连续缝纫式缝合术治疗外伤性睫状体离断及其疗效观察

目的：评价外伤性睫状体离断连续缝纫式缝合术的临床效果。方法：回顾性系列病例研究。对13例 （13眼）外伤性睫状体离断合并眼内其他闭合性损伤者，行晶状体、玻璃体切除同时采用内路法连续 缝纫式缝合复位离断的睫状体，并对其疗效，手术优点及有关注意事项进行分析。结果：术后随访 期间经超声生物显微镜及前房角镜检查，所有术眼睫状体复位良好。B超及眼底镜检查无视网膜脱 离。除2眼术后2～3 d有一过性高眼压外，所有术眼随访期间眼压均正常，最佳矫正视力均有不同 程度的提高。无其他术中及术后相关并发症。结论：睫状体离断内路法连续缝纫式复位术创伤小， 手术效果佳，可与虹膜、晶状体、玻璃体等手术同期进行。     

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。     

30G针头辅助下连续褥式缝合治疗外伤性睫状体离断

目的　探讨30G针头辅助下连续褥式缝合治疗外伤性睫状体离断的有效性及安全性。方法　收集2014年7月至2018年7月我院眼外伤科收治的外伤性睫状体离断患者12例（12眼），均行30G针头辅助下连续褥式缝合。观察角膜及前房反应情况，比较手术前后患者最佳矫正视力、眼压等，并利用超声生物显微镜观察手术后睫状体组织复位情况。结果　12例患者均成功实施30G针头辅助的睫状体连续褥式缝合术，术后睫状体均复位，最佳矫正视力、眼压均得到不同程度提高，术前眼压为（6.46±1.08）mmHg（1 kPa=7.5 mmHg），术后1周、1个月眼压分别为（16.50±4.97）mmHg、（14.58±4.00）mmHg，均较术前明显提高，差异均有统计学意义(t=-7.47、-6.81,均为P<0.05)。术后随访 3～12个月，未出现线结外露、缝线松脱、角膜内皮失代偿、交感性眼炎、眼内炎、脉络膜脱离等并发症。结论　30G针头辅助下连续褥式缝合治疗外伤性睫状体离断安全有效，手术操作简单，组织损伤小，并发症少。     

改良睫状体缝合术治疗外伤性睫状体脱离

目的 评价改良的睫状体缝合术治疗外伤性睫状体脱离的临床效果.方法 20例(20眼)外伤性睫状体脱离进行改良的缝合复位术,主要是只针对断离区进行水平叠错式缝合.分析临床资料并评价其疗效.结果 18眼术后视力不同程度提高.所有患眼术后眼压均提高,18眼眼压恢复至正常.3眼术中出现前房积血.结论 改良的睫状体缝合术治疗外伤性睫状体脱离效果良好.     

Closure of persistent cyclodialysis cleft using the haptics of the intraocular lens

PURPOSE: To evaluate a technique for ab-interno repair of cyclodialysis cleft in conjunction with placement of an intraocular lens (IOL). DESIGN: Interventional case reports. METHODS: setting: Clinical practice. patients: Two eyes of two patients, one phakic and one aphakic, present with hypotony secondary to traumatic cyclodialysis cleft. intervention: A single piece all-polymethyl methacrylate intraocular lens (PMMA IOL) 13.5 mm in diameter was placed in the ciliary sulcus with the haptics placed in the area of cyclodialysis cleft during cataract surgery and secondary placement of IOL. main outcome measures: Intraocular pressure (IOP). RESULTS: Hypotony resolved in both patients on the first postoperative day and the IOP was maintained above 10 mm Hg for more then 36 months postoperatively. CONCLUSIONS: In the setting of hypotony from a traumatic cyclodialysis cleft, the haptics of an IOL can be used as an internal cerclage during cataract or secondary IOL surgery to effectively close the cleft by direct apposition of the ciliary body to the overlying sclera.     

