Effects on ocular discomfort and tear film dynamics of suturing 23-gauge pars plana vitrectomies

ABSTRACT Purpose: To evaluate the effects of suturing 23-gauge pars plana vitrectomies on ocular discomfort and tear film dynamics. Methods: This retrospective chart review involved data from 50 procedures in 50 patients who underwent 23-gauge pars plana vitrectomy from January to November 2016. We divided the eyes into two groups according to the presence or absence of sutures; 35 eyes underwent sutureless vitrectomies (Group 1), and 15 eyes underwent vitrectomy with at least one sclerotomy suture site (Group 2). In each group, we assessed objective variables including tear film break-up time, Schirmer test I, corneal surface grading with Oxford system, and a quantitative method evaluating subjective dry eye symptoms using ocular surface disease index questionnaires preoperatively 1 week, and 1 and 3 months after surgery. Results: The tear film break-up time showed a significant difference at the 3-months follow-up (p=0.026). The Schirmer test I and corneal surface staining score showed no statistically significant differences between two groups at any time after the operations. The ocular surface disease index score was significantly lower in Group 1 than in Group 2 at 1 week (p=0.032), 1 month (p=0.026), and 3 months (p=0.041) after the operation. Conclusion: Sclerotomy suturing caused ocular discomfort and had a negative effect on tear film dynamics during the late postoperative period. Sclerotomies without suturing seem to reduce the ocular surface changes.

摘要：
目的：评估23-gauge经睫状体平坦部玻璃体切除术（pars plana vitrectomy）缝合操作对眼部不适及泪膜动力学的影响。
方法：本回顾性病历研究纳入2016年1月至11月间50例接受23-gauge经睫状体平坦部玻璃体切除术的患者的50例手术数据。根据是否使用缝合技术将患眼分为两组：35眼行无缝合玻璃体切除术（组1），15眼行至少存在1个巩膜穿刺口缝合的玻璃体切除术（组2）。于术前、术后1周、1个月及3个月，对两组患者的以下指标进行评估：泪膜破裂时间、Schirmer I试验（Schirmer test I）、采用牛津分级系统（Oxford system）的角膜表面评分，以及通过眼表疾病指数（ocular surface disease index）问卷量化评估主观干眼症状。
结果：术后3个月随访时，两组的泪膜破裂时间存在显著统计学差异（p=0.026）。术后各时间点，两组的Schirmer I试验结果及角膜表面染色评分均无统计学显著差异。术后1周（p=0.032）、1个月（p=0.026）及3个月（p=0.041）时，组1的眼表疾病指数评分均显著低于组2。
结论：巩膜穿刺口缝合会引发眼部不适，并在术后晚期对泪膜动力学产生负面影响。无缝合的巩膜穿刺术似乎可减轻眼表改变。