Vitreoretinal Service, Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, Iowa, USA.
Retina. 2011 May;31(5):893-901. doi: 10.1097/IAE.0b013e3181f4429b.
To review intraoperative choroidal detachments during 23-gauge vitrectomy and examine possible mechanism(s) involved.
A retrospective consecutive case review of 23-gauge vitrectomies was performed. Main outcomes included choroidal detachment incidence, location, extent, relation to infusion cannula, and postoperative course. Laboratory study of human donor eyes was conducted by placing 23-gauge cannulas at various angles through the pars plana and injecting viscoelastic material after cannula retraction.
Among 338 consecutive 23-gauge vitrectomy cases, 12 (3.55%) intraoperative choroidal detachments occurred. These included 6 (1.77%) serous detachments, 4 (1.18%) limited hemorrhagic detachments, and 1 case each of gas and silicone oil during an exchange. In four of six serous detachments and three of four hemorrhagic detachments, the detachment originated from the infusion cannula site. Intraoperative infusion cannula retraction (5 of 12 cases) and blockage (2 of 12 cases) caused transient hypotony. All cases of serous, hemorrhagic, and gas detachment resolved without intervention. Cannulas were placed at various angles to the sclera in human donor eyes. Choroidal detachments were produced after injecting viscoelastic material through obliquely placed cannulas after 1 mm of retraction.
Infusion cannula retraction is an important mechanism and risk factor for the development of intraoperative choroidal detachment during 23-gauge vitrectomy. Precautions to prevent retraction and intraoperative repositioning may help avoid this complication.
回顾 23 号auge 玻璃体切割术中的脉络膜脱离情况，并探讨可能涉及的机制。
对 23 号auge 玻璃体切割术进行回顾性连续病例研究。主要观察指标包括脉络膜脱离的发生率、位置、范围、与灌注套管的关系以及术后过程。通过将 23 号auge 套管以不同角度穿过扁平部并在套管缩回后注入粘弹性物质，对人供眼进行实验室研究。
在 338 例连续的 23 号auge 玻璃体切割术中，有 12 例（3.55%）发生术中脉络膜脱离。其中包括 6 例（1.77%）浆液性脱离、4 例（1.18%）局限性出血性脱离以及 1 例在交换时发生的气体和硅油。在 6 例浆液性脱离中的 4 例和 4 例出血性脱离中的 3 例，脱离起源于灌注套管部位。术中套管缩回（12 例中的 5 例）和阻塞（12 例中的 2 例）导致短暂低眼压。所有浆液性、出血性和气体性脱离均无需干预而自行缓解。套管以不同的角度与巩膜接触，在人供眼通过斜置套管缩回 1mm 后注入粘弹性物质，可产生脉络膜脱离。
套管缩回是 23 号auge 玻璃体切割术中发生术中脉络膜脱离的重要机制和危险因素。预防缩回和术中重新定位的措施可能有助于避免这种并发症。