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。     

复杂眼外伤伴睫状体离断的手术疗效

目的 观察复杂眼外伤致睫状体离断并伴有眼前后节损伤患者的手术治疗效果.方法 B型超声及超声生物显微镜(UBM)检查确诊存在不同程度睫状体离断伴眼前后节损伤,需行玻璃体切割手术治疗的复杂眼外伤患者55例55只眼纳入本研究.其中,眼球钝挫伤35例,眼球破裂伤20例.视力无光感～0.15,不能矫正.眼压1～10 mm Hg(1 mm Hg=0.133 kPa),睫状体离断范围1～12个钟点.所有患者均行经扁平部玻璃体切割联合睫状体离断复位术.对于睫状体离断范围≤3个钟点者,冷冻封闭睫状体离断口;睫状体离断范围＞3个钟点者,缝合离断的睫状体与相应巩膜.手术后就外伤愈合、视力、眼压、眼内出血、睫状体以及视网膜的复位情况进行随访.结果 手术后1个月,UBM检查显示,54例患者睫状体复位良好,1例患者前房角镜检查仍见针尖大小离断口,第2次手术缝合后复位成功.手术后3个月,55例患者眼外伤愈合良好,视力无光感～0.15,最佳矫正视力为0.8.视网膜在位,睫状体复位良好.52例患者眼压恢复至正常范围,另外3例眼压仍低于10 mm Hg.3例发生继发性青光眼,手术后15 d行抗青光眼手术,眼压得以控制.结论 经扁平部玻璃体切割联合睫状体冷冻或缝合复位手术治疗复杂眼外伤致睫状体离断并伴有眼前后节损伤患者安全有效,避免了分期手术的痛苦,手术后眼压恢复良好,部分患者恢复了有用的视力.     

外伤性睫状体分离复位后继发青光眼的治疗

目的:探讨外伤性睫状体分离复位后继发青光眼的治疗效果。方法:回顾性分析1999-06/2005-09诊治的外伤性睫状体分离35例的临床资料。结果:35例中26例治疗后出现眼压升高,25例药物治疗后眼压控制,1例行复合式小梁切除术后眼压控制。结论:外伤性睫状体分离经治疗复位后需密切观察眼压的变化,药物和手术治疗能较好地控制眼压,保护视功能。     

Efficacy of combined vitreous surgery and choroidal suture fixation on choroidal avulsion

 Purpose: To evaluate the feasibility and efficacy of combined vitreous surgery and choroidal suture fixation on choroidal avulsion. Methods: A total of 21 patients (21 eyes) with choroidal avulsion, secondary to open eye trauma and a history of one-stage eyeball wall closure were retrospectively evaluated in the present study. Preoperative findings included 3 to 7.5 mmHg (averagely 5.1±1.1mmHg) of intraocular pressure and presence/suspicion of visual light perception. Vitreo-retinal surgery in combination with choroidal suture fixation was conducted for these patients at 4 to 21 days (averagely 9.41±2.7 days) after the trauma. The postoperative follow-up lasted for 3 to 9 months (averagely 5.5±1.5 months). Results: The intraoperative findings indicated several choroid residuals with different densities attached on the sclera at the choroidal detachment area. Retinal proliferation/detachment, incarceration and/or partial retinal loss were also observed. Intraoperatively, the retina was separated and released, and the suture fixation outside the sclera in combination with intraocular photocoagulation and silicone oil filling were performed at the avulsed choroidal area. The suture fixation on the ciliary body was also introduced in some of the patients. At one month posteoperatively, a complete choroidal reattachment was achieved in 16 eyes (16/21, 76.19%) and partial reattachment in the remaining 5 eyes. At the end of follow-up, partial choroidal redetachment was observed in 4 of 16 eyes (25%), resulting in complete reattachment in 12 eyes (12/21, 57.1％) and partial reattachment in 9 eyes (9/21, 33.34％). The complete choroidal reattachment rate at the end of follow-up was not significantly different from that observed at one month after the surgery (Chi-square test, P<0.05), while the complete retinal reattachment rate at this time point was significantly lower than that at one month postoperatively (Chi-square test, P>0.05). Conclusion: Transscleral suture fixation serves as a reliable technique, particularly improving the choroidal reattachment rate in the choroidal avulsion.     

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.     

睫状体缝合复位术的临床观察及护理

目的:探讨适合睫状体缝合复位术病人的护理方法。方法:对34例(34只眼)因外伤致睫状体分离和脱离导致低眼压,随后行睫状体缝合复位术的病人进行观察和护理。结果:32只眼术后1周至6个月眼压恢复正常,其中5只眼术后2～5个月内分别进行第二次手术或氩离子激光光凝而痊愈。视力改善者21例,无变化者13例。结论:睫状体缝合复位术是治疗外伤性睫状体分离和脱离的有效方法。术前行超声生物显微镜(UBM)检查、术后密切观察眼压变化并给予正确处理、做好心理护理和出院指导是确保手术成功的重要措施。     

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.     

