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

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。

Clinical observation of postoperative intraocular pressure and complication for 25-gauge transconjunctival suture and sutureless vitrectomy

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.