摘要目的:探讨无晶状体眼玻璃体切除重硅油填充手术中联合12：00方位周边虹膜切除的临床效果。方法:前瞻性随机对照研究。收集2024年1至12月于哈尔滨医科大学附属第二医院眼科拟行晶状体摘除联合玻璃体切除重硅油填充手术的增生型糖尿病视网膜病变致牵拉性视网膜脱离患者，采用随机数字表将患者分为联合组（行无晶状体眼玻璃体切除重硅油填充联合12：00方位周边虹膜切除手术）和单纯组（行无晶状体眼玻璃体切除重硅油填充手术）。记录并比较两组术前和术后1 d、1周、4周、12周的眼压、最佳矫正视力（BCVA），术后重硅油进入前房情况、角膜状态、视网膜复位情况及其他并发症。采用独立样本 t检验、独立样本Mann-Whitney U检验、 χ2检验进行统计学分析。 结果:共纳入患者20例（20只眼），男11例（11只眼），女9例（9只眼），年龄为（59.65±8.92）岁（范围为46~78岁）。联合组和单纯组各10只眼，患者年龄、BCVA、眼压的差异均无统计学意义（均 P>0.05）。术后1、4、12周，联合组的眼压［（20.78±4.06）、（20.82±3.67）、（21.00±3.14）mmHg（1 mmHg=0.133 kPa）］显著低于单纯组［（25.15±4.63）、（28.52±8.12）、（29.80±8.34）mmHg］，差异均有统计学意义（均 P<0.05）。术后不同时间两组BCVA差异均无统计学意义（均 P>0.05）。联合组仅术后12周1只眼重硅油进入前房；单纯组术后1 d、1周、4周、12周分别0、2、5、7只眼重硅油进入前房。术后1 d、1周、4周、12周角膜水肿1级及以上的眼数联合组为3、1、1、1只眼，单纯组为3、2、5、6只眼。此外，术后12周单纯组1只眼视网膜未复位，联合组1只眼周边虹膜切除口关闭。 结论:在无晶状体眼玻璃体切除重硅油填充手术中联合12：00方位周边虹膜切除，可有效控制术后眼压，减少重硅油进入前房的情况发生，减轻术后并发症，提高手术安全性。

abstractsObjective:To investigate the clinical effect of performing a 12 o′clock peripheral iridectomy during vitrectomy with heavy silicone oil tamponade in aphakic eyes.Methods:This was a prospective controlled study. Patients diagnosed with tractional retinal detachment secondary to proliferative diabetic retinopathy and scheduled to undergo combined lens extraction and pars plana vitrectomy with heavy silicone oil tamponade at the Department of Ophthalmology, Second Affiliated Hospital of Harbin Medical University between January and December 2024 were enrolled in this study. Patients were randomly assigned, using a random number table, to either the combined group (undergoing aphakic vitrectomy with heavy silicone oil tamponade and a 12 o′clock peripheral iridectomy) or the simple group (undergoing aphakic vitrectomy with heavy silicone oil tamponade but without a peripheral iridectomy). Intraocular pressure (IOP) and best-corrected visual acuity (BCVA) were recorded preoperatively and at 1 day, 1, 4, and 12 weeks postoperatively. These measures, along with postoperative silicone oil migration into the anterior chamber, corneal condition, retinal reattachment status, and other complications, were compared between the two groups. Statistical analyses were performed using the independent-samples t-test, independent-samples Mann-Whitney U test, and chi-square ( χ2) test. Results:A total of 20 patients (20 eyes) were enrolled, including 11 males (11 eyes) and 9 females (9 eyes), with a mean age of (59.65±8.92) years (range, 46 to 78 years). There were 10 eyes in each of the combined and simple groups. No statistically significant differences were found between the two groups in terms of age, BCVA, or IOP at baseline (all P>0.05). At 1, 4, and 12 weeks postoperatively, the IOP in the combined group [(20.78±4.06), (20.82±3.67), and (21.00±3.14) mmHg; 1 mmHg=0.133 kPa] was significantly lower than that in the simple group [(25.15±4.63), (28.52±8.12), and (29.80±8.34) mmHg], with statistically significant differences at all time points (all P<0.05). There were no statistically significant differences in BCVA between the two groups at any postoperative time point (all P>0.05). Silicone oil migration into the anterior chamber occurred in only one eye in the combined group at 12 weeks postoperatively, whereas in the simple group, 0, 2, 5, and 7 eyes exhibited silicone oil in the anterior chamber at 1 day, 1, 4, and 12 weeks, respectively. Regarding corneal edema (grade≥1), the number of affected eyes in the combined group was 3, 1, 1, and 1 at the corresponding time points, while in the simple group it was 3, 2, 5, and 6, respectively. Additionally, at 12 weeks postoperatively, one eye in the simple group showed persistent retinal detachment, and one eye in the combined group exhibited closure of the peripheral iridectomy incision. Conclusion:Performing a 12 o′clock peripheral iridectomy during vitrectomy with heavy silicone oil tamponade in aphakic eyes can effectively control postoperative IOP, reduce the incidence of silicone oil migration into the anterior chamber, alleviate postoperative complications, and enhance surgical safety.