玻璃体切割术中穿刺口色素脱出并发症分析及处理

Analysis and treatment of complications of pigment prolapse in puncture during vitrectomy

目的玻璃体切割术色素脱出并发症预防、处理及相关因素探寻合理方案。方法回顾性分析2009年1月至2013年8月在北京中医药大学东方医院眼科行玻璃体积血切割术，在其手术做穿刺口时，出现大量色素组织、睫状上皮组织脱出病例19例，分析在术中、术后并发症发生；脱出穿刺口色素及上皮组织采用玻璃体切割头轻轻切除（勿牵拉）；术后详细检查周边视网膜尤其是穿刺口周围视网膜组织是否脱离，是否出现睫状上皮或视网膜裂孔。术中发现视网膜脱离、裂孔或睫状上皮缺失则采用网膜复位联合眼内激光及内填充。结果19例出现色素脱出的相关因素为玻璃体腔反复、大量出血及出血形成机化膜；术中出现视网膜锯齿缘离断4例占21．05％、视网膜脱离3例占15．79％，术后出现视网膜脱离2例占10．5％，并发白内障5例占26．32％。结论玻璃体切割术中，处理好脱出色素组织及穿刺口周围机化膜组织是预防术中、术后视网膜脱离、锯齿缘离断等并发症的关键；术中及时发现并且处理好可能脱离视网膜组织是预防术后视网膜脱离的的关键。

Objective To explore the reasonable proposals and related factors of pigment prolapse in puncture during vitrectomy, to prevent and treat the complications. Methods A retrospective analysis of 19 cases of vitreous hemorrhage cutting implementation was studied from 2009 to 2013 in our hospital. Characteristics of these cases were a large number of pigments and ciliary epithelial tissue hernia appeared in vitreous puncture during operation. The vitrectomy cutting head were used gently to remove （did not pull） the protrusion pigment. Peripheral retinal and around the puncture were checked carefully to avoid any retinal tissue and ciliary epithelium residues after operation finished. Intraocular laser and inner filling were used during the surgery if retinal detachment or lack of ciliary epithelium were found. Results The related factors of pigment out of 19 cases was the vitreous body cavity massive hemorrhage repeatedly and membrane formation. Ora serrata dialysis occurred in 4 cases （21.05%）, retinal detachment in 3 patients （15.79%）, postoperative retinal detachment in 2 cases （10.5%）, complicated cataract in 5 cases （26.32%）. Conclusions During vitrectomy handle the pigment tissue and piercing machine around the cut membrane is the key in the prevention of intraoperative and postoperative retinal detachment, serrated edge away from the circuit and other complications.