[1]李璐希,王雨生,李曼红,等.缝合切口与否对25G玻璃体切割术后患者眼压及相关并发症的影响[J].眼科新进展,2018,38(7):664-668.[doi:10.13389/j.cnki.rao.2018.0156]
　LI Lu-Xi,WANG Yu-Sheng,LI Man-Hong,et al.Clinical observation of postoperative intraocular pressure and complication for 25-gauge transconjunctival suture and sutureless vitrectomy[J].Recent Advances in Ophthalmology,2018,38(7):664-668.[doi:10.13389/j.cnki.rao.2018.0156]
点击复制

缝合切口与否对25G玻璃体切割术后患者眼压及相关并发症的影响/HTML
分享到：

《眼科新进展》[ISSN:1003-5141/CN:41-1105/R]

卷:
38卷
期数:
2018年7期
页码:
664-668
栏目:
应用研究
出版日期:
2018-07-05

文章信息/Info

Title:
Clinical observation of postoperative intraocular pressure and complication for 25-gauge transconjunctival suture and sutureless vitrectomy
作者:
李璐希; 王雨生; 李曼红; 田超伟; 张自峰; 杜红俊
710032　陕西省西安市，空军军医大学西京医院眼科，全军眼科研究所
Author(s):
LI Lu-Xi; WANG Yu-Sheng; LI Man-Hong; TIAN Chao-Wei; ZHANG Zi-Feng; DU Hong-Jun
Opthalmology，Eye Institute of Chinese PLA,Xijing Hospital，the Fourth Military Medical University，Xi’an 710032，Shaanxi Province，China
关键词:
玻璃体切割术; 眼压; 穿刺口缝合
Keywords:
vitrectomy; intraocular pressure; puncture incision suture
分类号:
R775
DOI:
10.13389/j.cnki.rao.2018.0156
文献标志码:
A
摘要:
目的　观察25G玻璃体切割术穿刺口缝合与免缝合术后眼压及其并发症发生情况，探讨小切口玻璃体切割术穿刺口缝合的必要性。方法　连续收集2015年5月至2016年9月西京医院眼科住院部206例（206眼）接受25G三通道玻璃体切割术患者的病例资料。根据手术结束时是否缝合巩膜切口分为2组，缝合组106例，免缝组100例。以术后第1天眼压≤5 mmHg（1 kPa=7.5 mmHg）为极低眼压，眼压＞21 mmHg为高眼压，术后高眼压在程度上分为：轻度>22～30 mmHg，中度>30～40 mmHg，重度＞40 mmHg。术后眼压等级变化（眼压变化幅度）分为：无变化、轻度降低（降1级）、重度降低（降2级）、轻度升高（升1级）、重度升高（升2级）。重点关注患者术后第1天眼压以及术后极低眼压和高眼压以及并发症的发生情况。结果　术后第1天缝合组眼压为4.7～48.0 mmHg （16.68±8.21）mmHg，免缝组为2.3～45.0 mmHg （14.41±7.72） mmHg，差异有统计学意义（P=0.031），免缝组术后第1天眼压总体低于缝合组。两组术后眼压等级比较，差异有统计学意义（P=0.029），免缝组术后发生极低眼压概率高，缝合组发生高眼压的概率高，缝合组术后眼压在正常范围内的概率大于免缝组。两组手术前后眼压等级变化（眼压变化幅度）比较，差异无统计学意义（P=0.120）。本研究资料术后极低眼压发生率为4.3%。免缝组出现8眼极低眼压，其中5眼发生并发症，包括术后第1天出现视网膜皱褶、脉络膜脱离1眼，4眼出现前房出血。缝合组出现1眼极低眼压，术后第1天可见前房出血及脉络膜水肿。两组手术后极低眼压并发症发生率差异有统计学意义（P=0.028），免缝组较缝合组术后发生极低眼压导致并发症发生率高。本研究资料高眼压发生率为14.1%。免缝组高眼压共12眼，其中轻度7眼、中度3眼、重度2眼。缝合组高眼压共17眼，其中轻度9眼、中度5眼、重度3眼。缝合组比免缝组高眼压发生率相对较高，但两组术后均未出现高眼压导致的并发症。两组术后高眼压程度差异无统计学意义（P=0.805），眼压以轻中度升高为主，经治疗3 d后，眼压均降到正常范围内。结论　25G玻璃体切割术毕时缝合穿刺口是相对更安全的，为了防止术后极发生低眼压及并发症，针对性缝合穿刺口是有必要的。
Abstract:
Objective　To observe intraocular pressure and complications after suture and sutureless in the incision of 25G vitrectomy，and discuss the necessity of suture for the incision with small incision vitrectomy.Methods　We continuously collected 206 cases （206 eyes） undergoing 25G triple-channel vitrectomy from May 2015 to September 2016 in the ophthalmic inpatient department of Xijing Hospital.According to whether sutur the scleral incision or not,the study was divided into two groups，106 cases of suture group，100 cases of sutureless group.On the first postoperative day，intraocular pressure ≤5 mmHg （1 kPa=7.5 mmHg） was hypotony，intraocular pressure >21 mmHg was hypetony，and postoperative hypetony was divided into：mild> 22-30 mmHg，moderate >30-40 mmHg，severe >40 mmHg.The postoperative intraocular pressure level changes （the magnitude of intraocular pressure changes） were divided into：no change，slight decrease （decrease 1 grade），severe decrease （decrease 2 grade），mild increase （increase 1 grade），and severe increase （increase 2 grade）.The patient’s intraocular pressure on the first postoperative day，postoperative polar intraocular pressure and intraocular pressure，and the occurrence of complications was analyzed.Results　On the first postoperative day，the intraocular pressure was 4.7-48.0 mmHg （16.68±8.21） mmHg in the suture group and 2.3-45.0 mmHg （14.41±7.72） mmHg in the sutureless group.The difference was statistically significant （P=0.031）.Intraocular pressure in the sutureless group was generally lower in the suture group on the first postoperative day.There was a statistically significant difference in the intraocular pressure levels between the two groups （P=0.029）. The probability of hypotony in the sutureless group was higher in the suture group，and the probability of hypetony in the suture group was higher in the sutureless group.The probability of intraocular pressure within the normal range after the suture group was higher than that of the sutureless group.Changes in intraocular pressure before and after surgery in both groups （intraocular pressure changes） were not statistically significant （P=0.120）.In this study，the incidence of hypotony was 4.3%.There were 8 eyes with hypotony in the sutureless group，in which 5 eyes had complications，including retinal folds，choroidal detachment in 1 eye，and anterior chamber hemorrhage in 4 eyes on the first postoperative day.In the suture group，one eye had hypotony，and on the first postoperative day，hyphema and choroidal edema were seen.There was a statistically significant difference in the incidence of the complications of hypotony between the two groups after surgery （P=0.120），and the incidence of complications was higher in the sutureless group than in the suture group.The incidence of hypetony in this study was 14.1%.There were 12 eyes with hypetony in the sutureless group，of which 7 were mild，3 were severe，and 2 were severe.In the suture group，there were 17 eyes with hypetony，including mild 9 eyes，moderate 5 eyes，and severe 3 eyes.The incidence of hypetony was higher in the suture group than in the sutureless group，but complications caused by hypetony did not appear in both groups.There was no significant difference in the degree of intraocular hypertension between the two groups （P=0.805），and the intraocular pressure was mainly mild to moderate.After 3 days of treatment，the intraocular pressure decreased to the normal range.Conclusion　It is relatively safe to suture the incision at the completion of 25G vitrectomy.In order to prevent postoperative low intraocular pressure and complications，targeted suture the incision is necessary.

