自闭式巩膜切口用于玻璃体切割术的研究

为探索自闭式巩膜切口用于经睫状体平．坦部玻璃体切割术的有效性和安全性，2002年12月-2003年7月，我们对39例78个切口经睫状体平坦部入路的玻璃体切割手术，采用巩膜自闭式隧道切口，取得较好效果，现报告如下。     

人工晶状体眼后发性白内障的手术

目的探讨巩膜隧道切口插管灌注经睫状体平坦部后囊切开术治疗人工晶状体眼后发性白内障的效果。方法32例(34眼)人工晶状体植入术后后发性白内障行巩膜隧道切口插管灌注经睫状体平坦部后囊切开术。平均随访18个月。结果全部术眼晶状体后囊中央均形成直径3.5~4mm的圆形透明区,后发性白内障切开术的成功率为100%;术中前房稳定,人工晶状体无损伤。术后能配合视力检查的患者最佳矫正视力均恢复至后发性白内障发生前的最佳水平;随访期间无切口渗漏、角膜水肿、瞳孔区玻璃体疝、人工晶状体损伤、视网膜脱离、高眼压或晶状体后囊膜切开区再次浑浊等并发症。结论巩膜隧道切口插管灌注经睫状体平坦部后囊切除术治疗人工晶状体植入术后的后发性白内障安全、有效。     

视网膜巨大裂孔缝合术

作者报告一种新的经玻璃体进行的视网膜缝合术。器械:用8-0的尼龙线,两端带针,长28mm,粗0.4mm。针的前端屈曲,其后部约有1/3稍呈扁平。手术方法:在闭合式玻璃体切割术后,第一针从睫状体平坦部的巩膜切口进入,穿过对侧视网膜破口的末端,再从巩膜的适当位置穿出。第二针同样操作,缝毕在巩膜外结扎。第二针也可不穿过视网膜,而从对侧睫状体平坦     

25G经结膜无缝线玻璃体切除手术系统的初步临床应用效果

经睫状体平坦部玻璃体切除手术技术自70年代用于眼科临床，明显提高了眼后段疾病的治愈率，最大限度地挽救了患者的视力。由于玻璃体切除术对眼内结构的干扰较大，手术创口出血，对玻璃体视网膜的牵引作用等，可发生相应的手术并发症。因而，选择合适的手术器械和较小的巩膜切口不但可减少手术创伤，还可使巩膜创口自闭，从而提     

单通道玻璃体切除在外伤性白内障术中应用

目的探讨晶状体前、后囊均破裂的外伤性白内障,经睫状体平坦部的单通道的前部玻璃体和晶状体切除术的效果。方法角巩膜穿透伤伴外伤性白内障26例(26眼)。术前视力:光感14眼,手动5眼,数指7眼。均在一期外伤清创缝合后进行二期玻璃体切除联合手术。玻切通道位于颞上方角膜缘后3.5～4mm处睫状体平坦部,另一切口为12点位角膜缘后2mm处的巩膜角膜隧道切口,切口宽2.8mm于透明角膜内2mm处进入前房。经巩膜切口插入玻切头,经隧道切口插入注水针头,进行前段玻璃体及晶体切除术,经角巩隧道植入折叠式人工晶状体。结果术后3个月视力0.2者5眼,0.3者4眼,0.5者8眼,0.8者6眼,1.0者3眼。术后5眼出现一过性高眼压,经对症处理后缓解,3例病人因虹膜损伤出现虹膜夹持。结论此手术方法简捷、手术效果佳、术中损伤小、视力恢复快,而且并发症少。     

