玻璃体切割手术中角膜缘后5．0mm巩膜穿刺口对晶状体及锯齿缘影响的安全性初步评价

Preliminary evaluation of the safety of the lens and the ora serrata during vitrectomy with scleral incisions at 5.0 mm behind the limbus

目的初步评价23G玻璃体切割手术（PPV）中角膜缘后5.0 mm巩膜穿刺口对晶状体及锯齿缘影响的安全性。方法前瞻性非对照病例研究。首次行23G PPV治疗的连续病例140例145只眼纳入研究。其中，男性56例59只眼；女性84例86只眼。平均年龄（56.34±9.98）岁。平均眼轴长度（23.99±2.57）mm。有晶状体眼139只眼；无晶状体眼6只眼。均接受标准经睫状体平坦部三通道23G PPV。灌注套管针穿刺口位于颞下方4：00或8：00时钟位，上方两个穿刺口分别位于2：00和10：00时钟位，穿刺口均位于角膜缘后5.0 mm处。选取同期行头颅轴向位CT检查的105例非眼部疾病患者的头颅CT像，应用CT图像分析软件测量眼球前后径、晶状体厚度、角膜缘至晶状体后顶点平面眼表距离。年龄、眼球前后径、晶状体厚度及角膜缘至晶状体后顶点平面眼表距离相关关系行Pearson相关性分析。结果145只眼中，手术中发生穿刺口附近视网膜裂孔3只眼，占所有患眼的2.1%；晶状体损伤3只眼，占有晶状体眼的2.5%。手术中未发生视网膜出血、暴发性脉络膜上腔出血、医源性视网膜脱离等其他并发症。眼球CT像测量结果显示，平均角膜缘至晶状体后顶点平面眼表距离为（6.72±0.81）mm；平均眼球前后径为（24.39±0.97）mm；平均晶状体厚度为（4.22±0.47）mm。Pearson相关性分析结果显示，年龄与晶状体厚度具有相关性（r=0.328 9，P=0.000 6）。结论23G PPV中角膜缘后5.0 mm巩膜穿刺口对晶状体及锯齿缘具有较高安全性，可以作为拟保留晶状体PPV的优选方法。

ObjectiveTo evaluate the safety to perform 23G vitrectomy with scleral incisions at 5.0 mm behind the limbus.MethodsThis is a prospective uncontrolled case study. The data of 140 consecutive primary 23G vitrectomy patients （145 eyes） were enrolled in this study. There were 56 males （59 eyes） and 84 females （86 eyes）, with the mean age of （56.34±9.98） years and axial length of （23.99±2.57） mm. There were 139 phakic eye and 6 aphakic eyes. All the eyes received 23G pars plana vitrectomy with scleral incisions at 5.0 mm behind the limbus. To measure the normal Chinese adult parameters of anteroposterior axis of the eyeball, lens thickness and scleral distances from the limbus to the plane passing through the lens posterior apex, the head CT scans of 105 patients without eye diseases in our hospital were studied during the same period of time for these vitrectomy surgeries. Pearson correlation analysis was used to analyze the relationship between age, anteroposterior axis of eyeball, lens thickness and scleral distances from the limbus to the plane passing through the lens posterior apex.ResultsSurgical related complications included retinal tears close to the scleral incision sites （3/145 eyes, 2.1%） and lens injury （3/121 eyes, 2.5%）. No other surgical complications occurred, such as retinal hemorrhage, supra-choroidal expulsive hemorrhage and iatrogenic retinal detachment. Based on CT images, the average scleral distance from limbus to the plane passing through the lens posterior apex, anteroposterior axis of eyeball and lens thickness was （6.72±0.81）, （24.39±0.97）, （4.22±0.47） mm, respectively. The results of Pearson correlation analysis showed that age and lens thickness had statistically significant correlation （r=0.328 9, P=0.000 6）.ConclusionPrimary 23G pars plana vitrectomy with incisions at 5.0 mm posterior to the limbus is safe.