Intraocular pressure after homologous penetrating keratoplasty

PURPOSE: To evaluate intraocular pressure (IOP) changes after homologous central penetrating keratoplasty in a noncomparative interventional case series. METHODS: The study included 245 patients undergoing homologous central penetrating keratoplasty for keratoconus (n = 77), herpetic corneal scars (n = 29), nonherpetic corneal scars (n = 46), Fuchs endothelial dystrophy (n = 24), and secondary corneal endothelial decompensation caused by preceding intraocular operations (n = 69). Mean follow-up time was 30.4 +/- 18.7 months (range, 12.1-111.6 months). The same surgeon operated on all patients, and a peripheral iridotomy was routinely performed. RESULTS: On the first postoperative day, IOP was significantly (P = 0.02) higher than that before keratoplasty. Taking the whole study group and taking the study groups separately, IOP measurements determined on the third postoperative day (P = 0.57), 1 week after surgery (P = 0.55), or later (P > 0.50) were not significantly different from the preoperative values. Eyes undergoing keratoplasty with cataract surgery and eyes undergoing keratoplasty without additional intraocular procedures did not vary significantly (P > 0.10) in IOP measurements. IOP did not differ significantly (P > 0.50) between eyes with an immunologic graft reaction (n = 29) and eyes without a reaction (n = 216). Acute angle-closure glaucoma was not detected in any of the patients. IOP measurements were statistically independent of suture type (P > 0.10), age (P > 0.05), preoperative and postoperative refractive error (P > 0.05), preoperative and postoperative corneal astigmatism (P > 0.10), preoperative and postoperative visual acuity (P > 0.10), diameter of graft and trephine (P > 0.15), and oversize of the graft (P > 0.50). Postoperative IOP measurements were significantly (P < 0.01) correlated with preoperative IOP values. CONCLUSIONS: In eyes with a peripheral iridotomy performed during surgery, homologous central penetrating keratoplasty usually does not markedly change IOP. The main risk factor for postoperatively increased IOP is increased IOP before surgery.     

改良小梁切除术治疗青光眼的临床分析

目的:采用改良小梁切除术治疗青光眼并观察其临床效果。方法:施行改良小梁切除术18例21眼,术中应用抗代谢药物及可调节缝线,术后观察视力、眼压、前房及并发症。结果:出院时术后视力与术前视力无变化者6例8眼,提高者9例10眼,降低者3例3眼。Ⅰ°浅前房3例3眼,球结膜伤口渗漏4例4眼,经治疗恢复愈合。术后眼压失控者1例1眼,需再次手术。根据术后眼压高低及前房深浅,对可调节缝线进行拆除。部分患者术后视野略有改善。结论:改良小梁切除术术后并发症少,获得了较好的临床效果,但需长期随访。     

Schlemm管为基础的青光眼内引流手术术后眼压分布特征

目的：分析以Schlemm管为基础的各类型青光眼内引流手术术后眼压分布特征。方法：回顾性系列病例研究。选取2015年6月至2019年1月于温州医科大学附属眼视光医院行以Schlemm管为基础的青光眼内引流手术（黏小管成形术和穿透性黏小管成形术）的患者资料,入选其中随访时间≥6个月, 且末次随访在未用药情况下眼压≤21 mmHg（1 mmHg=0.133 kPa）患者,分析患者的眼压分布特征。各类型青光眼的眼压比较采用单因素方差分析。结果：共纳入患者204例（236眼）,术前眼压为 （33.4±12.1）mmHg,用药（2.7±1.2）种。术后末次随访时（6个月及以上）眼压为（13.9±3.3）mmHg。 其中眼压分布在5～10 mmHg有37眼（15.7%）,分布在>10～12 mmHg有43眼（18.2%）,分布在 >12～15 mmHg有78眼（33.1%）,分布在>15～18 mmHg有56眼（23.7%）,分布在>18～21 mmHg有 22眼（9.3%）。原发性开角型青光眼（85眼）、原发性闭角型青光眼（30眼）、继发性青光眼（76眼）和先天性青光眼（45眼）的末次随访眼压分别为（13.9±3.2）（14.5±3.0）（14.0±3.3）（13.2±3.7）mmHg, 各类型青光眼总体眼压差异无统计学意义（F=1.011,P=0.289）。对于原发性开角型青光眼,早、中、 晚期青光眼的目标眼压达标率分别为82.4%、81.8%、36.8%。结论：以Schlemm管为基础的青光眼内引流手术术后平均眼压为14 mmHg,80%的早、中期以及1/3的晚期原发性开角型青光眼患者可以达到目标眼压。     

The effect of adjustable suture (Khaw) trabeculectomy on intraocular pressure: a retrospective case series

