Use of an Iris Speculum for Retrolental Membrane Dissection for Stage 5 Prematurity of Retinopathy Complicated With Pupillary Adhesion.
Use of an Iris Speculum for Retrolental Membrane Dissection for Stage 5 Prematurity of Retinopathy Complicated With Pupillary Adhesion.
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使用虹膜窥器进行晶状体后膜剥离术治疗伴有瞳孔粘连的 5 期早产儿视网膜病变
DOI：
10.1097/iae.0000000000002748
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发表时间：
2023-01-01
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补充数字内容在文本中可用。报告虹膜窥器辅助膜剥离和槽分离治疗5期早产儿相关漏斗状牵引性视网膜脱离并发瞳孔粘连的视网膜病变的新用途。对9例（10只眼）5期早产儿相关性牵拉性视网膜脱离伴瞳孔粘连的视网膜病变患者进行了基于角膜缘的闭合性玻璃体切除术和膜剥离术。粘连松解后，放置虹膜窥器以扩大瞳孔用于手术可视化并保持中性虹膜平面。用垂直剪刀和末端夹持钳，沿周边槽沿着向中央视网膜，双手和圆周剥离晶状体后膜。在所有10只眼中，晶状体后膜被完全去除，沟槽被周向解开。术后6 ~ 18个月随访，开-窄漏斗型3眼视网膜复位，窄-窄漏斗型7眼6眼视网膜复位。在所有9只显示视网膜复位的眼睛中，均保留了近圆形瞳孔，无复发性瞳孔粘连。虹膜窥器的这种使用有效地暴露了手术视野，以便在5期早产儿相关牵引性视网膜脱离并发瞳孔粘连的视网膜病变中完全去除晶状体后组织并中断外周槽。术后瞳孔形态保持良好。
Supplemental Digital Content is Available in the Text. To report a novel use of an iris speculum to assist with membrane dissection and trough separation for stage 5 retinopathy of prematurity–related funnel-shaped tractional retinal detachment complicated with pupillary adhesion. Limbus-based closed vitrectomy and membrane dissection were performed in 10 eyes (9 patients) with stage 5 retinopathy of prematurity–related tractional retinal detachment and pupillary adhesion. After synechiolysis, an iris speculum was positioned to enlarge the pupil for surgical visualization and maintain a neutral iris plane. The retrolental membrane was dissected bimanually and circumferentially along the peripheral trough and then toward the central retina with vertical scissors and end-gripping forceps. In all 10 eyes, retrolental membranes were entirely removed and troughs were circumferentially unraveled. Follow-up examinations performed 6 to 18 months postoperatively showed reattachment of the retina in 3 eyes with an open-narrow funnel and 6 of 7 eyes with a narrow–narrow funnel. A near-circular pupil without recurrent pupillary adhesion was preserved in all nine eyes showing retinal reattachment. This use of the iris speculum effectively exposes the surgical field for the entire removal of retrolental tissue and interruption of the peripheral trough in stage 5 retinopathy of prematurity–related tractional retinal detachment complicated with pupillary adhesion. The pupil's configuration is well preserved postoperatively.