参考文献/References:

［1］　FUJII G Y，DE JUAN E Jr，HUMAYUN M S，PIERAMICI D J，CHANG T S，AWH C，et al.A new 25-gauge instrument system for transconjunctival sutureless vitrectomy surgery［J］.Ophthalmology，2002，109（10）：1807-1812.
［2］　MO L J，RONG A.New clinical application of micro-invasive vitrectomy［J］.Rec Adv Ophthalmol，2009，29（11）：868-871.
莫利娟，荣翱.微创玻璃体切割术临床应用新进展［J］.眼科新进展，2009，29（11）：868-871.
［3］　MIKHAIL M，ALI-RIDHA A，CHORFI S，KAPUSTA M A.Long-term outcomes of sutureless 25-G+pars-plana vitrectomy for the management of diabetic tractional retinal detachment［J］.Graefes Arch Clin Exp Ophthalmol，2016，8（2）：1-7.
［4］　NGUYEN Q H.Incidence and management of glaucoma after intravitreal silicone oil injection for complicated retinal detachments［J］.Ophthalmology，1992，99（2）：1520-1526.
［5］　CHEN C J.Glaucoma after macular hole surgery［J］.Ophthalmology，1998，105（7）：94-100.
［6］　ARIKAN YORGUN M，TOKLU Y，MUTLU M，OZEN U.Clinical outcomes of 25-gauge vitrectomy surgery for vitreoretinal diseases：comparison of vitrectomyalone and phaco-vitrectomy［J］.Int J Ophthalmol，2016，9（8）：1163-1169.
［7］　TAO H，WU H Y，HOU B J，HOU S K，CHEN W M.Clinical application of 25G transconjunctival sutureless vitrectomyu system［J］.Chin J Ocul Fund Dis，2004，20（3）：139-141.
陶海，吴海洋，侯宝杰，侯世科，陈伟民.25G经结膜无缝合玻璃体切割系统临床应用初步报告［J］.中华眼底病杂志，2004，20（3）：139-141.
［8］　YU X Q，CAO G P.Analysis of incidence rate，characteristics and related risk factors of high intraocular pressure after pars plana vitrectomy［J］.Int Eye Sci，2015，15（5）：853-855.
余学群，曹国平.玻璃体切割术后高眼压的发生率和特点及相关危险因素的分析［J］.国际眼科杂志，2015，15（5）：853-855.
［9］　ZHOU L，YAO J.Study on secondary ocular hypertension after vitrectomy for proliferative diabetic retinopathy ［J］.Rec Adv Ophthalmol，2015，35（1）：74-77.
周林，姚进.增殖性糖尿病性视网膜病变玻璃体切割术后高眼压的研究［J］.眼科新进展，2015，35（1）：74-77.
［10］　MASSICOTTE E C，SCHUMAN J S.A malignant glaucoma-like syndrome following pars plana vitrectomy［J］.Ophthalmology，1999，106（3）：1375-1379.
［11］　SUGIURA Y，OKAMOTO F，OKAMOKO Y.Contrast sensitivity and foveal microstructure following vitrectomy for epiretinal membrane［J］.Invest Ophthalmol Vis Sci，2014，55（11）：7594-7600.
［12］　CHEN E.25-Gauge transconjunctival sutureless vitrectomy［J］.Curr Opin Ophthalmol，2007，18（5）：188-193.
［13］　SCOTT I U，FLYNN H W JR，DEV S，SHAIKH S，MITTRA T A，AREVALO J F，et al.Endophthalmitis after 25-gauge and 20-gauge pars plana vitrectomy：incidence and outcomes［J］.Retina，2008，28（11）：138-142.

相似文献/References:

[1]范虹 刘五存 蔡鸿英 赵堪兴.改良二极管激光睫状体光凝术治疗中晚期青光眼[J].眼科新进展,2012,32(4):000.
[2]王建萍 赵燕麟 马勇 朱涛 程燕 车选义 赵桂娥 王柯.噻吗洛尔和布林佐胺联合曲伏前列素治疗原发性开角型青光眼与高眼压患者的临床研究[J].眼科新进展,2012,32(5):000.
[3]董敬远 刘瑶 吴晓艳.玻璃体切割联合白内障手术治疗增生性糖尿病视网膜病变[J].眼科新进展,2012,32(5):000.
[4]赵宁 万超 刘宁宁 王建英 陈蕾 才娜.玻璃体切割联合超全视网膜光凝、白内障摘出术治疗新生血管性青光眼[J].眼科新进展,2012,32(6):000.
[5]张楚 邹玉平 邹秀兰 徐哲 王泳.内窥镜引导玻璃体视网膜手术治疗伴有角膜混浊的外伤性视网膜脱离[J].眼科新进展,2012,32(6):000.
[6]马恩普 赵小钊 董良 刘苏冰 曾照年.Healaflow在青光眼小梁切除术中的应用[J].眼科新进展,2012,32(6):000.
[7]沙英 刘黎明 孙勇 王绍飞 蒋晨 阿依努尔?艾买尔 陈星.联合激光虹膜切除术术后超声乳化晶状体摘出术治疗急性闭角型青光眼持续高眼压的疗效观察[J].眼科新进展,2012,32(6):000.
[8]刘刚 马英慧 贾万程.玻璃体切割术联合视网膜光凝或内界膜剥除术治疗黄斑裂孔性视网膜脱离的疗效分析[J].眼科新进展,2012,32(7):000.
[9]陈洁 王桂琴 白宗禧 洛桑 石晶 昌宏发 彭秀军.北京与西藏地区青壮年人群眼压分布特点比较[J].眼科新进展,2012,32(7):000.
[10]范松涛 卢建民.阿司匹林与糖尿病患者玻璃体出血以及玻璃体切割术疗效的相关性研究[J].眼科新进展,2012,32(11):000.
[11]高航 王蒙蒙 崔琨明 张凤妍.兔眼玻璃体切割术后不同填充物晶状体混浊情况的实验研究[J].眼科新进展,2012,32(10):000.

更新日期/Last Update: 2018-07-12