有晶状体眼的全玻璃体切除术

Total vitrectomy in crystalline lens

目的 :探讨有晶状体眼切除全玻璃体的可能性及其效果。方法 :对 4 8例 ( 50只 )有晶状体眼患者 ,做标准经睫状体平部三通道玻璃体切除术 ,同时将基底部和睫状体平部玻璃体一起切除。其中裂孔性视网膜脱离 1 4只眼 (包括巨大裂孔 3只眼 ) ,闭合性眼外伤 4只眼和开放性眼外伤 1 1只眼 (包括化脓性眼内炎 2只眼 ) ,黄斑部疾病 7只眼 ,各种原因玻璃体出血 5只眼 ,静脉周围炎 4只眼 ,急性视网膜坏死综合征 3只眼 ,糖尿病性视网膜病变 2只眼。手术后定期检查视力、眼球前段、眼底和眼压 ,最后复诊时用压陷三面镜检查并在再次手术中探查睫状体平部。结果 :充分全玻璃体切除 38只眼 ,部分全玻璃体切除 1 2只眼。无巩膜穿刺孔玻璃体嵌顿和轻度嵌顿者占 86 % ,未发生前段增生性玻璃体视网膜病变。无咬伤晶状体和睫状体并发症。一次手术成功率是 90 % ,再次视网膜和玻璃体手术总的成功率是 94 % ,患者视力较术前明显提高 (P <0 .0 5)。主要并发症是医源性视网膜裂孔、角膜上皮水肿、巩膜穿刺孔并发症、青光眼、视网膜再脱离和术中术后白内障。结论 :有晶状体眼全玻璃体切除术切实可行 ,能预防或减少与巩膜穿刺孔相关的并发症和前段增生性玻璃体视网膜病变。

Objective:To invest the possibility and effect of total vitrectomy in crystalline lens.Methods:A consecutive 48 patients (50 eyes) with crystalline lens were enrolled for standard three port pars plana vitrectomy. The vitreous on the surface of vitreous base and pars plana were also excised during operation. These cases included 14 eyes of rhegmategeous retinal detachment (3 eyes of giant break),4 eyes of closed globe injury,11 eyes of open globe injury (purulent endophthalmitis in 2 eyes),7 eyes of macular diseases,5 eyes of miscellaneous vitreous hemorrhage,4 eyes of Eales' disease,3 eyes of acute retinal necrosis syndrome and 2 eyes of proliferative diabetic retinopathy. The visual acuity (VA),anterior segment of globe,fundus and introcular pressure were examined periodically after operation. The vitreous base and pars plana were examined with the depressing three mirror lens at the last follow up visit or were viewed during the second operation.Results:Sufficient total vitrectomy was performed in 38 eyes,partial total vitrectomy in 12 eyes. Non or mild vitreous incarceration in the sclerotomy sites accounted for 86% of all the eyes. Anterior proliferative vitreoretinopathy (APVR) did not occurred in the study. The accidental injury of the lens and the ciliary body didn't appear. The successful rate was 90% after the primary surgery and the last successful rate was 94% after the additional operations. The VA was improved significantly after operation (P<0.05). The surgical complications were mainly iatrogenic retinal breaks,corneal epithelium edema,glaucoma,retinal redetachment,cataract during or after operation and those were related to sclerotomy sites.Conclusion:The total vitrectomy is feasible in crystalline lens. It can prevent or decrease the vitrectomic complications such as APVR and those related to sclerotomy sites.