玻璃体手术并闭合式睫状体复位治疗复杂眼外伤

目的评价玻璃体手术联合闭合式睫状体复位手术在治疗伴有睫状体离断、晶状体脱位、玻璃体积血的复杂眼外伤中的临床效果。方法对2005年1月至2014年10月在威海市中心医院就诊的眼球挫伤患者21例（21只眼）,裂隙灯下见晶状体脱位,超声生物显微镜（UBM）检查睫状体离断范围在4～12个钟点,玻璃体积血较多,眼压5～17mmHg（1mmHg=0．133kPa）的患者施行晶状体、玻璃体切除手术,联合闭合式睫状体复位术。结果术后复查UBM示睫状体离断口复位。术后眼压12～30mmHg,平均（18±3．25）mmHg。结论对睫状体离断口大合并有晶状体脱位、玻璃体积血的复杂眼外伤可施行晶体玻璃体切割联合闭合式睫状体复位术。     

玻璃体切割术在治疗伴有睫状体脱离的复杂眼外伤中的临床疗效观察

目的探讨玻璃体切割在治疗伴有睫状体脱离的复杂眼外伤中的临床疗效。方法 7例(7只眼)严重眼外伤患者中,3只眼钝挫伤,外伤性瞳孔散大、晶状体脱位或半脱位,玻璃体出积,4只眼眼球破裂伤,清创缝合术后,合并视网膜脱、脉络膜脱离和脉络膜上腔出血。7只眼经超声生物显微镜(UBM)探查所有外伤眼睫状体360°全周脱离,离断口的范围在1~2个象限。术前视力光感至眼前手动,平均眼压(6.03±3.25)mm Hg。2只眼钝挫伤患者先行睫状体复位,二期施行玻璃体切割术+晶状体切除+硅油充填,另5只眼行玻璃体切割术+晶状体切除+硅油充填视网膜复位+巩膜外穿刺放液等。结果硅油取出后随访UBM显示所有患眼睫状体复位。所有外伤眼术后视力较术前明显提高。眼压(19.33±5.05)mm Hg。结论对于合并睫状体脱离的严重眼外伤患者,分期或联合手术均可有效恢复眼球的解剖结构,并保存有效的的视功能。     

复杂眼外伤处理中Ⅰ期玻璃体手术联合睫状体离断复位观察

目的：评价Ⅰ期玻璃体手术联合睫状体缝合治疗合并睫状体离断的复杂眼外伤的临床治疗效果。

方法：观察2011-01-01/2014-10-31期间连续收治严重眼外伤合并睫状体离断患者13例13眼。其中2眼钝挫伤,7眼穿通伤和4眼破裂伤,伴随症状有角膜裂伤、角巩膜缘裂伤、巩膜裂伤、前房积血、虹膜根部离断、瞳孔括约肌撕裂、晶状体破裂或脱位、玻璃体积血、视网膜挫伤、视网膜脱离、脉络膜挫伤、脉络膜上腔出血、球内异物等。术前检查视力无光感～手动/眼前。术前UBM或三面镜检查或术中发现睫状体离断,脱离范围2：00～6：00。钝挫伤患者眼压分别5.4mmHg和10.2mmHg。手术时间为伤后6h～3d,主要操作包括关闭角膜巩膜伤口、切除玻璃体、切除晶状体、清除积血、视网膜复位、缝合方法复位脱离睫状体。脉络膜出血采用巩膜外穿刺切开放液处理。眼内采用惰性气体或硅油填充。

结果：术后检查13例脱离睫状体均复位。术后1mo,患眼视力有不同程度提高,检查最佳矫正视力手动/眼前～4.7,眼压9.8～24.5mmHg(除外严重角膜裂伤缝合术后角膜水肿1眼),术后三面镜或UBM检查睫状体复位,B超或眼底镜检查视网膜复位。

