玻璃体注气术前或术后进行前房穿刺的对比研究

Comparison of anterior chamber paracentesis before and after intravitreal gas injection

目的 比较玻璃体内注气术前或注气术后进行前房穿刺,其效果及并发症的发生情况.方法 收集32例（40眼）黄斑出血病例,用玻璃体内注气术治疗,术中采用分层随机化分为两组,A组是注气术前先行前房穿刺,B组是注气术后再行前房穿刺.观察术后视力、眼压以及术中、术后并发症的情况.结果 术后92.5％的患眼视力不同程度提高,但提高程度由黄斑出血性质及时间决定.B组术中眼压与A组及B组术毕的眼压对比,其差异有统计学意义（P＜0.05）,而A组和B组术毕的眼压差异无统计学意义（P＞0.05）,B组黑矇发生率、气体外溢发生率、并发性白内障发生率均高于A组,差异有统计学意义（P＜0.05）.所有病例手术顺利,术后眼压控制理想,均未发生其它并发症.结论 玻璃体腔注气术前先行前房穿刺,软化眼球,避免术中眼压波动过大导致严重并发症,不失为提高手术成功率的一种有效手段.

Objective To compare the clinical efficacy and complications of anterior chamber paracentesis before and after intravitreal gas injection.Methods Forty eyes of 32 cases with macular hemorrhage underwent intravitreal gas injection were enrolled.The patients were randomly divided into 2 groups.Patients in group A recieved the anterior chamber puncture before the intravitreal gas injection and patients in group B recieved the anterior chamber puncture after the intravitreal gas injection.The postoperative visual acuity,intraocular pressure （IOP）,intraoperative and postoperative complications were observed.Results The postoperative visual acuity was improved to different degree in 92.5% patients,but the degree of improvement depended on the nature and timing of macular hemorrhage.The IOP in the group B during surgery was different compared to the IOP in the group A or group B after operation and the difference was statistically significant （P 〈 0.05）.But there was no statistically significant difference in IOP between group A and group B after operation （P 〉 0.05）.The incidence of amaurosis,gas overflow,complicated cataract in group B were higher than that in group A,and the difference was statistically significant （P 〈 0.05）.The surgery was performed successfully in all cases and the postoperative IOP was controlled well without any other complications.Conclusion Anterior chamber puncture before intravitreal gas injection can soften the eyeball,avoid intraoperative IOP fluctuation which may cause serious complications,and is an effective means to improve the success rate of operation.