Department of Ophthalmology, University of Mississippi Medical Center, Jackson, Mississippi 39216, USA.
Retina. 2011 Jun;31(6):1101-8. doi: 10.1097/IAE.0b013e3181ff0d77.
To evaluate risk factors for sclerotomy leakage in 23-gauge sutureless pars plana vitrectomy in 219 patients.
Nested case-control study involving 48 patients with wound leaks (visible on-table sclerotomy leakage requiring sutures) and 171 control subjects without wound leaks. Patients received either a conventional sclerotomy incision at 45°, which was then changed to 90° midincision, or an extremely oblique sclerotomy incision (OSI) at 10°, which was then changed to 30° midincision. Risk factors studied included age, gender, laterality, surgical duration, sclerotomy incision (OSI vs. conventional sclerotomy incision), preoperative diagnosis (macular vs. nonmacular), history of vitrectomy, and primary surgeon (attending vs. supervised resident).
Multivariate logistic regression analysis found significant (P ≤ 0.05) protective factors for wound leakage including OSI, macular preoperative diagnosis, no previous vitrectomy, and female gender. Surgical duration at least 45 minutes was considered a borderline risk factor.
Using an extremely OSI versus a conventional sclerotomy incision reduces the incidence of wound leakage postoperatively because of its self-sealing effect. Other factors that contribute to wound leakage, such as increased surgical duration and nonmacular diagnosis, may be indirect measurements of extensive trocar rotation, causing wound leakage despite the use of an OSI.
评估 219 例 23 号无缝线经睫状体平坦部玻璃体切除术患者中巩膜切开渗漏的危险因素。
这是一项包含 48 例有伤口渗漏（术中可见巩膜切开处渗漏，需要缝合）患者的病例对照嵌套研究，同时选取 171 例无伤口渗漏患者作为对照。患者接受的巩膜切口为 45°的常规巩膜切口，然后改为 90°的中切口，或者为 10°的超倾斜巩膜切口（OSI），然后改为 30°的中切口。研究的危险因素包括年龄、性别、侧别、手术时间、巩膜切口（OSI 与常规巩膜切口）、术前诊断（黄斑与非黄斑）、玻璃体切除术史和主刀医师（主治医生与指导住院医生）。
多变量逻辑回归分析发现，OSI、黄斑术前诊断、无玻璃体切除术史和女性是预防伤口渗漏的显著保护因素（P ≤ 0.05）。手术时间至少 45 分钟被认为是一个边缘危险因素。
与常规巩膜切口相比，使用超 OSI 可减少术后伤口渗漏的发生率，这是因为它具有自密封作用。其他导致伤口渗漏的因素，如手术时间延长和非黄斑诊断，可能是由于套管旋转广泛，即使使用 OSI 也会导致伤口渗漏的间接测量。
