Takashina Hirotsugu, Watanabe Akira, Tsuneoka Hiroshi
Department of Ophthalmology, National Hospital Organization Sagamihara Hospital, 18-1 Sakuradai, Minami-ku, Sagaminara, Kanagawa, 252-0392, Japan.
Department of Ophthalmology, Jikei University School of Medicine, 3-19-18 Nishi-shinbashi Minato-ku, Tokyo, 105-8471, Japan.
BMC Ophthalmol. 2015 Dec 1;15:171. doi: 10.1186/s12886-015-0159-z.
Characteristic complications have been reported for transconjunctival sutureless vitrectomy, such as postoperative sclerotomy leakage and postoperative hypotony. Particular attention to sclerotomy closure is required in cases of silicone oil tamponade, because postoperative supplementation of silicone oil implies reoperation, whereas postoperative supplement of gas is comparatively easy. This study investigated sclerotomy closure in cases of silicone oil tamponade using 25-gauge transconjunctival sutureless vitrectomy.
We enrolled 19 consecutive eyes with silicone oil injection (Group A, self-sealing sclerotomies, n = 10) (Group B, sutured sclerotomies, n = 9) and 10 eyes with silicone oil removal (Group C, self-sealing sclerotomies) using 25-gauge TSV. Postoperative intraocular pressure was compared between Groups A and B, and between Groups A and C using repeated-measures analysis of variance (ANOVA), one-way factorial ANOVA, and the Tukey-Kramer test.
No significant differences in age or axial length were seen among groups, but surgical time differed significantly between Group C and the other groups. Mean duration of silicone oil tamponade was 3.2 ± 1.4 months in Group C, and no sclerotomies in Group A or C required suture placement. Postoperative silicone oil leakage to the subconjunctival space was not encountered in Group A. No cases showed postoperative hypotony (defined as intraocular pressure <5 mmHg). Significant differences in intraocular pressure within the same postoperative period were not identified between Groups A and B. Conversely, significant differences in intraocular pressure within the same postoperative period were identified at postoperative days 1 and 2, although not at postoperative week 1 or postoperative month 1 between Groups A and C.
The procedure for sclerotomy closure seems to have little influence on postoperative intraocular pressure in eyes with silicone oil tamponade using 25-gauge transconjunctival sutureless vitrectomy, because silicone oil tamponade may avoid postoperative hypotony by decreasing sclerotomy leakage in the early postoperative period.
经结膜无缝合玻璃体切除术已报告有一些典型并发症，如术后巩膜切口渗漏和术后低眼压。在硅油填充的病例中，需要特别注意巩膜切口的闭合，因为术后补充硅油意味着需要再次手术，而术后补充气体相对容易。本研究使用25G经结膜无缝合玻璃体切除术，对硅油填充病例的巩膜切口闭合情况进行了调查。
我们纳入了19例连续行硅油注射的眼（A组，自封闭巩膜切口，n = 10）（B组，巩膜切口缝合，n = 9）以及10例使用25G经结膜无缝合玻璃体切除术进行硅油取出的眼（C组，自封闭巩膜切口）。使用重复测量方差分析（ANOVA）、单因素析因方差分析和Tukey-Kramer检验，比较A组和B组之间以及A组和C组之间的术后眼压。
各组之间年龄或眼轴长度无显著差异，但C组与其他组之间手术时间差异显著。C组硅油填充的平均持续时间为3.2±1.4个月，A组或C组的巩膜切口均无需缝合。A组未出现术后硅油渗漏至结膜下间隙的情况。没有病例显示术后低眼压（定义为眼压<5 mmHg）。A组和B组在同一术后时期眼压无显著差异。相反，A组和C组在术后第1天和第2天同一术后时期眼压有显著差异，尽管在术后第1周或术后第1个月无显著差异。
对于使用25G经结膜无缝合玻璃体切除术并硅油填充的眼，巩膜切口闭合方式似乎对术后眼压影响不大，因为硅油填充可能通过减少术后早期巩膜切口渗漏来避免术后低眼压。
