玻璃体切除术中与巩膜切口相关视网膜裂孔的临床研究  

Intraoperative sclerotomy-related retinal breaks in vitrectomy

作　　者：王常观[1] 冯雪梅[2] 范建国[3] 马志中[1] 许艺民[1] 

机构地区：[1]北京大学第三医院眼科中心,北京100083 [2]中国医科大学附属第二医院眼科 [3]北京军区总医院眼科

出　　处：《中国实用眼科杂志》2004年第4期266-268,共3页Chinese Journal of Practical Ophthalmology

摘　　要：目的　分析玻璃体手术过程中由巩膜切口引起的周边部视网膜裂孔的发生率、可能原因及预防方法。方法　回顾分析 3 0 0例 3 14眼连续玻璃体手术病例 ,通过表格的形式 ,记录眼别、诊断、术前周边部视网膜情况、手术名称、术中操作、术中并发症。重点记录术中在巩膜切口附近是否发生锯齿缘解离或周边部视网膜裂孔 ,并记录裂孔的位置、大小以及处理。剔除术前已经存在上方视网膜锯齿缘解离或较大的周边视网膜裂孔的病例。分析术中巩膜切口附近视网膜裂孔的发生率及可能的原因。结果　入选的 2 94例玻璃体手术眼中 ,巩膜切口附近发生视网膜锯齿缘解离或周边部视网膜裂孔共 19例。其中 ,球内异物 5例 ( 5 /19) ,增殖性玻璃体视网膜病变 4例 ( 4/60 ) ,糖尿病 4例 ( 4/87) ,视网膜静脉阻塞并发玻璃体积血 1例 ( 1/16) ,角、巩膜穿通伤 4例 ( 4/5 2 ) ,静脉周围炎并发玻璃体积血 1例 ( 1/9)。其中 ,球内异物眼的发生率最高 ,为 2 6%。黄斑前膜或黄斑裂孔的发生率最低 ,3 4例手术病例中 ,无 1例发生巩膜切口附近的视网膜裂孔。结论　巩膜切口附近视网膜锯齿缘解离或视网膜裂孔的发生与术眼的病变程度、手术的复杂程度有关。Objective To evaluate the incidence,causes,and prophylaxis of sclerotmoy related retinal breaks(SRRB)during vitreous surgery.Methods 314 consecutive eyes of vitrectomy were reviewed.Preoperative findings of retinal breaks or dialysis of ora serrata(OS),name of surgical procedures and complications during surgery were filled into forms.Retinal breaks in the superior quadrant of the fundus were described in detail.If a retinal break did occurred,its exact location,size,and treatment were recorded.Results 294 cases were enrolled after removing 20 cases that have dialysis of ora serrata or retinal breaks in the superior quadrant before surgery.The incidence of SRRB was analyzed between different vitreoretinal diseases.During surgery retinal breaks or dialysis of OS around the site of sclerotomy occurred in 19 cases of the 294 eyes,among which 5 occurred in eyes of intraocular foreign body(5/19, P <0 01),4 in proliferative vitreoretinopathy(4/60),4 in proliferative diabetic retinopathy(4/87),1 in retinal vein occulusion(1/16),4 in penetrating eye trauma(4/52),1 in Eales disease(1/9).No sclerotomy related retinal breaks occurred in the 34 eyes of premacular membrane or macular holes( P <0 05).Conclusions Sclerotomy related retinal breaks were closely associated with the complexity of surgical procedures.Active prophylactic maneuvers should be taken to reduce the incidence of this complication.

关 键 词：玻璃体切除术 巩膜切口 视网膜裂孔 临床研究 

分 类 号：R779.6[医药卫生—眼科]