Dokos Athanassios, Diafas Asterios, Tzamalis Argyrios, Hussain Rumana, Heimann Heinrich, Tsinopoulos Ioannis, Tsinori Evangelia, Androudi Sofia
Ophthalmology, University of Thessaly, Larissa, GRC.
Ophthalmology, Papageorgiou General Hospital/Aristotle University of Thessaloniki, Thessaloniki, GRC.
Cureus. 2023 Mar 31;15(3):e36987. doi: 10.7759/cureus.36987. eCollection 2023 Mar.
To investigate the incidence and the risk factors for conjunctival pigmentation at the sclerotomy sites following valved and non-valved cannula pars plana vitrectomy (PPV) performed by different surgical techniques.
This is a prospective observational study which included 70 eyes of 70 patients who underwent PPV for rhegmatogenous retinal detachment with follow-up visits at 1, 3, 6, 12, and 24 months. Twenty-eight eyes were operated using 25G non-valved cannulas (Group A), 22 eyes using 25G non-valved cannulas (Group B), and 20 eyes using 25G valved cannulas (Group C). The evaluated clinical parameters include the surgical technique, the patients' age, the number of retinal tears, the tamponade agent, the presence of residual sub-retinal fluid (SRF), and the duration of postoperative posturing.
Group A was associated with significant conjunctival pigmentation at up to 6 months after PPV. Sulfur hexafluoride (SF6) gas tamponade was associated with less conjunctival pigmentation at 3 months follow-up visit [odds ratio, OR 0.09 (95% confidence interval, CI 0.01; 0.67)], whereas the presence of residual SRF was a significant risk factor for postoperative pigmentation at 1-year follow-up visit [OR 5.89 (95% CI 1.84; 23.12)]. The area of measured pigmentation was also positively correlated to the number of retinal tears at all follow-up visits over 2 years. Six patients presented with conjunctival pigmentation at 2 years follow-up visit.
New vitrectomy techniques with valved cannulas prevent the postoperative appearance of conjunctival pigmentation. The number of retinal tears, the presence of SRF, and the use of long-standing tamponade agents were the most significant predisposing factors. The post-vitrectomy conjunctival pigmentation gradually reduces over time.
探讨采用不同手术技术进行带瓣和不带瓣套管的扁平部玻璃体切除术（PPV）后巩膜切开部位结膜色素沉着的发生率及危险因素。
这是一项前瞻性观察性研究，纳入70例接受PPV治疗孔源性视网膜脱离的患者的70只眼，随访时间为1、3、6、12和24个月。28只眼使用25G不带瓣套管进行手术（A组），22只眼使用25G不带瓣套管（B组），20只眼使用25G带瓣套管（C组）。评估的临床参数包括手术技术、患者年龄、视网膜裂孔数量、填塞剂、视网膜下液（SRF）残留情况以及术后体位持续时间。
A组在PPV后长达6个月时出现显著的结膜色素沉着。在3个月随访时，六氟化硫（SF6）气体填塞与较少的结膜色素沉着相关[比值比，OR 0.09（95%置信区间，CI 0.01；0.67）]，而在1年随访时，SRF残留是术后色素沉着的显著危险因素[OR 5.89（95%CI 1.84；23.12）]。在超过2年的所有随访中，测量的色素沉着面积也与视网膜裂孔数量呈正相关。6例患者在2年随访时出现结膜色素沉着。
带瓣套管的新型玻璃体切除术技术可防止术后结膜色素沉着的出现。视网膜裂孔数量、SRF的存在以及长期使用填塞剂是最显著的诱发因素。玻璃体切除术后结膜色素沉着会随时间逐渐减轻。
