玻璃体腔注射曲安奈德联合部分前部玻璃体切割手术治疗白内障合并重度玻璃体积血的安全性观察  

Safety of intravitreal injection of triamcinolone acetonide combined with partial anterior vitrectomy for cataract with severe vitreous hemorrhage

作　　者：闫欢欢 屈超义 张妍春 郝琳娜 Yan Huanhuan;Qu Chaoyi;Zhang Yanchun;Hao Linna(Department of Ophthalmology,Xi'an People’s Hospital(Xi’an Fourth Hospital),Shaanxi Eye Hospital,Affiliated Guangren Hospital,School of Medicine,Xi'an Jiaotong University,Xi'an 710004,China)

机构地区：[1]西安市人民医院(西安市第四医院)眼科,陕西省眼科医院,西安交通大学医学院附属广仁医院,710004

出　　处：《中华眼底病杂志》2021年第4期267-270,共4页Chinese Journal of Ocular Fundus Diseases

摘　　要：目的观察玻璃体腔注射曲安奈德(TA)联合部分前部玻璃体切割手术(PPV)治疗白内障合并重度玻璃体积血的安全性。方法回顾性病例对照研究。2017年6月至2019年6月于西安市人民医院(西安市第四医院)眼科检查确诊的白内障合并重度玻璃体积血患者60例60只眼纳入研究。其中,男性32例32只眼,女性28例28只眼;平均年龄64.8岁。随机将患眼分为玻璃体腔注射TA组(TA组)、未注射TA组(对照组),各30只眼。TA组患眼于白内障超声乳化手术前玻璃体腔注射TA 0.05~0.10 ml,并切除玻璃体切割通道内口处部分玻璃体;对照组患眼行常规白内障超声乳化手术联合PPV。手术后随访时间≥6个月。比较两组手术中连续环形撕囊完成、后囊膜破裂、人工晶状体(IOL)植入囊袋内情况。计数资料比较行χ^(2)检验。结果TA组所有患眼,玻璃体腔注射TA联合部分前部玻璃体切割后,眼底白色反光可清晰显示晶状体前囊膜及后囊膜,均完成连续环形撕囊,后囊膜无破裂,IOL顺利植入囊袋内。对照组30只眼中,未完成连续环形撕囊4只眼,撕囊过程中发生放射状撕裂,使用囊膜剪辅助完成撕囊;后囊膜破裂5只眼,其中超声乳化过程中发生后囊膜破裂3只眼、注吸晶状体皮质时误吸后囊致后囊膜破裂2只眼,IOL植入睫状沟、囊袋内分别为4、1只眼。两组间连续撕囊是否成功、后囊膜是否破裂、IOL是否植入囊袋内眼数比较,差异均有统计学意义(χ^(2)=4.286、5.455、4.286,P=0.038、0.020、0.038)。末次随访时,所有患眼均未见特殊并发症发生。结论玻璃体腔注射TA联合部分前部PPV可提高白内障合并重度玻璃体积血患者超声乳化手术中晶状体前后囊膜及晶状体核的可视度,手术成功率高,并发症少;安全性较好。Objective To observe the safety of intravitreal injection of triamcinolone acetonide(TA)combined with partial anterior pars plana vitrectomy(PPV)for cataract with severe vitreous hemorrhage.Methods A retrospective case-control study.A total of 60 patients(60 eyes)with cataract and severe vitreous hemorrhage were included from June 2017 to June 2019 in Xi’an People’s Hospital(Xi’an Fourth Hospital).There were 32 males(32 eyes)and 28 females(28 eyes),with a mean age of 64.8 years.The eyes were randomly divided into intravitreal injection TA group(TA group)and non-TA injection group(control group),with 30 eyes in each group.Before phacoemulsification,0.05-0.10 ml TA was injected into the vitreous cavity in the TA group and the vitreous besides the vitrectomy channel was removed.The eyes of the control group underwent conventional cataract phacoemulsification combined with PPV.The follow-up time after surgery was≥6 months.The rate of success continuous circular capsulorhexis,posterior capsule rupture,and intraocular lens(IOL)implantation in the capsular bag were compared between the two groups.The statistical data were compared withχ^(2) test.Results For all eyes in the TA group,after intravitreal injection of TA combined with partial anterior PPV,the white reflection of the fundus can clearly show the anterior and posterior capsule of the lens.Continuous circular capsulorhexis was completed,the posterior capsule was not broken,and the IOL was successfully implanted inside the capsular bag.Among the 30 eyes of the control group,4 eyes did not complete continuous circular capsulorhexis.Radial tear occurred during capsulorhexis,and capsulorhexis was used to complete capsulorhexis.In 5 eyes with posterior capsule rupture,the posterior capsule occurred in 3 eyes during phacoemulsification,and injecting the lens cortex caused posterior capsule repture in 2 eyes;the IOL was implanted in the ciliary sulcus and the capsular bag in 4 and 1 eyes,respectively.Whether the consecutive capsulorhexis was successful(χ^(2)=

关 键 词：玻璃体出血 曲安奈德 玻璃体切除术 超声乳化白内障吸除术 

分 类 号：R779.6[医药卫生—眼科]