自闭穿刺套管在孔源性视网膜脱离玻璃体手术中的应用

摘要

Objetive To understand the feature of self-closing puncture cannula used in vitrectomy for rhegmatogenous retinal detachment.Method 26 patients (26 eyes) were operated for rhegmatogenous retinal detachment.23 Gauge vitrectomy system was used in all surgery.They were divided into group A (observation group) and B (control group) randomly.Group A used open puncture cannula and group B used self-closing puncture cannula.Time of the operation,postoperative visual acuity,postoperative intraocular pressure (IOP),intraoperative and postoperative complication,and retinal attachment rate were recorded.Results The average operative time of group A was 131 ± 46.1 min and group B was 138.7 ± 47.9 min.The difference was not statistically significant (P ＞ 0.05).There was no significant difference of postoperative visual acuity at final fellow-up compared with group A and group B (P ＞ 0.05).The visual acuity before operation with after operation at final fellow-up in group A or group B had significant difference (both P＜0.01).IOP were 8.94 ± 4.07mmHg and 12.86± 4.34mmHg before operation and 3 months after operation in group A,respectively,which in group B were 9.06 ± 2.32mmHg and 12.8 ± 4.12mmHg,respectively.The difference was statistically significant compared preoperative IOP with postoperative 3 months in both groups (both P ＜ 0.01).There were no statistical differences compared with group A and group B in IOP at preoperative or postoperative 3 months (both P ＞ 0.05).In group A,the complications of subretinal deuteroxide and scleral puncture emerged in 2 eyes and 1 eye,but in group B no complications occurred.The effective rates of postoperative retina reattachment were 92.9％ in group A and 91.7％ in group B.Conclusion Applying open or self-closing puncture cannula in vitrectomy had no difference for treating rhegmatogenous retinal detachment.But self-closing puncture cannula could control the IOL steadily and reduce the complication during operation.%目的 了解自闭式穿刺套管在孔源性视网膜脱离玻璃体手术中的优缺点.方法 26眼孔源性视网膜脱离病例实施23G玻璃体切除视网膜复位术,随机分成A组(对照组)和B组(研究组),A组使用开放式穿刺套管,B组使用自闭式穿刺套管,观察手术时间、术后视力、术后眼压、术中术后并发症、视网膜复位率.结果 A组、B组手术平均时间分别为131±46.1min、138.7±47.9min,比较无统计学意义(P＞0.05);两组术后末次随访视力比较,差异无统计学意义(P＞0.05),A组术前、术后末次随访视力和B组术前、术后末次随访视力比较,差异均有明显统计学意义(均为P＜0.01);A组术前和术后3个月眼压分别为8.94±4.07mmHg、12.86±4.34mmHg,B组术前和术后3个月眼压分别为9.06±2.32mmHg、12.8±4.12mmHg,两组术前和术后眼压比较均有统计学意义(P＜0.01),两组术前眼压比较和术后眼压比较均无统计学意义(均为P＞ 0.05);A组2眼出现视网膜下重水残留和1眼穿刺口并发症,B组则无,A组、B组视网膜复位率分别为92.9％、91.7％.结论 自闭与开放式穿刺套管在孔源性视网膜脱离玻璃体手术中使用效果无差别,但自闭式可以维持术中稳定的眼压,减少术中并发症出现.