论著

微创玻璃体切割术后急性眼内炎的临床分析

Clinical analysis of endophthalmitis after minimally invasive vitrectomy

:113-119
 
目的:分析23G/25G微创玻璃体切割术后发生眼内炎的危险因素。方法:回顾性分析2014年6月—2023年5月于中国人民解放军中部战区总医院行微创玻璃体切割术后,临床诊断为眼内炎患者(开放性眼外伤患者除外)的临床特征。结果:纳入8 955例行微创玻璃体切割术患者,其中11例微创玻璃体切割术后患眼发生眼内炎,发生率为0.12%。平均年龄(60.8±7.6)岁。11例其中,5例(45.4%)患者合并糖尿病;原发眼疾构成情况:黄斑疾病7例(63.6%)、增殖期糖尿病性视网膜病变继发玻璃体积血2例(18.2%),视网膜裂孔继发玻璃体积血1例(9.1%)、视网膜脱离1例(9.1%);术中联合行白内障手术3例(27.3 %);术毕8例(72.7%)患眼玻璃体腔填充无菌空气,3例(27.3%)填充平衡盐溶液,术毕所有患者均未缝合巩膜穿刺切口;术后低眼压3例(27.3 %)。术后发生眼内炎的时间为(2.8±1.1)d。11例患者经过局部和全身抗感染治疗后炎症控制不佳,均再次行玻璃体切割术联合术中配置万古霉素液灌注,其中9例术毕玻璃体腔填充硅油,术后所有眼内炎得到控制,10例(91.0%)患者最终矫正视力有所提高。结论:微创玻璃体切割术后,免缝合的巩膜切口可能是病原微生物侵入眼内导致眼内炎的潜在途径。尤其要重视黄斑手术中玻璃体不全切除引起巩膜切口处发生玻璃体束综合征可能是术后发生眼内炎的危险因素之一。


Objective: To analyze risk factors for endophthalmitis occurred after 23G/25G minimally invasive vitrectomy. Methods: Retrospective analysis of the clinical characteristics of patients with endophthalmitis (except patients with open eye trauma) after minimally invasive vitrectomy in General Hospital of Central Theater Command(Wuhan,430064) from June 2014 to May 2023. Results: This study included 8,955 patients, of which 11 cases occurred endophthalmitis after minimally invasive vitrectomy, with an incidence rate of 0.12%. The average age was (60.8±7.6) years, and 5 patients (45.4%) were complicated with diabetes; The composition of primary eye diseases: 7 cases (63.6%) of macular disease, 2 cases (18.2%) of vitreous hemorrhage secondary to proliferative diabetic retinopathy and 1 case (9.1%) vitreous hemorrhage secondary to retinal fissure, 1 case (9.1%) of retinal detachment; During the operation, 3 cases (27.3%) underwent combined cataract surgery; After the operation, 8 cases (72.7%) were filled with sterile air in the vitreous cavity of affected eye, the other 3 cases (27.3%) were filled with equilibrium liquid,and sclera puncture incision was not sutured in all patients; 3 cases (27.3%) had low intraocular pressure after operation. The time for postoperative endophthalmitis to occur after operation was 2.8±1.1day. 11 patients had poor inflammation control after local and systemic anti-inflammatory treatments, and all underwent vitrectomy combined with intraoperative injection of vancomycin solution. Among them, 9 patients were filled with silicone oil in the vitreous cavity after the surgery. After the operation, all the endophthalmitis were controlled and final corrected visual acuity of 10 patients improved. Conclusions: Minimally invasive vitrectomy and suture-free scleral incision may be a potential way for pathogenic microorganisms to invade the eye and cause endophthalmitis. Particular attention should be paid to the ‘Vitreous Wick Syndrome’ at the scleral incision caused by incomplete vitrectomy in macular surgery, which may be one of the risk factors for postoperative endophthalmitis.

综述

玻璃体切割术后高眼压的相关因素分析及治疗

Related factors analysis and treatment on high intraocular pressure after vitrectomy

:466-471
 
玻璃体切割术是目前临床上常见的眼科手术之一,其应用广泛,且具有良好的治疗效果,但术后仍会出现各种并发症,眼压升高便是其中常见的一种。玻璃体切割术后眼压升高的病因复杂多样,术前原发病的不同、术中处理方式的差异以及术后并发症均可引起眼压升高,根据不同的病因可以选用更合适的治疗方法。早期的眼压升高较易控制,主要采用药物及激光治疗,晚期眼压升高导致继发性青光眼则相对复杂,以手术治疗为主。该文主要对玻璃体切割术后高眼压的原因分析及治疗进展进行综述。
Pars plana vitrectomy is one of the common ophthalmic surgeries in clinic practice currently, which is widely used with good therapeutic effect. However, various complications may still occur after operation. Elevated intraocular pressure is one of common complications. The causes of postoperative ocular hypertension are complex and diverse. Elevated intraocular pressure could be caused by different preoperative primary diseases, intraoperative management methods,and postoperative complication. More appropriate treatment methods can be selected based on different causes. Early elevated intraocular pressure iseasier to control and is mainly treated with medicine and laser. Late elevated intraocular pressure leads to secondary glaucoma, which is relatively complex and mainly treated with surgery. This review mainly states causes and treatment progress of high intraocular pressure after vitrectomy.
其他期刊
  • 眼科学报

    主管:中华人民共和国教育部
    主办:中山大学
    承办:中山大学中山眼科中心
    主编:林浩添
    主管:中华人民共和国教育部
    主办:中山大学
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  • Eye Science

    主管:中华人民共和国教育部
    主办:中山大学
    承办:中山大学中山眼科中心
    主编:林浩添
    主管:中华人民共和国教育部
    主办:中山大学
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