虹膜拉钩联合非接触全视野镜在小瞳孔玻璃体切割术中的应用

摘要

目的 研究虹膜拉钩联合非接触全视野镜行小瞳孔玻璃体切割术的可行性及其优点.方法 前瞻性队列研究.实验组为2010年2月至2010年6月间诊断为小瞳孔合并眼底病变需行玻璃体切割术患者12例(12眼).虹膜拉钩撑开瞳孔后在非接触全视野镜下行玻璃体切割术,伴有晶状体混浊影响手术的一并行白内障超声乳化摘除术.对照组为同期在我院行玻璃体手术但不合并小瞳孔患者12例(12眼),均在角膜接触透镜下行经扁平部玻璃体手术.两组术后随访6～12个月,分析两组的术后视力、角膜内皮、视网膜复位情况.采用Mann-Whitney秩和检验,独立样本t检验,Fish确切概率法进行数据分析.结果 实验组和对照组术后视力提高程度差异无统计学意义；实验组术后1眼,对照组2眼出现视网膜脱离复发,两组视网膜复位率差异无统计学意义；实验组和对照组的术后角膜内皮细胞丢失率分别为(15.7±6.9)％及(16.1±6.4)％,差异无统计学意义,术后无虹膜撕裂、虹膜萎缩等并发症.结论 虹膜拉钩解决了白内障超声乳化过程及玻璃体切割过程中小瞳孔的问题,更好地暴露手术视野,而非接触全视野镜不仅解决了接触式透镜下玻璃体切割手术无法应用虹膜拉钩的问题,而且使手术视野更为清晰完全.虹膜拉钩联合非接触全视野镜是一种应对需行玻璃体切割手术的小瞳孔患者的简便安全的方法.%Objective To explore the feasibility and advantages of iris retractors combined with a full-field non-contact lens used during vitreous surgeries of patients with small pupils.Methods Twenty-four patients were included in this prospective cohort study during February to June 2010 in Lihuili Hospital of Ningbo.The experimental group consisted of 12 patients (12 eyes),all of who had small pupils but needed vitrectomy.All vitreous surgeries in the experimental group were carried out with the help of iris retractors as well as full-field non-contact lenses.For those with cloudy lenses,which affect the operation,phacoemulsifications were also performed.The control group consisted of 12 patients (12 eyes) with normal pupils who needed vitreous surgeries during the same period of time.Closed pars plana vitrectomies with contact lenses were used on them.All patients were followed up for 6-12 months,and then the differences in visual acuity,the corneal epithelium,and retinal reattachment between the two groups were analyzed.Statistical analysis included the Mann-Whitney rank sum test,independent samples t test and Fish's exact test.Results There was no significant difference between the experimental and control groups for postoperative visual acuity; 1 eye in the experimental group and 2 eyes in the control group had recurrent retinal detachment,but there was no significant difference in retinal reattachment between the two groups.Corneal endothelial loss in the experimental and control groups was (15.7±6.9)％ and (16.1±6.4)％,respectively,with no significant differences between the two groups.No complications such as iridothexis or iris atrophy occurred.Conclusion The iris retractor is a useful implement in the course of phacoemulsification and vitrectomy with a small pupil,and it fully exposed the surgical field.A full-field non-contact lens is appropriate for use with an iris retractor rather than a corneal contact lens.Futhermore,it provides a clear and complete view during surgery.An iris retractor combines with a non-contact full-field lens is simple and safe for use in vitreous surgeries of patients with small pupils.