Amato Josh E, Akduman Levent
Saint Louis University Eye Institute, Missouri 63104, USA.
Ophthalmic Surg Lasers Imaging. 2007 Mar-Apr;38(2):100-2. doi: 10.3928/15428877-20070301-02.
The complications of 25-gauge transconjunctival sutureless vitrectomy based on the surgical indications were reviewed.
Thirty-eight patients underwent 25-gauge transconjunctival sutureless vitrectomy. Indications for vitrectomy, preoperative and postoperative best-corrected visual acuity, preoperative and postoperative intraocular pressure, and any intraoperative or postoperative complications were recorded.
Complications included the need to suture a leaking sclerotomy intraoperatively in four eyes (9%), all of which involved oil removal; postoperative hypotony with choroidals in two eyes (5%); mild progression of nuclear sclerotic cataract in one eye (2% of all eyes, 4% of phakic eyes); the need to switch to 20-gauge pars plana vitrectomy in one eye (2%); corneal abrasion in one eye (2%); and retinal detachment in one eye (2%). Sclerotomy leakage and hyopotony with choroidals were only encountered in cases involving previously vitrectomized eyes, whereas none of the eyes without previous vitrectomy had leakage-related complications.
Previously vitrectomized eyes have a higher incidence of complications related to postoperative leakage, possibly due to the lack of plugging effect of peripheral vitreous on the unsutured sclerotomy. One should consider suturing any leaking sclerotomy at the conclusion of surgery involving previously vitrectomized eyes.
基于手术适应症,对25G经结膜无缝线玻璃体切除术的并发症进行回顾。
38例患者接受了25G经结膜无缝线玻璃体切除术。记录玻璃体切除术的适应症、术前及术后最佳矫正视力、术前及术后眼压,以及任何术中或术后并发症。
并发症包括术中4只眼(9%)需要缝合渗漏的巩膜切口,所有这些均涉及硅油取出;2只眼(5%)出现脉络膜脱离性低眼压;1只眼(占所有眼的2%,有晶状体眼的4%)核性硬化性白内障轻度进展;1只眼(2%)需要转换为20G经平坦部玻璃体切除术;1只眼(2%)发生角膜擦伤;1只眼(2%)发生视网膜脱离。巩膜切口渗漏和脉络膜脱离性低眼压仅在既往接受过玻璃体切除术的病例中出现,而既往未接受过玻璃体切除术的眼中均无与渗漏相关的并发症。
既往接受过玻璃体切除术的眼术后渗漏相关并发症的发生率较高,可能是由于周边玻璃体对未缝合的巩膜切口缺乏封堵作用。对于既往接受过玻璃体切除术的眼,在手术结束时应考虑缝合任何渗漏的巩膜切口。