Clinical Analysis Of Complication After Pars Plana Vitrectomy

Vitrectomy is an important and effective method of treatment for some disease like ophthalmic posterior segment. Because it can effectively improve visual function and quality of life,medical workers and ophthalmic patients of the eye both think highly of it.Vitrectomy has been widely used to treat complicated retinal detachment, severe ocular trauma, vitreous hemorrhage turbidity, infectious endophthalmitis, proliferative diabetic retinopathy, macular lutea disease, proliferative vitreoretinopathy and other complex vitreoretinopathy . With the development of the technology of vitrectomy, people pay more attention to complications after the surgery. But it is undeniable that there are still many complications after vitrectomy, such as postoperative ocular hypertension, secondary glaucoma, complicated cataract, vitreous hemorrhage, and so on. These complications will also seriously affect postoperative visual acuity and surgical results. Many domestic and foreign scholars also note that the correct treatment of postoperative complications of vitrectomy is an important issue, this is still the hotspot of our work in the future.In this paper, 92 cases (103 eyes)who had been treated by vitrectomy in our hospital from September 2005 to September 2007 were reviewed with special attention to the complication after vitrectomy. 103 eyes are divided into three groups according to different packing material: pure vitrectomy (45 eyes), filled with silicone oil group (40 eyes) and filled with inert gas (18 eyes) ; and the other two groups are divided according to different age: above 50 years (including 50-year-old, 61 eyes) and below 50 years (42 eyes). All cases were followed up 3-24 months with special doctor,who observed and recorded their visual acuity,intraocular pressure(IOP),crystalline lens,vitreous and retina closely to detect complications after surgery in time and treat it correctly. Statistics were done to analyze complications among each group and assess the therapeutic effect after vitrectomy surgery. And we could summarize treatment principles through analysis and discussion of complications to provide some clinical reference value in the future.The result show that: 1. visual acuity: Raise 2 row than before were seen as improved standard of visual acuity ,85.76% patients obtained better visual acuity. 2. Hypertonia intraocular pressure: Calculate the patients whose IOP had been 25 mmHg or more,we found patients who got hypertonia intraocular pressure occured in 41 eyes (39.81%), 18.45%patients has been defined as a temporary hypertonia IOP, 4.85%patients has been defined as a persistent hypertonia IOP.Especially in inert-gas tamponade group , persistent IOP occured in 3 eyes( 16.67%). 3. Secondarg glaucoma:The rate of secondarg glaucoma was 5.56% in inert-gas tamponade group,and it was 12.5% in silicon-oil tamponade group. 4.Keratopathy:Temporary corneal edema after vitrectomy occured in 17 eyes in total ,the rate of occurrence is 16.50 %.In silicon-oil tamponade group, complicated keratopathy occured in 3 eyes,other groups didn't happen. 5. Complicated cataract:In >50 years old (include 50 years old)group , complicated cataract occured in 43 eyes of all 61 eyes , the rate of its occurrence is 70.49%;in <50 years old group,it occured in 20 eyes of all 42 eyes , the rate of which is 46.51%.The rate in silicon-oil tamponade group is 46.51%, and in inert-gas tamponade group is 44.44%. 6.Vitreous hemorrhage:In all patients,vitreous hemorrhage occured in 11 eyes about 10.67% ,and 54.54%occured in the first day after vitrectomy. There are not any distinct differences among every groups. 7. Retinal detachment: Retinal detachment occurred again in 6 eyes(5.83%). Among these groups, non-tamponade groups occurred in 1 eye(2.22%), silicon-oil tamponade group occurred in 3 eyes(7.5%), inert-gas tamponade group occurred in 2 eyes( 11.11%). 8. Iatrogenic tears retinal: Iatrogenic tears retinal occured in 11 eyes, the rate of occurrence is 10.68%in all.Old slit pore was not found in 5 eyes, old slit pore is larger than before ocured in 4 eyes, 2 eyes oppeared new slit pore.Thus, we come to the following conclusions:1. Pars plana vitrectomy is an important and effective method for posterior segment diseas,patients in every group obtained better visual improvement, the quality of their life has been raised, and they got better therapeutic effect. 2. In present study of every groups, hypertonia intraocular pressure,secondarg glaucoma,complicated cataract,vitreous hemorrhage and retinal detachment are hackneyed complication after vitrectomy. 3.There are obvious differences among every groups about postoperative complications according to statistical datas.The incidence rates of persistent hypertonia intraocular pressure and neovascular glaucoma in inert-gas tamponade group are obviously more than silicon-oil tamponade group and non-tamponade group(P<0.05). The rates of complicated cataract and keratopathy in silicon-oil tamponade group are obviously more than other two groups(P<0.05). 4.How to raise skill of operation and avoid or decrease postoperative complications and deal with the complications correctly is still a problem which need to be solved in the future.