The aim of the study is to investigate long-term intraocular pressure (IOP) outcome as well as complications associated with adjustable suture trabeculectomy in glaucoma patients who were uncontrolled under maximum medical therapy. In this retrospective case series, 35 eyes of 30 patients are included in the study. Adjustable suture trabeculectomy with 0.2 mg/cc mitomycin-C for 3 min was performed by the same surgeon. Subconjunctival 5-fluorouracil injection, transconjunctival suture adjustment, digital massage, and/or argon suturolysis were utilized postoperatively as needed. Complete success, qualified success, and failure were defined as IOP ≤18 mmHg without medication, IOP ≤18 mmHg with one or more medications, and IOP >18 mmHg with medication or need for additional glaucoma surgery, respectively. Of the 35 eyes, 13 had primary open angle, 18 had psuedoexfoliative, 1 had juvenile, 1 had pigmentary, 1 had uveitic, and 1 had chronic angle-closure glaucoma. Mean preoperative IOP of 30.1 ± 10.5 mmHg dropped to 10.8 ± 4.7 mmHg (p < 0.001) after a mean follow-up of 595 ± 435 days. Nine eyes had the desired IOP on first postoperative day where no transconjunctival suture adjustment was performed. Remaining 26 eyes required a mean of two adjustments (range 1–7) during the first postoperative 24 days in order to achieve a desirable IOP. Complete success, qualified success, and failure were observed in 28 (80 %), 5 (14 %), and 2 (6 %) eyes, respectively. There were no serious complications related to adjustable suture trabeculectomy. We believe adjustable suture trabeculectomy to be a safe and effective alternative to standard trabeculectomy where a desirable low IOP can be achieved.     

玻璃体切除术治疗严重眼挫伤所致玻璃体积血

目的观察玻璃体切除术治疗严重眼挫伤所致大量玻璃体积血的效果。方法回顾性分析76例（76只眼）严重眼外伤所致大量玻璃体积血玻璃体切除术的术前及术后情况。结果76只眼中术后视力提高者73只眼。术前无光感的4眼中术后仍无光感1只眼,光感2只眼,1只眼视力恢复至0．6。22只眼视网膜脱离者中,21只眼成功复位,复位率为95．45％。外伤性晶状体脱位28只眼,玻璃体术后一期人工晶状体植入5例。外伤性黄斑孔4只眼,3只眼玻璃体切除术中联合内界膜剥离,术后黄斑孔闭合。1例因黄斑区视网膜下大量积血,内界膜未剥离,孔未闭合,进行激光光凝,以防止孔周围视网膜脱离。结论严重眼挫伤所致大量玻璃体积血,均可在外伤后及时进行玻璃体切除术治疗,对于术前无光感眼,当眼B超显示玻璃体团块状回声,未能分清视网膜及脉络膜结构者,需待玻璃体机化后,经过恰当的玻璃体切除术联合其他相应的治疗措施,大多能解剖治愈,部分患者可功能治愈。     

Laser suture lysis after trabeculectomy

In an effort to achieve the early postoperative safety and stability provided by trabeculectomy plus the late lower intraocular pressure (IOP) advantages of full-thickness glaucoma filtration surgery, 43 eyes of 38 patients with chronic open-angle glaucoma had laser suture lysis after primary trabeculectomy. The technique of laser suture lysis afforded serial release of resistance to aqueous outflow through the newly performed trabeculectomy, allowing initial tight closure of the trabeculectomy to avoid the dangers of hypotony. Serial gradual loosening of the trabeculectomy closure decreased resistance to outflow through the trabeculectomy and thereby lowered the IOP to desired levels in a controlled, titrated manner. Complications decreased with experience. For 25 eyes with at least 6 months follow-up (average, 54 weeks), the average IOP decreased from 25.0 mmHg preoperatively to 12.2 mmHg postoperatively.     

Surgical management of retinal detachment associated with myopic macular hole: anatomic and functional status of the macula

PURPOSE: To evaluate the postoperative status of the macula after vitreous surgery with internal limiting membrane removal for macular hole related retinal detachment in patients with severe myopia. DESIGN: Interventional case series. METHODS: We prospectively examined 10 eyes with retinal detachment associated with a myopic macular hole from 10 consecutive patients, and performed pars plana vitrectomy with internal limiting membrane peeling. Macular buckling was performed in one eye during the initial treatment and in three eyes during subsequent operations. The main outcome measures were the anatomic reattachment rate and the postoperative status of the macular hole. We examined the macular area pre- and postoperatively with slit-lamp biomicroscopy and with a scanning laser ophthalmoscope. Cross-sectional imaging of the macular area was conducted with optical coherence tomography. RESULTS: Successful retinal reattachment was achieved in seven eyes (70%) after the initial surgery and in three eyes (30%) after additional procedures. Visual acuity remained unchanged in two eyes (20%), and improved by two or more logarithmic units of minimum angle of resolution (logMAR) measurement in eight eyes (80%). The macular hole was anatomically closed in only one eye (10%). Postoperative enlargement of the macular hole was observed in seven eyes. CONCLUSIONS: In highly myopic eyes with macular hole related retinal detachment, closure of the macular hole is difficult to attain despite the complete relief of tangential traction by internal limiting membrane peeling. Results indicate the presence of a possible imbalance between the retina and the choroid-sclera complex associated with axial elongation and posterior staphyloma in highly myopic eyes.