结论：对于合并睫状体离断复杂眼外伤眼,采用Ⅰ期玻璃体手术联合睫状体缝合治疗可有效恢复眼球解剖结构,并有效保存视功能。     

睫状体复位联合玻璃体手术治疗复杂眼外伤

目的 评价睫状体复位联合玻璃体手术在治疗伴有睫状体脱离的复杂眼外伤中的临床疗效.方法 对严重钝挫伤患者20例(20只眼),超声生物显微镜(UBM)探查所有外伤眼睫状体360°全周脱离,离断口的范围在3～5个钟点,其中6例伴有不同程度的房角后退.术前眼压4～17mmHg,12例IOP≤6mmHg.伴随症状包括外伤性扩瞳、浅前房、前房积血、虹膜根部离断、晶状体脱位或半脱位、外伤性白内障、玻璃体混浊、视网膜脱离、脉络膜脱离等.所有患眼施行玻璃体视网膜手术联合睫状体修补术.结果 术后UBM检查睫状体脱离消失,离断口封闭.术后1月眼压13≤21mmHg,平均(17±3.15)mmHg.随访所有外伤眼视网膜在位,屈光间质清晰.结论 对于复杂眼外伤,尤其是伴有低眼压的患者,术前应常规行UBM检查.对于睫状体离断口范围超过2个钟点的,在行玻璃体视网膜手术的同时要联合睫状体修补术.     

玻璃体切除联合不同睫状体复位术式的疗效观察

目的:观察玻璃体切除联合两种睫状体复位缝合手术方法治疗复杂性睫状体脱离的临床疗效.方法:回顾42例42眼经B超及超声生物显微镜(ultrasound biomicroscopy,UBM)检查存在睫状体脱离(离断口范围≥600),同时伴有晶状体、玻璃体、视网膜病变和眼外伤患者的临床资料.按照睫状体复位手术方式分为玻璃体切除联合睫状体巩膜间断缝合组20眼(A组)、玻璃体切除联合睫状体巩膜连续褥式缝合组22眼(B组).A组首先间断缝合巩膜睫状体,然后进行玻璃体切除术.B组首先进行晶状体玻璃体切除术,然后由巩膜表面进针进入玻璃体腔内连续褥式缝合睫状体组织.观察术后最佳矫正视力、术后眼压情况、睫状体复位情况及两组患者睫状体复位手术时间,并进行统计分析.结果:两组患者术后视力及眼压情况差异无统计学意义(P＞0.05),两组患者术后视力及眼压较术前差异有统计学意义(P＜0.05),两组患者睫状体复位成功率(A组90％,B组86.36％)差异无统计学意义(P＞0.05),两组患者睫状体复位手术时间差异有统计学意义(P＜0.05).结论:玻璃体切除联合两种术式复位缝合睫状体治疗复杂性睫状体脱离均安全有效,对于保留晶状体者适宜应用睫状体巩膜间断缝合方法,睫状体巩膜连续褥式缝合法适用于无晶状体眼、人工晶状体眼患者,对于广泛性睫状体脱离者更为简便.     

玻璃体视网膜手术后早期低眼压和睫状体脱离的临床观察

目的 观察玻璃体视网膜手术后早期睫状体脱离的发生率及其自然病程，并分析其与手术后早期低眼压的关系。方法 利用超声生物显微镜检查(UBM)连续观察行玻璃体视网膜手术治疗的患者46例46只眼。按玻璃体视网膜手术后不同填充内容分组：气体填充组11例11只眼，硅油填充组8例8只眼，平衡盐溶液（BSS）填充组27例27只眼。按手术后眼压分组：眼压<10 mm Hg（1 mm Hg=0.133 kPa)组25例25只眼，≥10 mm Hg组21例21只眼。玻璃体视网膜手术后第3天行UBM确定有无睫状体脱离，手术后每天用非接触眼压计监测眼压，有睫状体脱离者每隔7 d复查1次，直至睫状体脱离复位，所有患者均随访观察14～35 d。结果 手术后睫状体脱离20例，占本组患者的43.5％。无睫状体脱离者26例，占本组患者的56.5%。玻璃体视网膜手术后气体填充组睫状体脱离发生率 27.3％，硅油填充组25.0％，而BSS填充组为55.6％。睫状体脱离者手术后平均眼压(6.47±4.49) mm Hg （1 mm Hg=0.133 kPa），无睫状体脱离者平均眼压(15.61±7.72) mm Hg，两者差异有统计学意义（t=8.031,P＜0.001）。手术后眼压<10 mm Hg组患者睫状体脱离发生率为68.0％，眼压≥10 mm Hg组患者睫状体脱离发生率为14.3％，两组差异有统计学意义(χ2＝15.60, P＜0.001)。玻璃体视网膜手术后早期睫状体脱离患者除1例因低眼压引起视盘水肿而需行气体填充外，其余患者均在手术后30 d内自行复位。结论 手术后早期睫状体脱离是玻璃体视网膜手术的常见并发症。玻璃体视网膜手术后行BSS填充患者手术后睫状体脱离的发生率高。绝大多数患者睫状体脱离能够在玻璃体视网膜手术后30 d内自行复位。     

