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1.
目的 比较应用临时人工角膜行玻璃体切割联合穿透性角膜移植术治疗不同类型严重眼外伤的临床效果.方法 对伴有严重角膜混浊的眼外伤患者20例(21只眼),包括爆炸伤11例(12只眼)、眼球穿通伤9例(9只眼).术前视力为光感~眼前手动,采用临时人工角膜代替病变角膜完成闭合式玻璃体切割、白内障切除、球内异物取出、视网膜复位等眼内操作后,再用新鲜供体角膜置换人工角膜.术后随访3~36个月,平均17月,随访视力、眼压、眼球解剖完整性及并发症.结果 全部眼爆炸伤和78%的眼球穿通伤,共19只眼(90%)保存眼球解剖结构完整性.11只眼(52%)保持最佳矫正视力≥0.05,其中眼爆炸伤9只眼(9/12),穿通伤2只眼(2/9).严重影响预后的并发症有持续性低眼压、复发性视网膜脱离,均发生在眼穿通伤.结论 临时人工角膜下行前后节联合手术是治疗伴有严重角膜混浊的外伤眼的惟一有效的方法,眼爆炸伤预后好于眼球穿通伤.  相似文献   

2.
应用临时人工角膜行眼前后节联合手术   总被引:3,自引:0,他引:3  
目的 评价应用临时人工角膜进行穿透性角膜移植联合眼后节手术的安全性及治疗效果。方法 对复杂性眼球穿通伤所致角膜混浊同时伴有玻璃体视网膜病变 10例患者 11眼 ,施行临时人工角膜下的经睫状体平坦部的闭合式玻璃体切除、球内异物取出、视网膜复位、硅油充填、穿透性角膜移植等联合手术。结果 术后随访 2~ 14月 ,11眼均得到保留 ,9眼角膜植片透明 ,10眼视网膜复位 ,9眼视力较术前提高。其中 3眼矫正视力≥ 0 1,矫正视力在 0 0 5~ 0 1的 4眼 ,1眼术后再次视网膜脱离 ,1眼角膜混浊并萎缩。结论 应用临时人工角膜进行玻璃体手术联合穿透性角膜移植术是治疗严重眼前后节受伤患者的一种有效手术方法  相似文献   

3.
目的:分析探讨玻璃体切除联合穿透性角膜移植术对复杂性眼球穿通伤的治疗价值。 方法;对18例复杂性眼球穿通伤致角膜瘢痕性混浊同时伴有玻璃体、视网膜病变患者的18只眼,应用临时人工角膜I期完成经睫状体平坦部的闭合式玻璃体切除、视网膜复位、穿透性角膜移植等联合手术。 结果:术后随访6个月一2年,14例角膜植片透明,16例视网膜复位。15例患者矫正视力为指数/1m以上,10只眼脱盲,6只眼脱残。 结论:应用现代显微手术设备和技巧,对严重眼前后节复杂性眼外伤患者,行玻璃体切除联合穿透性角膜移植术,可以使多数伤眼眼球保存和复明。 (中华眼底病杂志,1997,13:102-103)  相似文献   

4.
眼前后段联合手术治疗复杂性眼病的远期疗效评价   总被引:5,自引:0,他引:5  
Dong XG  Wang W  Xie LX 《中华眼科杂志》2004,40(8):514-516
目的 探讨临时人工角膜下行前后段联合手术治疗复杂性眼病的远期疗效。方法1994年6月至2001年6月,107例(107只眼)眼前后段复杂病变的患者于我院在临时人工角膜下行玻璃体视网膜手术,再联合穿透性角膜移植术,术后局部及全身应用糖皮质激素,并随访观察患者视力、眼压、角膜植片及眼底情况。手术治愈标准:(1)植片透明;(2)视网膜复位;(3)眼压正常或经药物控制眼压正常。结果 达到手术治愈标准者78只跟(72.9%),手术后眼球保存者92,只眼(86.0%),术后发生植片免疫排斥者34只眼(31.8%),眼球萎缩13只眼(12.2%),继发性青光眼15只眼(14.0%)。术前存在增生性玻璃体视网膜病变(PVR)患眼的视网膜手术治愈率与无PVR者比较,差异有显著意义(x2=3.90,P<0.05)。结论 临时人工角膜下眼球前后段联合手术是治疗角膜明显混浊合并玻璃体视网膜病变的有效方法。远期失败的主要原因是角膜植片内皮功能失代偿和增生性玻璃体视网膜病变。(中华眼科杂志,2004,40:514-516)  相似文献   

