Singh Ajay, Stewart Jay M
Department of Ophthalmology, University of California, San Francisco, San Francisco, California 94143- 0730, USA.
Retina. 2009 Apr;29(4):451-5. doi: 10.1097/IAE.0b013e31819c6347.
BACKGROUND/PURPOSE: To examine the histologic architecture of 25-gauge transconjunctival sutureless vitrectomy incisions.
Four groups of sutureless incisions were constructed in cadaver eyes using a 25-gauge trocar-cannula system. In Group 1, oblique incisions were constructed by inserting the trocar to the bevel and then turning vertically to enter the vitreous cavity. Oblique incisions in Group 2 were constructed as in Group 1, but the trocar was inserted to the beginning of the 25-gauge cannula. Incisions in Group 3 were constructed as in Group 2, but before removing the cannula from the eye vitrectomy was performed. Incisions in Group 4 were constructed vertically, and then vitrectomy was performed. Histologic analysis of the incisions was performed.
In Group 1, 5 of 9 incisions (55%) demonstrated a two-plane structure. In Group 2, 3 of 9 incisions (33%) demonstrated a two-plane structure. Scleral fibers in the internal aspect of wounds were frayed in all incisions in Group 1 (100%), in 88% of incisions in Group 2, and in all incisions in Group 3 (100%). All incisions in Group 4 were single-planed and two incisions demonstrated disruption on their inner aspect.
Oblique incision architecture was inconsistent within each group. Most incisions showed tissue disruptions in their inner aspect. The internal wound edge disruption reduces the effective distance between the ocular surface and the vitreous cavity. Oblique incisions may not be secure in the immediate postoperative period before wound healing.
背景/目的：研究25G经结膜无缝线玻璃体切割术切口的组织学结构。
使用25G套管针系统在尸体眼上构建四组无缝线切口。第1组，将套管针斜插入至斜面，然后垂直转动进入玻璃体腔以构建斜切口。第2组斜切口构建方法同第1组，但套管针插入至25G套管起始处。第3组切口构建方法同第2组，但在从眼内取出套管前进行玻璃体切割术。第4组垂直构建切口，然后进行玻璃体切割术。对切口进行组织学分析。
第1组，9个切口中有5个（55%）呈现双平面结构。第2组，9个切口中有3个（33%）呈现双平面结构。第1组所有切口（100%）、第2组88%的切口以及第3组所有切口（100%）伤口内侧的巩膜纤维均有磨损。第4组所有切口均为单平面，2个切口内侧出现破损。
每组内斜切口结构不一致。大多数切口内侧显示组织破损。伤口内侧边缘破损减少了眼表与玻璃体腔之间的有效距离。在伤口愈合前的术后早期，斜切口可能不安全。
