摘要目的 观察23G微创玻璃体手术相关并发症,分析其影响因素.方法 行23G玻璃体切割手术治疗的150例纳入研究.其中,黄斑疾病98例,占65.3％；增生型糖尿病视网膜病变46例,占30.7％；其他原因玻璃体积血4例,占2.7％；孔源性视网膜脱离1例,占0.7％；白内障手术中晶状体核脱落1例,占0.7％.黄斑疾病患者中眼表面麻醉21例,占21.4％,球后阻滞麻醉77例,占78.6％.应用DORC系统两步法3例,Alcon 23G微创玻璃体切割手术套管穿刺一步法147例.手术中操作包括曲安奈德辅助下玻璃体后脱离、清除玻璃体后皮质,剥除视网膜前膜、内界膜,眼内激光光凝、气液交换,联合晶状体超声乳化人工晶状体植入等.手术时间20～100 min,平均手术时间(51.1±18.9) min.手术后随访3～12个月.观察手术中和手术后并发症发生情况.结果 150例中,手术中发生并发症7例,占4.7％.其中,器械断裂致医源性裂孔 1例,占0.7％；患者头部活动致黄斑损伤1例,占0.7％；灌注套管松脱致脉络膜上腔灌注1例,占0.7％；穿刺口渗漏、切口缝合2例,占1.3％；穿刺口出血进入玻璃体腔1例,占0.7％；发生塞子断裂于套管内1例,占0.7％.手术后发生并发症34例,占22.7％.其中,视网膜脱离1例,占0.7％,再次手术复位；玻璃体积血再次手术3例,占2.0％；行二期白内障手术3例,占2.0％；眼压＜10 mm Hg(1 mm Hg=0.133 kPa)20例,占13.3％,未干预眼压恢复正常14例,行包扎制动等保守治疗,眼压恢复正常5例,缝合切口,眼压恢复1例；一过性高眼压7例,占4.7％,经降眼压药物治疗,眼压均恢复正常.末次随访时,未见与手术相关的眼内炎等并发症.结论 手术中切口相关并发症和手术后一过性低眼压是23G微创手术的常见并发症.

abstractsObjective To observe the related complications of 23G pars plana vitrectomy (PPV).Methods One hundred and fifteen patients who underwent 23G PPV were enrolled in this study.There were 98 patients (65.3％) with macular diseases, 46 patients (30.7％) with proliferative diabetic retinopathy,four patients (2.7％) with vitreous hemorrhage,one patient (0.7％) with rhegmatogenous retinal detachment,and lens nucleus falling off in cataract surgery in one patient (0.7％).Among 98 patients with macular diseases,21 patients (21.4％) underwent topical anesthesia,77 patients (78.6％)underwent retrobulbar anesthesia.DORC "two-step method" was performed in three patients,and Alcon 23G PPV "one-step method" was performed in 147 patients.The operation times ranged from 20 to 100 minutes,with a mean of (51.1 ± 18.9) minutes.The follow-up ranged from three to 12 months.The intraoperative and postoperative complications were observed.Results Intraoperative complications was found in seven patients (4.7％),which included iatrogenic retinal breaks in one patient (0.7％),macular damage in one patient (0.7％),suprachoroidal perfusion in one patient (0.7％),puncture leakage and closure incision in two patients (1.3 ％ ),vitreous hemorrhage in one patient (0.7 ％ ) and stopper broken off in cannula in one patient (0.7％).Postoperative complications was found in 34 patients (22.7％),which including retinal detachment in one patient (0.7 ％),vitreous hemorrhage in three patients (2.0 ％ ),cataract in three patient (2.0％),intraocular pressure ＜ 10 mm Hg (1 mm Hg =0.133 kPa) in 20 patient (13.3％),and transient ocular hypertension in seven patients (4.7％). After treatment there was no complication associated with surgery. Conclusion Intraoperative complications related to incision and transient hypotony are mainly complications of 23G PPV.