玻璃体手术中探查巩膜穿刺孔内口的临床意义

Clinical significance of intraoperative observation of inner sclerotomy sites

目的探讨玻璃体手术中检查巩膜穿刺孔内口的必要性和重要性。方法阅读国内有代表性的两种眼科期刊近4年发表的有关玻璃体手术的文章，统计分析探查巩膜穿刺孔内口的描述；回顾分析转入我科治疗的连续49例玻璃体手术后视网膜脱离患者巩膜穿刺孔内口的探查结果。结果2000年1月～2004年6月．两家杂志共发表有关玻璃体手术文章87篇，除笔者的3篇文章外，无一篇论及到检查巩膜穿刺孔内口的情况。在49例玻璃体手术后视网膜脱离患者中，发现巩膜穿刺孔并发症引起的手术失败为主要原因者28例（57．2％），为次要原因者10例（20．4％）。结论玻璃体手术中，巩膜穿刺孔玻璃体嵌顿引起的并发症十分常见。应重视手术中巩膜穿刺孔内口的探查，预防和处理巩膜穿刺孔玻璃体嵌顿引起的并发症。

Objective Sclerotomy-related complications are common risk factors for unsuccessful vitreous surgeries. The relation between vitreous incarceration of inner sclerotomy sites and failure of vitreous surgeries is indefinitely addressed. This study was to clarify the obligation and the importance of exploring inner aspects of sclerotomies （IAS） during vitreous surgery. Methods The original articles of clinical studies relevant vitreous surgery, which published on some journals in China in the last 4 years,were reviewed and the descriptions about exploring IAS was noted. A retrospective series study on examining of IAS was curried out in 49 patients with retinal detachment following vitrectomy. Results Total 87 articles related to vitreous surgery were published from January 2000 to June 2004. Except 3 pieces of the penman, no one paid any attention to IAS. Our retrospective study showed that vitreous incarceration in IAS was the first cause of surgery failure in 57.2% （28 cases） and became the secondary cause in 20.4% （ 10 cases） with a total affecting rate 77.6% of all. Conclusion The vitreous incarceration in sclerotomy sites is a very common clinical complication during vitreous surgeries, but the sclerotomy-related complications are frequently overlooked. More attentions should be paid to intraoperative observation and treatment of IAS.