经结膜免缝合20G玻璃体切割术的临床观察

Clinical observation of transconjunctival sutureless 20G pars plana vitrectomy

目的探讨经结膜免缝合20G玻璃体切割术的安全性和有效性。方法临床病例回顾性研究。选取2011年10月至2012年7月在河南省眼科研究所住院行经结膜免缝合20G玻璃体切割术治疗的患者131例（131只眼），平均年龄为（53±12）岁，男72例，女59例。观察术前和术后患者的最佳矫正视力、眼压和散光度的变化以评价手术的安全性和有效性。结果131只眼共393个巩膜穿刺口，309个切口无需缝合自行闭合良好，自行闭合率为78．6％。术前、术后1周和术后3个月最佳矫正视力（LogMAR）分别为＋2．05±0．81（0-3—3．0）、＋1．60±0．80（0．04—3．0）和＋1．58_±0．78（0．1-3．0）。术后1周和3个月均较术前明显改善，差异均有统计学意义（t1=4．69，P1〈0．01；t2=5．07，B〈0．01）。术前、术后1天、术后1周和术后3个月平均眼压分别为（11．8±3．4）mmHg、（11．9±5．4）mmHg、（12．5±4．5）mmHg和（12．2±3．8）mmHg，术前与术后眼压比较均无统计学意义（h=-0．186，只〉0．05；t2=-1．716，最〉0．05；t3=-1．749，P3〉0．05）。术前、术后1周和术后3个月平均散光度分别为0．50D±0．3D、0．7613±0．38D和0．68D±0．35D，术前与术后比较均无统计学意义（t1=-1．51，只〉0．05；t2=-1．21，B〉0．05）。术后第1天眼压低（〈6mmHg）的患者12例（9．2％），在1周内自行恢复至正常范围。术后未发生眼内炎、视网膜脱离等并发症。结论经结膜免缝合20G玻璃体切割术的巩膜切口术后自行闭合良好，可减少医源性散光，是一种安全有效地手术方法。

Objective To assess the efficacy and safety of a transconjunctival sutureless tech- nique for pars plana vitrectomy using conventional 20-gauge instruments. Methods Clinical data were reviewed retrospectively for a consecutive series of patients who underwent transconjunctival su-tureless vitrectomy （TSV; 131 eyes of 131 patients）. The mean age was 53±12 years. Results In to-tal, 309 of 393 sclerotomies （78.6%） self-sealed without the need for sutures. The mean preoperative visual acuity （in logarithm of the minimum angle of resolution units） was ＋2.05±0.81, the mean post- operative visual acuity had improved to ＋1.60.4,0.80 （P 〈0.01） one week and ＋1.58±0.78 （P 〈0.01） 3 months after surgery. These differences were statistically significant. Mean preoperative intraocular pressure was 11.8±3.4mmHg. Mean postoperative intraocular pressure was ll.9±5.4mmHg （P 〉0.05） at day 1, 12.5±4.5mmHg （P 〉0.05） at day 7, and 12.2±3.8mmHg （P 〉0.05） 3 months after surgery. Mean astigmatism preoperative and postoperative days 7 and 3 months was ＋0.50diopter （D）, ＋0.76 D （P 〉0.05）, and 0.68D （P 〉0.05）, respectively. These differences were not statistically significant. Hypotony was present in 12 patients （9.2%） on the first postoperative day, but their intraocular pres-sure normalized spontaneously within 1 week. None of the patients developed postoperative endophthal-mitis or retinal detachment. Conclusions The 20-gauge TSV technique is a safe and effective tech-nique for the surgical treatment of a variety of vitreoretinal pathologies. It is as effective as the con- ventional technique, offers earlier postoperative recovery, and reduces surgically induced astigmatism.