巩膜切开术治疗严重眼外伤脉络膜上腔出血

目的评价巩膜切开术治疗严重外伤眼脉络膜上腔出血的疗效。方法对18例（18眼）因严重眼外伤致脉络膜上腔出血行巩膜切开联合玻璃体切除术治疗。在睫状体平坦部做巩膜切口,必要时于赤道前做放射状巩膜切口引流脉络膜上腔积血,然后行玻璃体切除术,术终眼内填充气体或硅油。结果经睫状体平坦部切口脉络膜上腔积血引流充分者11眼;7眼需要另外做放射状巩膜切口引流,其中3眼完全复位,4眼部分复位。2眼因合并脉络膜破口,术后硅油进入脉络膜上腔。2眼因眼球萎缩而摘除眼球。结论巩膜切开术可以有效引流眼外伤所致脉络膜上腔出血。有脉络膜破口的出血性脉络膜脱离是治疗的难点,预后差。     

眼内巨大异物摘出联合晶状体玻璃体视网膜手术

目的　探讨经前房通过巩膜隧道切口摘出眼内巨大异物联合晶状体玻璃体视网膜手术的临床疗效及术式选择。方法　分析12例(12眼)眼内巨大异物摘出病例,联合晶状体切除、玻璃体切除及视网膜手术。采用常规睫状体平坦部三切口闭合式玻璃体切除联合晶状体切除、巩膜垫压、环扎、气液交换、硅油填充及眼内光凝等,异物通过巩膜隧道切口用异物镊经前房夹出。结果　12眼异物均一次摘出成功,摘出成功率10 0 %。手术后并发症主要有出血、角膜水肿等。术后视力下降1眼,不变1眼,好转10眼。结论　经前房通过巩膜隧道切口摘出巨大眼内异物联合晶状体玻璃体视网膜手术安全、有效,术后角膜散光小,有利于视功能的恢复,可减少术后并发症的发生。     

玻璃体切除术中3针式巩膜创口缝合密闭性的观察

经巩膜睫状体平坦部的密闭式玻璃体切除术已经广泛地应用于眼科临床,对治疗某些眼科疾病有不可替代的作用[1]。虽然目前23G玻璃体切除技术已经成功地应用于临床[2],但是该术式的使用范围依然有限,因此经典的20G玻璃体切除技术仍然不可替代。在经典的20G玻璃体切除术中,巩膜创口的缝合常采用2针式"8"字缝合方式,巩膜创口密闭性相对较差,在注气或硅油填压患者,常导致填充物外溢,造成诸多隐     

玻璃体切除联合不同睫状体复位术式的疗效观察

目的:观察玻璃体切除联合两种睫状体复位缝合手术方法治疗复杂性睫状体脱离的临床疗效.方法:回顾42例42眼经B超及超声生物显微镜(ultrasound biomicroscopy,UBM)检查存在睫状体脱离(离断口范围≥600),同时伴有晶状体、玻璃体、视网膜病变和眼外伤患者的临床资料.按照睫状体复位手术方式分为玻璃体切除联合睫状体巩膜间断缝合组20眼(A组)、玻璃体切除联合睫状体巩膜连续褥式缝合组22眼(B组).A组首先间断缝合巩膜睫状体,然后进行玻璃体切除术.B组首先进行晶状体玻璃体切除术,然后由巩膜表面进针进入玻璃体腔内连续褥式缝合睫状体组织.观察术后最佳矫正视力、术后眼压情况、睫状体复位情况及两组患者睫状体复位手术时间,并进行统计分析.结果:两组患者术后视力及眼压情况差异无统计学意义(P＞0.05),两组患者术后视力及眼压较术前差异有统计学意义(P＜0.05),两组患者睫状体复位成功率(A组90％,B组86.36％)差异无统计学意义(P＞0.05),两组患者睫状体复位手术时间差异有统计学意义(P＜0.05).结论:玻璃体切除联合两种术式复位缝合睫状体治疗复杂性睫状体脱离均安全有效,对于保留晶状体者适宜应用睫状体巩膜间断缝合方法,睫状体巩膜连续褥式缝合法适用于无晶状体眼、人工晶状体眼患者,对于广泛性睫状体脱离者更为简便.     

