玻璃体.25-G玻璃体手术系统设置最快玻切频率为1500次/min,负压吸引为250 mmHg.人工晶状体（IOL）通过原角膜切口植入晶状体囊袋内或睫状沟,术后予以药物抗炎治疗.术后随访3～13个月,平均4个月.患者均于术前及术后1、3、7 d进行相关眼科检查,记录最佳矫正视力、眼压和术后并发症.结果 应用25-G玻璃体手术系统过程中,患者前房稳定,无前房消失和眼球塌陷情况发生.所有病例均一期植入了IOL.患者术后视力均有不同程度的提高,有14例（77.8%）术后最佳矫正视力≥0.5,仅2例眼底病变患者及2例高度近视患者的最佳矫正视力＜0.5.术后第1天,角膜水肿10例（55.6%）,至术后第7天角膜均恢复透明.4例（22.2%）术后发生一过性高眼压,予前房放液或药物治疗后恢复正常.随访期间无继发性青光眼、黄斑囊样水肿、角膜内皮失代偿、视网膜脱离等严重并发症.结论 无灌注25-G玻璃体手术系统处理白内障超声乳化术中玻璃体脱出的方法安全、有效,术后炎症反应轻,恢复快.Objective To investigate the efficacy and safety of dry anterior vitrectomy using a 25-Gauge （25-G） vitrectomy system in the management of vitreous loss associated with phacoemulsification. Methods This retrospective review was comprised of the records of 18 patients who underwent dry anterior vitrectomy using a 25-G vitrectomy system to manage vitreous loss resulting from posterior capsule rupture during phacoemulsification. The group consisted of 18 eyes of 18 patients, 13 eyes with age-related cataract, 2 eyes with diabetic cataract,and 3 eyes with combined cataract. Patients ranged in age from 41 to 86 years [mean age （64.8±11.6）years]. All patients had ophthalmic examinations preoperatively, 1 day postoperatively and 3 to 7 days postoperatively. Topical anesthesia was used on 15 patients and paraocular anesthesia was used on 3patients. When finding vitreous prolapse into the anterior chamber, an anterior vitrectomy was performed with a 25-G vitrectomy system using a dry technique to clear the anterior chamber of vitreous. The 25-G vitrectomy system was set on the fastest cutting frequency, 1500 times/min, and suction was 250 mmHg. Intraocular lenses were implanted in the capsule or sulcus, and steroid eye drops were prescribed. The follow-up period was 3-13 months （average 4 months）. Additional outcome measurements were best corrected visual acuity （BCVA）, intraocular pressure, and postoperative complications. Results All procedures were uneventful and all intraocular lenses were primary implants. No intraoperative complications were attributed to the small-gauge instruments. Excluding 2 eyes with pre-existing conditions, 14 of 18 eyes （77.8%） had a final BCVA of 0.5 or better, and 38.9% （7/18） had a final BCVA of 1.0 or better. The other 2 patients with poor postoperative visual acuity were diagnosed with high myopia associated with pathologic change. Transient high intraocular pressure occurred in 4 eyes （22.2%） and was controlled with drugs and/or aqueous humor release in 3 da

关 键 词：玻璃体脱离 玻璃体切除术 超声乳化白内障吸除术 晶体 人工 

分 类 号：R779.66[医药卫生—眼科]