摘要目的 应用超声生物显微镜对比观察20G及23G玻璃体切除手术后眼前节的形态学变化,并分析其影响因素.方法 前瞻性分析研究.对2013年1月至2014年8月间在沈阳军区总医院眼科行初次玻璃体手术治疗成功的131例患者133只眼,分为20G手术组和23G手术组,随访3个月.应用UBM观察术后眼前节各种改变,比较两组间眼压、前房深度、房角、虹膜及睫状体形态学变化的差异.结果 玻璃体切除术后眼前节UBM的形态学变化有以下几种情况:(1)睫状体脱离;(2)房角关闭;(3)巩膜穿刺口玻璃体崁塞;(4)睫状体前增殖膜形成;(5)睫状体萎缩.20G组手术后出现眼前节改变的有46只眼,23G组术后出现眼前节改变的有22只眼.两组相比,巩膜穿刺口崁塞在23G组显著高于20G组,有统计学差异(P =0.003).睫状体脱离在23G组比例也明显高于20G组,但无统计学意义(P =0.062)而其余的眼前节改变在两组无显著差别(P =0.098,0.172,1.000).术后1周及3个月20G组的前房深度均深于23G组,但无统计学差异(P =0.162,0.301).术后1周20G组眼压显著高于23G组(P=0.05),至术后3个月,仍高于23G组,但无显著统计学差异(P =0.113).睫状体脱离在不同疾病间的发生率有显著不同(P =0.041),PDR和RVO患者术后发病率高于其他患者,单因素相关分析显示PDR是术后睫状体脱离的影响因素(Spearman相关分析,r=0.296 P=0.002).术后前房深度与睫状体脱离间的关系密切(r =-0.344,P=0.026),而房角及眼压与睫状体脱离均无显著相关.结论 睫状体脱离、房角关闭及玻璃体崁塞是PPV术后常见的眼前节改变.PDR患者玻璃体切除术后睫状体脱离发生率更高,而巩膜穿刺口玻璃体崁塞及睫状体脱离在23G手术后更为常见.

abstractsObjective To evaluate morphologic changes in anterior segment and the influencing factors for the changes after 20-, 23-G pars plana vitrectomy (PPV) by Ultrasound biomicroscope (UBM).Methods One hundred and thirty-one patients (133 eyes) who underwent primary PPV and 3 months follow-up after surgery in our hospital from January 2013 to February 2014 were enrolled in this prospective study.The patients were divided in 20-G group and 23-G group.UBM was applied to determine the tomographic features of anterior segment before and 1 week and 3 months after the surgery.The pre-and postoperative intraocular pressure (IOP), anterior chamber depth (ACD),parameters of anterior chamber angle, iris and ciliary body in 2 groups were assessed.Results The morphologic changes in anterior segment after surgery included: (1) ciliary body detachment (CBD) (2) anterior chamber angle closure (3) vitreous incarceration (4) anterior hyaloids proliferation (5) ciliary body atrophy.Forty-six of 86 eyes in 20G group presented morphologic changes after surgery compared with 22 of 47 eyes in 23G group.Vitreous incarceration was significantly higher in 23Ggroup (P =0.003).The proportion of CBD in 23G group was also higher than that in 20G, but there are no statistical significance within two groups (P =0.062).The other morphologic changes between 2 group were not statistical difference (P =0.098, 0.172, 1.000).The postoperative ACD of 20G group were deeper than that of 23G group, but the statistical difference were not significant (P =0.162, 0.301).The postoperative IOP of 20G group were significantly higher than that of 23G group in lweek (P =0.05) and sustained higher till 3 months after surgery.The incidence of CBD was significant difference among different diseases (P =0.041), CBD most frequently occurred in eyes of patients with proliferation diabetic retinopathy (PDR) or retinal vascular obstructive diseases (RVO).PDR was an influencing factor for postoperative CBD (Spearman analysis, r =0.296 P =0.002).The postoperative ACD of eyes with or without CBD were significantly different (r =-0.344, P =0.026) but the postoperative IOP, features of anterior were chamber angle were not statistical difference among the eyes with or without CBD.Conclusions CBD, anterior chamber angle closure and vitreous incarceration occurred frequently after PPV.A diagnosis of PDR has a higher incidence of CBD occurrence.Vitreous incarceration and CBD occurred more frequently in 23G PPV.