视网膜活检的手术操作和结果

角膜、视网膜的许多变性和炎性疾患的诊断和处理,都因缺乏活检而受限。采用眼球外取视网膜组织活检的手术方法很有用,近来又在玻璃体切割术中进一步改进了取视网膜脉络膜进行活检的方法。但此法罕为他人采用。其方法是:于睫状体平坦部做三处巩膜切开,其中一个切口放置灌注管。如病情需要,则做充分的睫状体平坦部玻璃体切割。在将取活检的     

Self-sealing sclerotomies for sutureless pars plana vitrectomy

OBJECTIVE: To determine the efficacy of self-sealing pars plana sclerotomies for vitrectomy and to identify complications associated with this new technique. METHOD: There were 150 self-sealing sclerotomies performed in 50 patients undergoing pars plana vitrectomy between October 1996 and March 1998. RESULTS: Of the 150 sclerotomies, 115 (76.6%) did not require suturing while 35 (23.3%) were closed with one radial 7.0 vicryl suture. The scleral tunnel incisions ensured minimal loss of intraocular fluids during instrument exchange and scleral plugs were not required to avoid ocular hypotony during scleral indentation. Distortion of scleral flap incisions requiring a suture were commonly seen in procedures using multiple instrumentations and extensive explants. CONCLUSIONS: Sutureless sclerotomies are simple to perform, save operative time, and reduce the risk of peroperative hypotony following removal of instruments or the infusion cannula. The technique reduces postoperative inflammation, suture-related problems including astigmatism, and allows more rapid rehabilitation.     

20G与23G玻璃体切割术临床应用比较

目的 比较20G自闭式巩膜隧道切口玻璃体切割手术与23G玻璃体切割手术治疗黄斑前膜的临床疗效.方法 随机选取21(21只眼)例黄斑前膜患者,10例(10只眼)行20G自闭式巩膜隧道切口玻璃体切割手术,11(11只眼)例行23G玻璃体切割手术.结果 20G自闭式巩膜隧道切口玻璃体切割手术组切口自行闭合率为93.3%,23G玻璃体切割手术组切口自行闭合率为100%,但两组差异无统计学意义(P>0.05).结论 选取合适病例使用20G自闭式巩膜隧道切口玻璃体切割手术,也可以实现切口无需缝合,且操作简捷、术后反应轻、恢复快,无需增加额外操作设备,具备与23G相似的优点,在无条件实施23G玻璃体切割手术时,是理想的替代术式.

Abstract：

Objective To compare the efficacy of 20 Gauge three-channel self-sealing sclerotomy pars plana vitrectomy and sutureless 23Gauge pars plana vitrectomy in macula hole surgery. Methods Twenty-one patients were divided into group A and B. Three-channel self-sealing sclerotomy and 23 Gauge pars plana vitrectomy were performed on patients in group A and B respectively. Results The closure rate of sclerotomies was 93.3% in group A; compared to 100% in group B. No significant difference was found between two groups(P >0.05). Conclusions Sutureless surgery can be performed by three-channel self-sealing sclerotomy 20G vitrectomy for appropriate cases with less complication, better recovery and no extra instrument. It might be an alternative substitute for 23Gauge pars plana vitrectomy.     

20G与23G玻璃体切割术临床应用比较

目的 比较20G自闭式巩膜隧道切口玻璃体切割手术与23G玻璃体切割手术治疗黄斑前膜的临床疗效.方法 随机选取21(21只眼)例黄斑前膜患者,10例(10只眼)行20G自闭式巩膜隧道切口玻璃体切割手术,11(11只眼)例行23G玻璃体切割手术.结果 20G自闭式巩膜隧道切口玻璃体切割手术组切口自行闭合率为93.3%,23G玻璃体切割手术组切口自行闭合率为100%,但两组差异无统计学意义(P>0.05).结论 选取合适病例使用20G自闭式巩膜隧道切口玻璃体切割手术,也可以实现切口无需缝合,且操作简捷、术后反应轻、恢复快,无需增加额外操作设备,具备与23G相似的优点,在无条件实施23G玻璃体切割手术时,是理想的替代术式.     

