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目的探讨巩膜穿刺孔玻璃体嵌顿与玻璃体手术失败的关系。方法对连续49例(49只眼)玻璃体手术后视网膜脱离患者,根据术中探查,将巩膜穿刺孔内口玻璃体嵌顿分为5级:0级:无任何玻璃体嵌顿;Ⅰ级:穿刺孔内口玻璃体嵌顿,但对视网膜无牵拉;Ⅱ级:玻璃体嵌顿,对视网膜产生牵拉,表现向前移位;Ⅲ级:视网膜嵌顿在穿刺孔内口处;Ⅳ级:玻璃体嵌顿牵拉形成视网膜裂孔。Ⅲ和Ⅳ级定为是手术失败的主要原因,Ⅱ级判为手术失败的次要原因,0和Ⅰ级为非巩膜穿刺孔并发症引起的手术失败。结果患者原发疾病为裂孔性视网膜脱离22例,眼外伤21例(包括取眼内异物8例);分支静脉阻塞和化脓性眼内炎各2例;糖尿病性视网膜病变和急性视网膜坏死综合症各1例。做过1次玻璃体手术37例,2次以上12例。前段增生性玻璃体视网膜病变分级:单纯视网膜环形收缩2例;视网膜前移位31例(合并环形收缩11例)。主要因巩膜穿刺孔并发症引起的手术失败占57.2%(28例),巩膜穿刺孔并发症为次要原因占20.4%(10例),二者占77.6%。非巩膜穿刺孔并发症引起的手术失败占22.4%(11例)。结论巩膜穿刺孔玻璃体嵌顿的并发症是玻璃体手术失败的首要原因。
Objective To investigate the relationship between vitreous incarceration and failure of vitreous surgery in scleral puncture. Methods 49 consecutive patients (49 eyes) with vitreous detachment after vitreous surgery were divided into 5 grades according to intraoperative exploration: grade 0: no vitreous incarceration; grade Ⅰ: puncture Class I: intraocular vitreous incarceration, but no traction on the retina; Grade II: vitreous incarceration, pulling the retina, the performance of the forward shift; grade: retinal incarcerated in the puncture hole; Dayton pull the formation of retinal tears. Ⅲ and Ⅳ grade as the main reason for surgical failure, Ⅱ grade sentence for the secondary cause of failure, 0 and Ⅰ grade non-scleral puncture complications caused by the operation failed. Results The primary diseases of patients were retinal detachment in 22 cases, ocular trauma in 21 cases (including intraocular foreign bodies in 8 cases), branch vein occlusion and suppurative endophthalmitis in 2 cases, diabetic retinopathy and acute retinal necrosis syndrome One case each. Have done a vitreous surgery in 37 cases, more than 2 times in 12 cases. Prostatic proliferative vitreoretinopathy grading: simple retinal ring-shaped contraction in 2 cases; retinal pre-displacement in 31 cases (combined ring contraction in 11 cases). Mainly due to complications of scleral puncture caused by surgical failure accounted for 57.2% (28 cases), secondary to scleral puncture complications accounted for 20.4% (10 cases), the two accounted for 77.6%. Non-scleral puncture complications caused by surgery accounted for 22.4% (11 cases). Conclusion The complications of vitreous incarceration in the scleral puncture hole are the primary cause of failure of vitreous surgery.