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.
综述

玻璃体切除术后白内障患者屈光预测误差来源的研究进展

Research progress on the sources of refractive prediction error in cataract patients after vitrectomy

:143-149
 
随着微创玻璃体切除术(pars plana vitrectomy,PPV)的广泛开展和手术技术的提高,患者对手术后视觉质量的要求越来越高。白内障是PPV术后最常见并发症,而具有玻璃体切除史的白内障患者屈光变异大,预测难度高。本文综述了生物测量误差、人工晶状体屈光力计算公式选择以及有效晶状体位置预测等影响有玻璃体切除手术史的白内障患者术后屈光误差的主要因素,旨在为降低这一类特殊人群白内障术后屈光误差提供参考。
With the widespread application of minimally invasive vitrectomy and the improvement of surgical techniques, the demands of patients for better postoperative visual quality are increasing. Cataract is the most common complication after vitrectomy, whereas the refractive outcomes of cataract patients with prior vitrectomy are viable and difficult to predict. In this paper, the main factors affecting postoperative refractive error of cataract patients with a history of vitrectomy, such as biometric error, selection of intraocular lens calculation formulas and prediction of effective lens position, were reviewed in order to provide reference for reducing postoperative refractive error of this special group of cataract patients.
发明与创新

一种基于眼科日间病房的玻璃体手术体位护理座椅

A seat for position nursing after pars plana vitrectomy in an ophthalmic day ward

:840-842
 
为在眼科日间手术模式下既能满足玻璃体视网膜术后体位需求,又能合理利用有限空间,本研究团队在原有的眼科日间病房座椅的基础上,增加玻璃体手术后体位护理等功能,发明了一种护理座椅[专利号:国家实用新型专利(ZL 2017 2 0942404. 1)]。该座椅采用钢喷塑(或不锈钢)、木板、海绵和人造革皮等材料,其结构主要包括座椅的主体部分、俯卧台、杂物篮、收纳架、输液杆套筒等部分。其制作材料简单,操作方便,安全使用,既能保证临床体位护理需求,又能节省空间,便于病房环境管理。
To meet the needs of the postoperative position nursing after pars plana vitrectomy in the day surgery mode,this research team has designed a nursing chair [patent number: National Uutility Model Patent (ZL 201720942404. 1)] based on the original chair of ophthalmic day ward, adding the functions of postvitreous nursing and so on. The seat is made from steel spray plastic (or stainless steel), wood, sponge and artificial leather, and the structure mainly consists of the main body, the countertop for prone position, the junk basket, the storage rack, and the infusion rod sleeve. The seat can be made by simple materials. The seat is easy to operate and safe to use, which can not only meet the needs of clinical body position nursing care, but also save the ward’ space and facilitate the environmental management of the ward.
论著

玻璃体切除硅油填充术后患者面向下体位依从性的调查研究

Compliance with the face-down positioning after vitrectomy and silicone oil tamponade

:532-536
 
目的:了解玻璃体切除硅油填充术后患者(face-down positioning,FDP)依从性的相关影响因素。方法:采用随机抽样研究的方法,选取2018年1月至2019年12月于无锡市人民医院眼科行玻璃体切除硅油填充术后的患者100例,采用问卷调查对一般资料、FDP可能发生的反应和依从性进行调查。采用SPSS 19.0进行统计分析。结果:患者性别、对疾病的重视程度与FDP的依从性有显著差异(P<0.05),但家庭支持系统与FDP的依从性差异无统计学意义(P>0.05)。患者术后第1天对FDP依从性的主要影响因素依次为呼吸不畅(84%)、睡眠不佳(78%)、肩颈部不适(10%);术后第3天的主要影响因素依次为呼吸不畅(66%)、腰酸背痛(50%)、睡眠不佳(39%);术后第5天的主要影响因素依次为肢体麻木(70%)、腰酸背痛(87%)、睡眠不佳(30%)、肩颈部不适(18%)以及肘关节疼痛(10%)。结论:影响患者依从性的主要因素主要有性别、对疾病的自我重视程度以及FDP引起的不适症状。需加强对高危因素的识别,不同病情时段给予征对性的宣教和指导,以提高患者对FDP的依从性。
Objective: To investigate the influencing factors of compliance of patients with silicone oil tamponade after vitrectomy. Methods: A total of 100 patients with silicone oil tamponade after vitrectomy in Wuxi People’s Hospital of Jiangsu Province from January 2018 to December 2019 were selected by random sampling method.The general information, possible reaction, and compliance of face-down positioning (FDP) were investigated by questionnaire. SPSS 19.0 was used for statistical analysis. Results: There were significant differences in patients’gender, attention to disease and FDP compliance (P<0.05), but there was no significant difference between family support system and FDP (P>0.05). The main influencing factors of FDP compliance were dyspnea (84%), poor sleep (78%), the discomfort of shoulder and neck (10%); on the third day after operation, the main influencing factors were dyspnea (66%), low back pain (50%) and poor sleep (39%); on the fifth day, the main influencing factors were numbness of the limbs (70%), low back pain (87%) and poor sleep (30%), the discomfort of shoulder and neck (18%) and elbow pain (10%). Conclusion: The main factors that affect the compliance of patients are gender, self-awareness of the disease and discomfort caused by FDP. It is necessary to strengthen the identification of high-risk factors, and give symptomatic education and guidance at different stages of illness, to improve the compliance of patients to FDP.
论著

品管圈在提高玻璃体切除术后患者俯卧位执行率中的应用

Application of quality control circle in improving the execution rate of patients in prone position after vitrectomy

:247-355
 
目的:探讨品管圈在提高玻璃体切除术后患者俯卧位执行率中的应用效果。方法:成立品管圈活动小组,选定提高玻璃体切除术后患者俯卧位执行率作为活动主题,运用品管圈工具和方法,对现状进行分析,找出影响因素,制定相应的措施并组织实施,比较品管圈活动前后玻璃体切除术后患者俯卧位执行率情况。结果:玻璃体切除术后患者俯卧位执行率由活动前的64.70%提高到95.83%。结论:运用品管圈能显著提高玻璃体切除术后患者俯卧位执行率,值得临床推广。
Objective: To explore the effect of quality control circle on improving the prone position execution rate of patients after vitrectomy. Methods: Establish quality control circle activity group, select improving the prone position execution rate of patients after vitrectomy as the activity theme, use quality control circle tools and methods to analyze the status quo, find out the influencing factors, formulate corresponding measures and implement them, and compare the prone position execution rate of patients before and after quality control circle activity. Results: The prone position execution rate of patients after vitrectomy increased from 64.70% to 95.83%.Conclusion: The application of quality control circle can significantly improve the prone position implementation rate of patients after vitrectomy, which is worthy of clinical promotion.
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
    浏览
  • 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
    浏览
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