Zhang Xian, Chen Bo, Yang Huajing, Song Yinwei, Zhang Di, Soetikno Brian T, Sun Xufang
Ophthalmic Surg Lasers Imaging Retina. 2018 Sep 1;49(9):e44-e51. doi: 10.3928/23258160-20180907-06.
To evaluate the correlation between pars plana incision and transient hypotony after silicone oil removal in aphakic eyes PATIENTS AND METHODS:Twenty-two patients with aphakia and a high degree of myopia with silicone oil tamponade were recruited for this prospective study and randomly scheduled to two groups for silicone oil removal: 3.5-mm corneal incision with suture corneal or 20-gauge pars plana incision with suture. Intraocular pressure (IOP) was measured and fundus and anterior structure were examined preoperatively on the first, third, and seventh postoperative day and at 1 month after surgery.
IOPs in the pars plana group were significantly lower than the corneal group on the first and third day after surgery (P < .001). Nine of the 11 patients in the pars plana group suffered ciliary detachment accompanied by hypotony (IOP < 8 mm Hg), among whom three patients exhibited excessive hypotony (IOP < 5 mm Hg), whereas the ciliary bodies remained tightly attached and IOP was normal in the corneal group. Among these nine patients, six eyes were observed to have multiple silicone oil granules in the supraciliary cavity, three exhibited gaps of pars plana below the scleral incision site, and two had vitreous hemorrhage. Hypotony spontaneously relieved at the seventh postoperative day for all patients.
Pars plana incision is the crucial cause of ciliary detachment and consequent transient hypotony after silicone oil removal. Using corneal limbus incision in patients with aphakic eyes to avoid the par plana incision is expected to reduce the incidence of hypotony with minimal complications. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:e44-e51.].
评估无晶状体眼硅油取出术后平坦部切口与短暂性低眼压之间的相关性。
本前瞻性研究纳入了22例无晶状体且高度近视并接受硅油填充的患者，随机分为两组进行硅油取出术：3.5毫米角膜切口缝合角膜或20G平坦部切口缝合。在术前、术后第1天、第3天、第7天以及术后1个月测量眼压（IOP），并检查眼底和眼前节结构。
平坦部切口组术后第1天和第3天的眼压显著低于角膜切口组（P <.001）。平坦部切口组11例患者中有9例发生睫状体脱离并伴有低眼压（IOP < 8 mmHg），其中3例出现严重低眼压（IOP < 5 mmHg），而角膜切口组睫状体保持紧密附着且眼压正常。在这9例患者中，6只眼在睫状体上腔观察到多个硅油颗粒，3只眼在巩膜切口部位下方的平坦部出现间隙，2只眼发生玻璃体积血。所有患者的低眼压在术后第7天自行缓解。
平坦部切口是硅油取出术后睫状体脱离及随之而来的短暂性低眼压的关键原因。在无晶状体眼患者中使用角膜缘切口以避免平坦部切口，有望降低低眼压的发生率并减少并发症。[《眼科手术、激光与影像学杂志》。2018；49：e44 - e51。]
