扁平部玻璃体切割手术巩膜切口玻璃体禁闭引起周边部玻璃体牵拉

Peripheral vitreous traction secondary to vitrous incarceration at pars plana vitrectomy sites

为了解玻璃体切割手术后，在扁平部巩膜切口处由玻璃体禁闭引起的周边部玻璃体牵拉，同时解释由该周边部玻璃体牵拉引起视网膜裂孔及脱离的发生原因。选择１５例非复杂性玻切手术病人，研究在扁平部巩膜切口处周边部玻璃体与视网膜的关系，观察方法包括，在巩膜压迫器及眼内照明辅助下通过手术显微镜观察或眼内窥镜直接观察。结果：通过眼内窥镜观察发现，所有病人均存在由于玻璃体禁闭而产生的玻璃体对周边部视网膜牵拉，单纯用手术显微镜观察的方法是不可靠的。结论：玻璃体在玻切手术切口处禁闭是经常发生的，在普通的扁平部玻切手术术后，周边部视网膜存在的玻璃体牵拉可引起潜在的视网膜裂孔和脱离，应该尽快发明一种手术技术来解决这一问题。

Purpost:To document and understand vitreous traction on perpheral retina secondary to vitreous incarceration at pars plana vitrectomy sclerotomy sitesand to explain post vitrectomy retinal tears and detachment from such traction.Methods:Peripheral vitreoretinal relationship near pars plana sclerotomy sites was studied at the completion of 15 selected uncomplicated vitrectomies.The observations were made either through direct microscope visualization with the help of scleral indentation and endoillumination,or through the use of an endoscope.When vitreous traction was deemed significant,additional vitrectomy was performed near the sclerotomy sites under endoscopic guidance.Results:Vitreous incarceration with resultant vitreous traction on the peripheral retina was observed in all cases through the endoscope.Direct visualization was not a reliable method of observation.Vitreous traction may be visibly reduced with further vitreous dissection near sclerotomy sites with endoscopic guidance but with difficulty.Conclusion:Vitreous incarceration into sclerotomy sites occur frequently if not invariably.The resultant vitreous traction exerted on the peripheral retina may be the cause of latent retinal tears and retinal detachments after uneventful pars plana vvitrectomy.Better surgical techniques should be developed to deal with this problem.