玻璃体切割手术中角膜缘后5.0 mm与4.0 mm巩膜穿刺口对晶状体及锯齿缘的安全性对比研究

Comparative evaluation of the safety of the lens and the ora serrata during vitrectomy with scleral incisions at 5.0 mm or 4.0 mm posterior to the limbus

目的对比观察23G玻璃体切割手术(PPV)中角膜缘后5.0 mm和4.0 mm巩膜穿刺口对晶状体及锯齿缘的安全性。方法前瞻性病例对照研究。2016年4月至2018年1月在扬州大学附属苏北人民医院眼科首次行PPV的连续玻璃体视网膜疾病患者290例300只眼纳入研究。手术中做5.0、4.0 mm巩膜穿刺口分别为146例150只眼和144例150只眼,并据此分组。两组患者年龄、眼轴长度(AL)比较差异无统计学意义(t=?1.324、0.867,P=0.186、0.387);性别、眼别、玻璃体视网膜疾病构成比比较,差异无统计学意义(χ2=1.366、2.615、10.195,P=0.242、0.106、0.070)。患者均接受标准经睫状体平坦部三通道23G PPV。对比观察两组患眼手术中晶状体损伤、穿刺口附近视网膜裂孔发生率,以及手术中是否发生视网膜出血、暴发性脉络膜上腔出血、医源性视网膜脱离等手术相关并发症。两组患眼手术中切除基底部玻璃体时间比较行两独立样本t检验;晶状体损伤及穿刺口视网膜裂孔的发生率比较行χ2检验。结果300只眼中,手术中发生晶状体损伤18只眼。其中,5.0 mm组4只眼,占2.67%(4/150);4.0 mm组14只眼,占9.33%(14/150)。两组患眼晶状体损伤发生率比较,差异有统计学意义(χ2=5.910,P=0.015)。手术中发生穿刺口附近视网膜裂孔11只眼。其中,5.0 mm组5只眼,占3.33%(5/150);4.0 mm组6只眼,占4.00%(6/150)。两组患眼穿刺口附近视网膜裂孔发生率比较,差异无统计学意义(χ2=0.094,P=0.759)。5.0 mm组、4.0 mm组患眼手术中切除基底部玻璃体平均时间分别为(6.17±2.76)、(10.03±5.56)min;两组患眼切除基底部玻璃体平均时间比较,差异有统计学意义(t=7.599,P<0.01)。手术中所有患眼均未发生视网膜出血、暴发性脉络膜上腔出血、医源性视网膜脱离等手术相关并发症。结论23G PPV中角膜缘后5.0、4.0 mm穿刺口对锯齿缘安全性相近;但5.0 mm穿刺口对晶状体具有较高安全性,且切除基底部玻璃体效率更高。

Objective To investigate the lens and ora serrata safety during 23G vitrectomy with sclera incisions at 5.0 mm or 4.0 mm posterior to the limbus.Methods A prospective case-controlled study was adopted.From April 2016 to January 2018,290 consecutive primary 23G vitrectomy patients(300 eyes)with vitreoretinal disease in Department of Ophthalmology of Subei People’s Hospital Affiliated to Yangzhou University were enrolled in this study.Among them,146 patients(150 eyes)received 23G pars plana vitrectomy(PPV)with scleral incisions at 5.0 mm posterior to the limbus(5.0 mm group),and 144 patients(150 eyes)at 4.0 mm(4.0 mm group).No statistically significant difference was found in age,axial length(t=?1.324,0.867;P=0.186,0.387)and in gender,right/left eyes,proportion of indications(χ2=1.366,2.615,10.195;P=0.242,0.106,0.070)between the two groups.The incidence rate of complications between the two groups were comparatively observed,such as lens injury,retinal tears close to the scleral incision,retinal hemorrhage,supra-choroidal expulsive hemorrhage and iatrogenic retinal detachment.Independent sample t test andχ2 test were performed for comparison between the two groups.Results Lens injury was observed in 4 eyes(2.67%)and 14 eyes(9.33%)respectively in the 5.0 mm and 4.0 mm group during surgery(χ2=5.910,P=0.015).Retinal tears close to the scleral incision sites were observed in 5 eyes(3.33%)and 6 eyes(4.00%)respectively in the 5.0 mm and 4.0 mm group during surgery(χ2=0.094,P=0.759).The mean time of removing the vitreous base was 6.17±2.76 min and 10.03±5.56 min respectively in the 5.0 mm and 4.0 mm group(t=7.599,P<0.01).No other surgical complications occurred in any group,such as retinal hemorrhage,supra-choroidal expulsive hemorrhage and iatrogenic retinal detachment,etc.Conclusion In primary 23G PPV,the safety of ora serrata with incisions at 5.0 mm posterior to limbus is similar to that at 4.0 mm,but the safety of lens and the efficiency of vitreous resection is higher with incisions at 5.0 mm.