| 中文摘要
目的：探讨玻璃体手术并发医源性周边视网膜裂孔的发生率、危险因素、临床特征和治疗预后。
设计：回顾性系列病例研究。
研究对象：术前不伴有视网膜脱离的玻璃体手术患者379例共404只眼。
方法：记录并分析玻璃体手术中或手术后发现医源性周边视网膜裂孔的病例。
主要指标：术中或术后发现视网膜裂孔的部位、数量、以及是否伴有视网膜脱离，并比较术中或术后发现裂孔两组病例的视网膜复位率。
结果：379例共404只玻璃体手术眼中，32只眼出现了55个医源性周边视网膜裂孔，平均发生率7.9%；其中视网膜分支静脉阻塞患者的发生率最高，为13.3%；糖尿病视网膜病变患者的发生率较低，为3.7%。55个裂孔中，46个（84%）发生在颞上和鼻上象限，其中29个（53%）发生在手术者主操作手一侧，17个（31%）位于导光纤维主照明一侧；另外5个裂孔（9%）位于颞下象限（眼内灌注头部位），4个（7%）位于鼻下象限。32只眼中，14只眼于手术中发现视网膜裂孔或脱离，最终14只眼均获得视网膜解剖学复位，复位率100%；18只眼于手术后发现视网膜裂孔或脱离，最终12只眼获得视网膜解剖学复位， 2只眼部分复位，4只眼未复位，复位率67%。
结论: 医源性周边视网膜裂孔仍然是目前条件下玻璃体手术的重要并发症，其发生主要与巩膜切口相关，但较多见于视网膜分支静脉阻塞患者。手术中发现裂孔的患者组，其视网膜复位率高于手术后发现裂孔的患者组。提示在玻璃体手术结束前，应常规于巩膜外顶压下检查周边视网膜，以提高医源性周边视网膜裂孔的手术中检出率。
关键词: 玻璃体手术，并发症，医源性视网膜裂孔
Abstract
Objective: To establish the current incidence, risk factors, and characteristics of iatrogenic retinal breaks complicating pars plana vitrectomy and to propose a protocol for their management.
Design: Retrospective study of consecutive case series.
Participants: 404 consecutive vitrectomies performed on eyes without preexisting retinal breaks or retinal detachments.
Methods: Cases with iatrogenic peripheral retinal breaks during or after the vitrectomies were recorded and analyzed.
Main Outcome Measures: Number and location of retinal breaks, and anatomic outcome after surgical managements.
Results: Of the 404 vitrectomies, 32 eyes had 55 iatrogenic peripheral retinal breaks with an average incidence of 7.9%. Iatrogenic breaks were most common in cases with branch retinal vein occlusion (BRVO) (13.3%) and less common in cases with proliferative diabetic retinopathy (PDR) (3.7%). Of the 55 breaks, 46 (84%) occurred around the site of insertion of the vitreous and illumination probes. Breaks detected during surgery in 14 eyes, in which all 14 eyes obtained anatomic retinal reattachment. Breaks detected in 18 eyes after surgery, in which 12 eyes (67%) obtained successful anatomic outcome.
Conclusion: Despite improvements in instrumentation and surgical techniques, iatrogenic retinal breaks continue to be an important complication of pars plana vitrectomy. This complication is sclerotomy related but is more common in cases with BRVO compared with cases with PDR. Early detection during surgery tends to have a better outcome, suggesting that careful intraoperative examination of peripheral retina at the end of surgery is necessary.
Key words: pars plana vitrectomy, complications, iatrogenic retinal breaks
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