CAJ | 학술논문

目的寻找一种无创、安全有效、简单的方法预防23G微创玻璃体手术后早期低眼压的发生.方法前瞻性对照研究.将2011年7月至2012年9月在徐州市眼病防治研究所行23G微创玻璃体手术的连续病例资料分为3组:术中无巩膜切口渗漏未予缝合为无渗漏组,有巩膜切口渗漏者按照随机数字表法分为瞬康胶组(用α-氰基丙烯酸烷基酯医用胶封闭伤口)、缝线组(用8-0缝线缝合巩膜切口),每组30例.用卡方检验比较各组间术后早期低眼压的发生率,用秩和检验比较各组结膜充血程度、患者舒适度、最终随访视力的差异.结果 3组术后1周内发生低眼压的情况:缝线组无低眼压发生,瞬康胶组、无渗漏组分别有1例(3％)、4例(13％)发生低眼压,3组差异具有统计学意义(x2=6.291,P＜0.05).3组患者在术后1 d(Z=9.917,P＜0.01)、3d(Z=9.620,P＜0.01)、1周(Z=10.221,P＜0.01)时结膜充血程度差异具有统计学意义,无渗漏组最轻,缝线组最重.3组患者在术后3d时术眼疼痛程度差异具有统计学意义(Z=12.502,P＜0.01),无渗漏组最轻,缝线组最重.3组患者术后2个月时视力进行比较差异无统计学意义(Z=4.234,P＞0.05).3组在术后2周、4周用超声生物显微镜检测均未发现切口内有纤维组织内生.结论应用α-氰基丙烯酸烷基酯医用胶或缝线封闭渗漏的巩膜切口能够有效地预防23G微创玻璃体手术后早期低眼压的发生.其中α-氰基丙烯酸烷基酯医用胶具有无创、安全有效、使用简便等优点.
목적 심조일충무창、안전유효、간단적방법예방23G미창파리체수술후조기저안압적발생.방법 전첨성대조연구.장2011년7월지2012년9월재서주시안병방치연구소행23G미창파리체수술적련속병례자료분위3조:술중무공막절구삼루미여봉합위무삼루조,유공막절구삼루자안조수궤수자표법분위순강효조(용α-청기병희산완기지의용효봉폐상구)、봉선조(용8-0봉선봉합공막절구),매조30례.용잡방검험비교각조간술후조기저안압적발생솔,용질화검험비교각조결막충혈정도、환자서괄도、최종수방시력적차이.결과 3조술후1주내발생저안압적정황:봉선조무저안압발생,순강효조、무삼루조분별유1례(3％)、4례(13％)발생저안압,3조차이구유통계학의의(x2=6.291,P＜0.05).3조환자재술후1 d(Z=9.917,P＜0.01)、3d(Z=9.620,P＜0.01)、1주(Z=10.221,P＜0.01)시결막충혈정도차이구유통계학의의,무삼루조최경,봉선조최중.3조환자재술후3d시술안동통정도차이구유통계학의의(Z=12.502,P＜0.01),무삼루조최경,봉선조최중.3조환자술후2개월시시력진행비교차이무통계학의의(Z=4.234,P＞0.05).3조재술후2주、4주용초성생물현미경검측균미발현절구내유섬유조직내생.결론 응용α-청기병희산완기지의용효혹봉선봉폐삼루적공막절구능구유효지예방23G미창파리체수술후조기저안압적발생.기중α-청기병희산완기지의용효구유무창、안전유효、사용간편등우점.
Objective To find a non-invasive,safe,effective,and simple method to prevent the occurrence of early hypotony after 23G vitrectomy.Methods Using a prospective,controlled study,90 patients who met hospital standards for 23G vitrectomy underwent surgery in Eye Institute of Xuzhou from July 2011 to September 2012.Patients were divided into three groups of 30 patients each.No-leakage group had no wound leakage.Those who had wound leakage were divided further into 2 groups based on treatment approach:Suncon medical adhesive group,whose scleral incisions were coated with an α-cyanoacrylate medical adhesive,and suture group,whose incisions were sutured with an 8-0 absorbable suture.All surgeries were performed by the same surgeon.Early postoperative hypotony,conjunctival hyperemia,postoperative comfort level,and scleral incision healing were compared among the three groups.A chi-square test and rank sum test were used.Results Occurrence of hypotony was evaluated for all three groups 1 week after surgery:no hypotony occurred in the suture group while the no-leakage group and Suncon medical adhesive group had 1 and 4 cases of hypotony,respectively.The differences in rates of hypotony among the three groups were statistically significant (x2=6.291,P＜0.05).The differences in postoperative occurrence of conjunctival hyperemia among the three groups at 1 day (Z=9.917,P＜0.01),3 days (Z=9.620,P＜0.01),and 1 week (Z=10.221,P＜0.01) were all statistically significant.Congestion occurred the least in no-leakage group and was the worst in suture group.At day 3 postoperatively,the pain and discomfort of patients in the three groups were significantly different (Z=12.502,P＜0.01).Discomfort was the least in the no-leakage group and was the worst in the suture group.BCVA improved in all groups 2 months after surgery (Z=4.234,P＞0.05).Abnormal fibrous ingrowth was not detected at the sclerotomy sites with ultrasound biomicroscopy.Conclusion It was demonstrated that the use of an α-cyanoacrylate medical adhesive or suture to close scleral incision leakage in 23G vitrectomy is effective in preventing early hypotony.The former is noninvasive and feasible and provides a better approach.