眼挫伤后睫状体脱离的UBM观察

目的:超声生物显微镜(ultrasound biomicroscopy,UBM)观察眼挫伤后睫状体脱离的特点,并评价UBM指导下睫状体缝合手术治疗眼挫伤后睫状体脱离的临床效果。方法:应用UBM观察30例30眼因眼球挫伤导致睫状体脱离的特点,其中5例5眼行房角漏对应位置和范围的睫状体缝合复位手术,观察视力、眼压及复查UBM及B超(其余患者为门诊患者,具体治疗及预后情况不详)。结果:UBM检查示不同程度的睫状体脱离,27眼为全周睫状体脱离,26眼存在房角漏口,平均中央前房深度(1.830±0.575)mm。5眼行房角漏对应位置和范围的睫状体缝合复位手术后,所有患者房角漏口全部封闭,全周睫状体脉络膜脱离痊愈,前房加深,视力提高,眼压上升至正常。5眼中,4眼行1次手术后睫状体脉络膜脱离痊愈,1眼行4次手术后痊愈。结论:UBM是诊断眼挫伤后睫状体脱离的较好的工具,UBM指导下睫状体缝合手术治疗房角漏的临床效果好,UBM对于眼挫伤致睫状体脱离的临床诊断、治疗和随访具有指导意义。     

改良式外伤性睫状体解离缝合复位术的临床研究

目的:评估改良式外伤性睫状体解离缝合复位术的手术效果,以探索睫状体解离更理想的手术方案。方法:选取外伤性睫状体解离患者33例33眼,超声生物显微镜(UBM)检查定位离断口范围后,采用改良式睫状体解离缝合复位术。术后随访3~6mo,观察术后睫状体复位、眼压、视力和并发症情况。结果:术后1wk复查UBM,30例30眼睫状体完全复位,3例3眼局部有睫状体浅脱离,术后15d复查UBM睫状体完全复位。术后20例20眼眼压高,早期眼压高17例17眼,3d后眼压恢复正常;1眼1wk后眼压恢复正常;2眼眼压高者药物不能控制至正常,1眼2mo后行抗青光眼手术,1眼行睫状体激光光凝术,术后眼压均控制正常。术后视力均有不同程度改善,未见眼前段缺血并发症和角膜大散光。结论:改良式睫状体解离复位缝合术操作简单安全、疗效可靠、术源性损伤小,并发症少。     

外伤性睫状体断离直视下睫状体复位术

目的 探讨在直视下睫状体复位术治疗外伤性睫状体断离的临床效果.方法 回顾性分析外伤性睫状体断离23例（23眼）在直视下行改良睫状体缝合复位术的临床资料.男19例,女4例.病程1 h～2年半.就诊时眼压为4 ～ 10 mmHg（1 mmHg =0.133 kPa）.术前均通过前房角镜及超声生物显微镜（UBM）确定睫状体断离的位置和范围.结果 术后随访1～6个月,全组23眼眼压均提高到＞8 mmHg.随访6个月时23眼眼压均正常,和术前相比差异有统计学意义（t=10.8597,P=0.0000）.术后视力提高者17眼（73.9％）.大部分前房加深或正常,眼底有不同程度的改善.结论 直视下改良睫状体缝合复位术治疗外伤性睫状体离断疗效显著,手术成功率高.UBM可明确睫状体离断的位置和范围,对手术成功有重要作用.     