Suprachoroidal hemorrhage during pars plana vitrectomy

Suprachoroidal hemorrhage is an uncommon but serious complication of pars plana vitrectomy that can be associated with a guarded visual prognosis. Risk factors for development of suprachoroidal hemorrhage during pars plana vitrectomy include high myopia, history of previous retinal detachment surgery, rhegmatogenous retinal detachment, use of cryotherapy, scleral buckling at the time of pars plana vitrectomy, external drainage of the subretinal fluid, intraoperative systemic hypertension, and bucking during general anesthesia. In eyes with suprachoroidal hemorrhage during pars plana vitrectomy, the final visual and anatomic outcomes may be compromised by persistent retinal detachment, secondary glaucoma, and ocular hypotony. In most cases, intraoperative drainage of suprachoroidal hemorrhage is not associated with a better outcome. The prognosis is more favorable if the suprachoroidal hemorrhage is localized and does not extend in to the posterior pole.     

Cataract Surgery and Transpupillary Silicone Oil Removal Through a Single Scleral Tunnel Incision Under Topical Anesthesia; Sutureless Surgery

The author evaluated the results of combined cataract extraction and transpupillary silicone oil removal through a single scleral tunnel incision, in eyes that had undergone pars plana vitrectomy with silicone oil tamponade. Twenty-four of the 46 eyes were operated on under topical anesthesia with Blumenthal mode mini-nucleus manual extracapsular cataract extraction technique (mini-nuc ECCE), and silicone oil was removed passively through planned posterior capsulorhexis via the scleral tunnel, followed by endocapsular intraocular lens (IOL) implantation. The operation was completed without any suturing. The remaining 22 eyes were similarly operated on with the same cataract extraction technique, but in these cases silicone oil was classically aspirated actively through pars plana sclerotomies. Results were evaluated by visual acuity measurement, duration of operation, and complications. The transpupillary silicone oil removal group had significantly less vitreous hemorrhage (0- 31.8%) and posterior capsule opacification (0-36.4%). Also, the mean duration of the operation was significantly shorter in this group. There was no significant difference between the two groups with regard to postoperative recurrence of retinal detachment (12.5-18.1%) and visual acuity outcome. The combination of mini-nuc ECCE with transpupillary silicone oil removal compares favorably with the combination of silicone oil aspiration through pars plana sclerotomies. This combined technique allows the surgeon to perform the operation under topical anesthesia and no sutures are required. The intervention period is shorter and no posterior capsule opacification or vitreous hemorrhage develops.     

Ultrasound biomicroscopy of conventional and sutureless pars plana sclerotomies: a comparative and longitudinal study

PURPOSE: To report the rate of ultrasonically visible vitreous incarceration and longitudinal changes of incarcerated vitreous in pars plana sclerotomies after conventional suturing or sutureless technique using ultrasound biomicroscopy. METHODS: Twenty-five consecutive eyes (25 patients) undergoing primary three-port pars plana vitrectomy participated. The first 16 pars plana vitrectomies were performed with standard conventional sutured sclerotomies, and the following nine pars plana vitrectomies were performed with modified sutureless sclerotomies. Patient demographics, diagnoses, procedures, and complications were recorded. Each patient had ultrasound biomicroscopy performed 1 week before surgery, and also after surgery at 1 week, 2 weeks, 3 weeks, 4 weeks, 2 months, 3 months, and 6 months. Visible vitreous incarceration was graded as 0 to 3. RESULTS: Vitreous incarceration was seen in 41 of 48 sclerotomies (85.4%) in the conventionally sutured group, and in 23 of 27 sclerotomies (85.2%) in the sutureless group, with no significant difference in severity among sclerotomies within each group and between the two groups. There was a significant difference in the rate of vitreous incarceration between diabetic patients with proliferative retinopathy and others (P =.002). No progressive change of visible vitreous incarceration was noted in any eye during the 6-month postoperative period. No sclerotomy-related complications occurred during the study period. CONCLUSIONS: Ultrasound biomicroscopy showed no difference in the amount of visible vitreous incarceration in conventionally sutured or sutureless sclerotomies. There was no visible longitudinal change in the incarcerated vitreous during the 6 months of follow-up in uncomplicated cases.     

