玻璃体切除联合超声乳化术巩膜穿刺口UBM临床分析

Ultrasound biomicroscopy of sclerotomy sites after pars plana vitrectomy combined with phacoemulsification

目的 通过UBM对比观察单纯玻璃体切除和玻切联合超声乳化术后巩膜穿刺口的愈合情况,分析联合手术是否可以减少巩膜穿刺口玻璃体增殖条索的形成.方法 UBM 检查巩膜穿刺口的愈合情况共分为4级,0级,无玻璃体嵌顿;1级,穿刺口内可见玻璃体嵌顿;2级,玻璃体嵌顿并形成同穿刺口相连的增殖条索;3级,出现牵拉性视网膜脱离或存在视网膜组织嵌顿.对30例单纯玻璃体切除手术和20例联合超声乳化手术后行UBM检查巩膜穿刺口的愈合情况,对检查结果进行x2检验,分析两组之间巩膜切口愈合情况的差异.结果 在单纯玻切手术组：0级、1级切口愈合17例,占56.7%;2级、3级切口愈合13例,占43.3%.联合超声乳化组：0级、1级切口愈合17例,占85.0%;2级愈合3例,占15.0%,无3级愈合病例.单纯玻切手术组术后巩膜切口发生玻璃体嵌顿并产生增殖牵拉的病例数明显高于联合手术组,差异有统计学意义（P〈0.05）.结论 玻璃体切除联合超声乳化手术可以减轻术后巩膜穿刺口的玻璃体嵌顿.

Objective To observe the difference of sclerotomy sites healing between vitrectomy and vitrectomy combined with phacoemulsification and analyze whether the vitrectomy combined with phacoemulsification can reduce the vitreous incarceration.Methods The degree of vitreous incarceration was graded as follows：Grade 0,no vitreous seen by UBM at sclerotomy site;Grade 1,delicate membrane-like strands barely visible by UBM at sclerotomy site;Grade 2,overtly visible vitreous incarceration at sclerotomy site.Vitreous incarceration was also studied in respect to the preoperative diagnosis.Grade 3,high reflective echoes originating at the selerotomy and extending along the pars plana,peripheral retina and anterior hyaloid were Seen.Postoperative UBM examination of Sclerotomy Sites healing were performed on 30 cases of simple vitrectomy patients and 20 cases of that combined with phacoemulsification,statistical analysis of test results were given between the two groups.Results In vitrectomy group,wound healing was 17 cases in grade 0,grade 1;13cases in grade 2,grade 3;17 cases in joint operation group with grade 0,grade1.Grade 2 healing was in 3cases and no grade 3 healing.Vitreous incarceration on scleral incision site with proliferation and traction in simple vitrectomy group were significantly higher than that of combined surgery group,there were statistically significant differences（P〈0.05） between two groups.Conclusions Vitrectomy combined with phacoemulsification surgery can reduce the extent of postoperative vitreous incarceration.