复杂眼外伤玻璃体视网膜手术后睫状体断离的原因探讨

目的探讨合并视网膜脱离的复杂眼外伤行玻璃体视网膜手术后发现睫状体断离的可能原因,并探讨其处理的基本原则。方法收集自2004年1~12月在我院因复杂眼外伤住院者资料4例,均因视网膜脱离曾在外院或我院行玻璃体视网膜手术,术中填充硅油或惰性气体,术后发现持续低眼压及睫状体断离。结果4例均再次手术行睫状体复位术,眼压恢复正常。结论对于复杂眼外伤发生低眼压者,进行前房角镜检查或超声生物显微镜(UBM)检查具有重要意义。术前未发现睫状体分离,或虽发现睫状体分离但未予处理或者处理不善,术后会因持续的低眼压而影响视力。     

Surgical treatment of cyclodialysis

PURPOSE: Cyclodialysis is a rare complication following blunt traumatic bulb injuries or surgical interventions. When treatment with cycloplegics or steroids is ineffective in attaching the ciliary body, cyclodialysis should be surgically treated. However, for reliable diagnosis and surgical therapy, an exact identification (size and extent) of the cyclodialysis cleft is imperative. Ultrasound biomicroscopy (UBM) provides the appropriate information. CASE REPORT: Four patients (19 to 65 years old, mean 45 years) with a detached ciliary body are described. Three patients had suffered an injury, and one patient presented with a prior trabeculotomy. The diagnosis was established with UBM. The location of the cyclodialysis cleft ranged between 2 and 3 o'clock (mean 2.4 o'clock). In spite of an intense treatment with cycloplegics and steroids no reattachment of the cyclodialysis took place. Therefore, a surgical intervention was performed. The span between the injury and trabeculotomy, respectively, and the cyclodialysis operation ranged from 3 to 30 months (mean 12 months). On average, visual acuity was increased from 0.3 preoperatively to 0.6 postoperatively, and the intraocular pressure was 6 mm Hg before and 15 mm Hg after operation. Symptoms preoperatively found without exception (choroidal detachment, papilledema "e vacuo", macular edema) had a complete recovery after operation. CONCLUSION: In cases where drug therapies are unsuccessful in attaching the ciliary body, an operative fixation is recommended. UBM is a very useful tool for making an exact diagnosis and defining the location of cyclodialysis as well as for follow-up of surgical treatment.     

Four cases of hypotony maculopathy caused by traumatic cyclodialysis and treated by vitrectomy, cryotherapy, and gas tamponade

Purpose We report our results in four cases of hypotony maculopathy caused by traumatic cyclodialysis and treated by combined vitrectomy and cataract surgery.Methods The patients' visual acuities ranged from light perception to 0.2, and intraocular pressures ranged from 4.7 to 5.7 mmHg (mean 5.1 mmHg) before surgery. Ultrasound biomicroscopy (UBM) revealed cyclodialysis associated with ciliary body detachment of 180° to 360°. We performed combined vitrectomy and cataract surgery, with pars plana cryopexy for detached ciliary body and an SF₆ gas tamponade.Results Postoperative UBM showed that cyclodialysis and/or ciliary body detachment disappeared in the whole circumference of two eyes, while it partially remained at 15° in one eye and at 30° in one eye. Postoperative visual acuity ranged from 0.06 to 1.2, with IOP ranging from 9.0 to 14.7 mmHg (mean 12.2 mmHg).Conclusions Based on our results, we consider that the present combined therapy is highly reliable for closing and adhering traumatic cyclodialysis and normalizing hypotony.     

Surgical treatment for 42 patients with traumatic annular ciliochoroidal detachment

AIM: To observe the central corneal thickness (CCT) changes in infants and young children who had been undergone bilateral congenital cataract surgery, and to compare the changes with normal control group which was selected from healthy population. METHODS: A cross section case-control study contained 28 cases (56 eyes) of bilateral aphakia (aphakic group) due to congenital cataract surgery combining with posterior continuous curvilinear capsulorhexis and with anterior vitrectomy during 2-6 months after birth. Fourteen children (28 eyes) of age-sex matched with the aphalic group were selected as normal control group. CCT and intraocular pressure (IOP) were measured postoperatively and the results were compared between groups. RESULTS: The mean CCT was 653.5±82.4μm in the aphakic group and 579.6±39.2μm in the control group, with a significant difference (P=0.000). The mean value of IOP in aphakic group (22.0±1.6mmHg) was greater than that of control group (16.9±2.1mmHg), P=0.023. There was a negative correlation between age and CCT in normal control group (r=-0.531, P=0.026), and there was no correlation in bilateral aphakia group (r=-0.324, P=0.165) CONCLUSION: Aphakic children due to congenital cataract surgery have a greater CCT than normal children. It is necessary to consider CCT in evaluating IOP for children after congenital cataract surgery.     

