无缝线无灌注25-G玻璃体手术系统治疗婴幼儿白内障的应用研究现状

Dry transconjunctival sutureless 25-gauge vitrectomy in the treatment of pediatric cataract

后发性白内障是婴幼儿白内障术后最常见的并发症，为预防后发性白内障的形成，普遍采用的手术方式是白内障摘除、晶状体后囊膜切开联合前段玻璃体切除和人工晶状体植入。前段玻璃体切除仪是同步灌注、吸出与切除，切除最高频率为600次／rain，切除头为18G，术中、术后并发症多，操作难度大。扁平部20G玻璃体切除需做2个巩膜穿刺口，拔管后需缝合，灌注液直接进入玻璃体腔，使玻璃体水化膨胀向前移动进入前房，对眼内组织扰动较大，而且20G切除头相对婴幼儿眼球较大。25G玻璃体切除最高频率为1500次／min，可将前段玻璃体整齐切除，减少了玻璃体牵拉和震动；只需做一个巩膜穿刺口，减少了术中出血，缩短了手术时间，同时也避免了术后由缝线污染引起的不适。本文就无缝线无灌注25G手术治疗婴幼儿白内障的应用研究现状作一综述。

Posterior capsule opacification is the most frequent complication of pediatric cataract surgery. To prevent posterior capsule opacification, primary phacoemulsification, posterior capsulotomy and anterior vitrectomy with intraocular lens implantation is the preferred method in the treatment of pediatric cataract. Anterior vitrectomy cutter, with 18-gauge, maximum frequency at 600/rain and has simultaneous cutting, irrigation and aspiration functions, is associated with more complications and poor outcomes. In 20- gauge surgery, pars plana vitrectomy is performed with two-port sclerotomy. The irrigation increases movement of vitreous and 20-gauge sclerotomy needs suture for closing. In 25-gauge surgery, the vitreous cutter can be introduced into the vitreous cavity directly though conjunctiva and sclera. The stab incision is roughly haft the size of 20-gauge cutter, therefore, the slcerotomy incision can be left unsutured. Surgery with dry transconjunctival sutureless 25-gauge vitrectomy may decrease the requirement for secondary membrane surgery and the risk for retinal detachment. The application of dry transconjunctival sutureless 25- gauge vitrectomy in the treatment of pediatric cataract is reviewed.