Ataka Shinsuke, Yamaguchi Makoto, Kohno Takeya, Shiraki Kunihiko
Department of Ophthalmology and Visual Sciences, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan.
Int Ophthalmol. 2012 Apr;32(2):177-81. doi: 10.1007/s10792-012-9530-8. Epub 2012 Feb 14.
We report here a case in which ciliary detachment related to the preparation of a scleral wound was suspected as the cause of persistent hypotony following 23-gauge vitrectomy for proliferative diabetic retinopathy. Ultrasound biomicroscopy (UBM) was performed following injection of a viscoelastic substance into the anterior chamber to carefully investigate the treatment and cause of persistent hypotony. Deepening the anterior chamber by means of the viscoelastic substance enabled UBM identification of ciliary detachment that had not been detected in the shallow anterior chamber. The extent of ciliary detachment was approximately 8 degrees; however, the detachment could not be seen on gonioscopy. UBM showed no continuity between the anterior chamber and choroid, with findings suggesting that the two structures had been split by posterior traction. The ciliary detachment site was the same site at which a three-port system had been prepared. One advantage of a 23-gauge system is that few complications are associated with the insertion and retraction of instruments. However, the difference in level between the cannula and trocar may result in ciliary detachment even if no resistance is felt when the trocar is inserted.
我们在此报告一例，在因增殖性糖尿病视网膜病变行23G玻璃体切除术后，怀疑与巩膜伤口制备相关的睫状体脱离是持续性低眼压的原因。在前房注入粘弹剂后进行超声生物显微镜检查（UBM），以仔细研究持续性低眼压的治疗方法和病因。通过粘弹剂加深前房，使UBM能够识别在浅前房中未检测到的睫状体脱离。睫状体脱离范围约为8度；然而，在房角镜检查中未见脱离情况。UBM显示前房与脉络膜之间无连续性，结果提示这两个结构已被后部牵拉分开。睫状体脱离部位与三通道系统制备部位相同。23G系统的一个优点是器械插入和回撤相关的并发症较少。然而，套管和套针之间的高度差可能导致睫状体脱离，即使插入套针时未感觉到阻力。