Inzidenz und Prophylaxe der Netzhautablösung nach Pars-plana-Vitrektomie

PURPOSE: The aim of this study was to investigate the incidence of retinal detachment (RD) following pars plana vitrectomy and the efficacy of prophylactic means by cryoapplication central to the superior sclerotomies. PATIENTS AND METHODS: From February 2002 to January 2005 a total of 2,298 eyes received a pars plana vitrectomy in our department. Excluding eyes with previous peripheral coagulation therapy, preexisting retinal detachment, and endophthalmitis 1,640 eyes could be reexamined at least 6 months after surgery (mean: 17+/-12 months). The incidence of RD was compared between two groups: one with intraoperative cryoapplication central to the superior sclerotomies (n=533) and one without any prophylactic treatment (n=1,107). RESULTS: A total of 66 rhegmatogenous RD occurred during the follow-up, 23 with prophylactic cryotherapy and 43 without. This difference does not reach the level of significance. Only a subgroup of eyes operated on for macular pucker and venous occlusions showed a strong trend to prove the efficacy of prophylactic cryotherapy (p=0.07). Comparing the first 934 surgeries performed with the last 706 the incidence of RD decreased from 5.25 to 2.41%. CONCLUSIONS: The incidence of RD could be decreased significantly during the period investigated. Cryoapplication at the superior sclerotomies failed to reach statistical significance in the total group, though the results in eyes in two special subgroups showed a strong trend towards a protective effect of cryoapplication (p=0.07). Other factors may have contributed to the reduction of RD after pars plana vitrectomy.     

Pneumatic retinopexy, scleral buckling, and vitrectomy surgery in the management of pseudophakic retinal detachments

BACKGROUND: To review the indications for and results of pneumatic retinopexy, scleral buckling, combined pars plana vitrectomy and scleral buckling surgery, and primary pars plana vitrectomy in the management of pseudophakic retinal detachment. METHODS: We retrospectively reviewed a series of 100 pseudophakic retinal detachments in 98 patients who were referred to a tertiary care centre for management over a 3-year period. RESULTS: Forty-one cases were treated with retinopexy procedures; 38 underwent scleral buckling surgery; 19 underwent combined pars plana vitrectomy and scleral buckling procedures; and 2 cases underwent vitrectomy only. Pneumatic retinopexy resulted in primary reattachment in 21 out of 41 cases (51%). Scleral buckling surgery resulted in primary reattachment in 32 out of 38 cases (84%). Combined pars plana vitrectomy and scleral buckling surgery was successful in 18 out of 19 cases (95%), and vitrectomy alone was successful in 2 out of 2 cases (100%). Seventy-three cases were successfully repaired after 1 procedure. In the 27 primary failures, subsequent surgery was successful in 26 cases, with a final reattachment rate of 99%. Seventy-four percent of all cases regained 20/50 or better vision. In the 61 cases of macula-off detachments, 35 (57%) regained 20/50 or better vision. INTERPRETATION: Pseudophakic retinal detachments can be successfully managed with pneumatic retinopexy, scleral buckling, and combined vitrectomy and buckling procedures with good anatomic and visual results.     

Modified sutureless sclerotomies in pars plana vitrectomy

PURPOSE: To study the effectiveness and safety of a modified sutureless sclerotomy technique in pars plana vitrectomy. METHODS: We rotated the scleral tunnels of the original sutureless sclerotomy technique through 90 degrees, thus rendering them parallel to the corneoscleral limbus. This modified technique was applied to 25 consecutive eyes (25 patients) that had pars plana vitrectomy during a 2-month period. RESULTS: Twenty (80%) of 25 eyes (25 patients) did not require suturing of the sclerotomy sites associated with pars plana vitrectomy. Eight (11%) of 75 sclerotomy sites required suturing to ensure watertight closure. No clinically significant complications were encountered. CONCLUSION: The modified sutureless sclerotomy technique was found to be safe, more convenient, and easier to perform, especially in eyes with small interpalpebral space.