Pham T, Volkmer C, Antoni H J, Anders N, Wollensak J
Augenklinik, Humboldt-Universität zu Berlin.
Ophthalmologe. 1997 Sep;94(9):647-50. doi: 10.1007/s003470050176.
Since increased intraoperative iris irritation can lead to increased postoperative inflammation, we are interested in postoperative reactions to several varied surgical procedures. We performed pupil stretching, iridotomy with iris suture, and partial sphincterectomy.
From January 1995 to January 1996, 100 patients (103 eyes) with narrow pupils underwent cataract surgery. In 13 eyes a iridotomy and iris suture were performed, in 28 eyes a partial sphincterectomy. In 62 eyes there was no surgical intervention after pupil stretching. Postoperative examinations were carried out in the early postoperative phase (up to 5 days postoperative) as well as 4 weeks after surgery. Fibrin reaction was classified according to 3 grades, (1) faint fibrinous threads, (II) fibrinous net, and (III) membranous fibrin exsudation.
In the group without additional surgery there was a fibrinous reaction of grade I and II in 11 eyes. This complication occurred after iridotomy and iris suture in four cases and after sphincterectomy in four cases. While the intensity of fibrinous reaction was comparable in the first two groups, the fibrinous reaction after sphincterectomy was more intensive in one eye (grade III). However, response to intensive local antiphlogistic therapy was good. Frequency of fibrinous reaction in the three groups was statistically not significant. It should be pointed out that there was a partial restoration of pupil movements through sphincterectomy: mean pupil diameter was 4 mm, and 2.5 mm under exposure to light. Three patients had no pupillary reaction at all.
Partial sphincterectomy facilities intraoperative manipulations of cataract surgery. Postoperative inflammatory reaction is rare and was very responsive to medical treatment. The reconstruction of pupillary movement is part of full visual function and, last but not least a round pupil is aesthetically more desirable.
由于术中虹膜刺激增加会导致术后炎症加剧，我们对几种不同手术操作的术后反应感兴趣。我们进行了瞳孔扩张、虹膜切开联合虹膜缝合以及部分括约肌切除术。
1995年1月至1996年1月，100例（103只眼）瞳孔狭窄患者接受了白内障手术。13只眼进行了虹膜切开联合虹膜缝合，28只眼进行了部分括约肌切除术。62只眼在瞳孔扩张后未进行手术干预。术后早期（术后5天内）以及术后4周进行了检查。纤维蛋白反应分为3级，（1）轻微纤维蛋白丝，（II）纤维蛋白网，（III）膜状纤维蛋白渗出。
在未进行额外手术的组中，11只眼出现了I级和II级纤维蛋白反应。这种并发症在4例虹膜切开联合虹膜缝合术后以及4例括约肌切除术后出现。虽然前两组的纤维蛋白反应强度相当，但括约肌切除术后有1只眼的纤维蛋白反应更强烈（III级）。然而，对强化局部抗炎治疗的反应良好。三组中纤维蛋白反应的频率在统计学上无显著差异。需要指出的是，通过括约肌切除术瞳孔运动有部分恢复：平均瞳孔直径为4mm，光照下为2.5mm。3例患者完全没有瞳孔反应。
部分括约肌切除术便于白内障手术的术中操作。术后炎症反应罕见，对药物治疗反应良好。瞳孔运动的重建是完整视觉功能的一部分，最后但同样重要的是，圆形瞳孔在美学上更令人满意。