Long-term outcomes following the surgical repair of traumatic cyclodialysis clefts

Purpose

To evaluate the long-term visual prognosis and intraocular pressure (IOP) control following direct and indirect cycloplexy for the surgical treatment of traumatic cyclodialysis clefts.

Methods

Retrospective consecutive case series of 17 eyes of 17 patients. All eyes showing signs of ocular hypotony were treated with either cleft cyclocryotherapy and/or direct surgical cycloplexy. Cycloplexy was performed by directly suturing the ciliary body to the scleral spur under a double-lamellar limbal-based scleral flap. The main outcome measures were IOP, best-corrected visual acuity (BCVA), and the occurrence of postoperative complications.

Results

The cyclodialysis clefts were post-traumatic in all the 17 eyes and extended for 2.1±1.6 clock-hours (range, 0.5–6 clock-hours). The mean follow-up time was 43.7±24.6 months (range, 12–110 months). Preoperatively, the mean IOP was 6.9±4.0 mm Hg (range, 2–14 mm Hg). Postoperatively, painful reversible IOP spikes of up to 70 mm Hg developed in 13 eyes. The final mean postoperative IOP was 12.2±4.1 mm Hg with no cases of secondary glaucoma. Preoperatively, BCVA was 6/12 or better in 4 eyes (24%), which rose to 12 eyes (71%) at final follow-up. Of the 12 patients who underwent direct cycloplexy, 75% achieved a final BCVA of 6/12 or better. There were no serious complications related to direct cycloplexy, including suprachoroidal haemorrhage or endophthalmitis.

Conclusions

Successful cyclodialysis cleft repair can lead to a good long-term visual prognosis and stable IOP control, even in cases with a protracted history of ocular hypotony.     

外伤性睫状体脱离手术治疗

目的探讨外伤性睫状体脱离行睫状体缝合复位术的效果。方法外伤性睫状体脱离范围超过60°、经散瞳及皮质类固醇等保守治疗无效、低眼压持续时间超过15d者31例（31眼）,进行直接睫状体缝合复位术,分析临床资料并评价其手术效果。结果术后观察3～6个月。术后第1天,14眼眼压〉21mmHg;眼压在10～21mmHg者15眼;〈10mmHg者2眼。对眼压〉21mmHg者给予局部降眼压药1～2种,眼压均控制在24mmHg以下,所有病例在2月内眼压均控制良好并停药。视力均有提高,其中〈0．1者2眼,0．1～0．25有6眼,0．3～0．5有9眼,0．6～0．9有12眼．≥1．0有2眼。视盘及视网膜水肿减轻或恢复正常。其中2眼因低眼压持续时间〉2个月。视盘色淡,视力分别为0．06和数指／50cm。结论睫状体脱离缝合复位术是治疗眼挫伤后睫状体脱离的有效方法,对脱离范同大、保守治疗无效者,应及早手术,有利于恢复眼压,保护视功能。     

Diagnosis and management of traumatic cyclodialysis cleft

A 48-year-old man presented with hyphema, iridocyclitis, iridophacodonesis, and maculopathy after a contusive trauma. Ultrasound biomicroscopy identified a 90-degree cyclodialysis cleft with severe damage of the zonular fibers. Echographic B-scan examination revealed intravitreal hemorrhage and a 360-degree choroidal detachment. One month later, phacoemulsification was performed and a single-piece poly(methyl methacrylate) intraocular lens was inserted into the ciliary sulcus, with the haptic rotated toward the cyclodialysis cleft area. Postoperatively, the visual acuity improved and the intraocular pressure returned to normal. Ultrasound biomicroscopy showed closure of the cleft by reattachment of the ciliary body to the scleral spur. Optical coherence tomography revealed complete resolution of the macular and choroidal folds. Ultrasound biomicroscopy is a useful method for appropriate management of traumatic cyclodialysis cleft. In cases of small cyclodialysis clefts, with the surgical method we describe, the lens haptics apply directional force toward the sclera, fostering adherence of the ciliary body fibers.     

超声生物显微镜在睫状体脱离复位术中的应用价值

目的 评价超声生物显微镜在挫伤性睫状体脱离复位手术中的应用价值。方法 对３３例经ＵＢＭ检查证实为睫状体脱离的患者进行手术分析评价,并回顾总结单纯应用前房角镜检查施行睫状体复位８３例的手术效果。