5.
严重眼外伤前后段联合手术中临时人工角膜的应用   总被引:3,自引:1,他引:2  
目的 观察临时人工角膜用于严重眼外伤眼前后段联合手术的远期疗效。方法 分析38例(38眼)由于眼球破裂伤导致眼前后段严重损伤,实施临时人工角膜下的晶状体玻璃体切除、眼内异物摘出、视网膜复位及穿透性角膜移植联合手术的效果及相关因素的影响。结果 术后随访6月~6年,平均2年。保存0.02以上有用视力者23眼(6l%),眼球萎缩2眼。9眼合并眼内异物全部摘出成功,20眼合并视网膜脱离者,术后再脱离4眼,16眼复位(80%)。28眼角膜植片保持透明(74%),2次移植5眼,3次移植l眼,4眼植片半透明仍在观察中。结论 在临时人工角膜下的眼前后段联合手术使部分患者经过1次手术达到复明目的。影响视网膜复位及角膜移植片透明的因素有PVR和硅油填充等。  相似文献   

6.
外伤眼穿透性角膜移植玻璃体视网膜联合手术   总被引:2,自引:1,他引:1  
目的评价眼外伤患者穿透性角膜移植玻璃体视网膜联合手术的疗效。方法回顾性分析自2002年3月~2004年8月间在我院接受眼外伤后联合穿透性角膜移植的玻璃体视网膜手术20例(20眼),观察术后视力、角膜植片、视网膜脱离的复位情况和手术并发症。结果术后随访6月~3年,平均12±5.8月。末次随访期9眼(45.00%)视力优于术前。10眼(50.00%)角膜移植片保持透明,1眼(5.00%)角膜移植片发生严重的排斥反应,8眼(40.00%)角膜移植片出现浑浊水肿。3眼(15.00%)原视网膜脱离者术后再次出现视网膜脱离,其中1眼接受第二次玻璃体手术后视网膜复位。眼球萎缩2眼(10.00%)。结论临时性人工角膜下玻璃体手术联合穿透性角膜移植术治疗合并角膜病变的视网膜玻璃体病变效果明显,恢复时间短。术前患眼的情况、前后段眼科医师手术技巧的熟练和配合程度是手术成功的关键。  相似文献   

7.
贺涛  艾明  邢怡桥  陈彬 《眼科新进展》2005,25(2):151-152
目的探讨在人工晶状体眼合并大泡性角膜病变及视网膜脱离病例中应用临时人工角膜行玻璃体切割联合穿透性角膜移植的临床价值。方法对6例(6眼)人工晶状体眼合并大泡性角膜病变及视网膜脱离患者行临时人工角膜下玻璃体切割联合穿透性角膜移植术。结果6例患者术后视网膜均复位良好,5例角膜植片透明,1例患者视力达0.1.2例患者手术中取出人工晶状体。结论该手术是一种安全、有效的治疗手段,对保留人工晶状体眼合并大泡性角膜病变及视网膜脱离患者的眼球及部分视力起到了积极的作用。  相似文献   

8.
穿透性角膜移植术后创口裂开的临床观察   总被引:7,自引:1,他引:6  
目的探讨穿透性角膜移植术后创口裂开的特点、治疗方法及对视功能的影响.方法选择1997年7月至2003年6月于中山眼科中心就诊的32例穿透性角膜移植术后创口裂开的患者,根据眼球裂伤程度采用创口缝合或联合虹膜切除、晶状体切除、人工晶状体摘出、前段玻璃体切除、同期或Ⅱ期玻璃体切除或联合眼内气体和硅油填充视网膜脱离复位术等处理创口裂开及其并发症,随访观察术后视力、植片透明度、眼压及眼球后段结构的变化.结果术后24例患者保留了眼球,8例患者眼球萎缩.8例缝线断裂或松脱患者,术后6例视力提高,角膜植片均透明,眼压正常,未出现玻璃体出血及脉络膜、视网膜脱离.14例创口裂伤范围1/4~1/2周的患者,术后8例视力下降,11例角膜植片混浊,5例眼压异常(降低或升高).8例创口裂伤范围1/2~3/4周患者,术后7例视力下降,5例角膜植片混浊,7例眼压异常(降低或升高),4例玻璃体出血,4例脉络膜、视网膜脱离.2例创口裂伤范围≥3/4周的患者,术后均无光感,角膜植片混浊,眼压降低(眼球萎缩),出现玻璃体出血及脉络膜、视网膜脱离.结论穿透性角膜移植术后创口稳定性和抗张能力差,较小的外力打击可引起破裂.穿透性角膜移植术后外伤性创口裂开常合并更严重的眼内容物脱出、玻璃体出血或脉络膜视网膜脱离,比普通眼外伤程度更严重、预后更差.  相似文献   

9.
曾华  白钢 《眼科》1997,6(3):149-150
对6例累及角膜病变混浊及玻璃体视网膜病变的复杂性眼外伤患者,于临时人工角膜下行三通道睫状体平坦部闭合式玻璃体切除,对1例伴眼内异物,2例伴视网膜脱离患者分别行眼内异物取出,玻璃体腔内复杂操作,如气流交换,眼内冷冻,惰性气体或硅油内填充等,使复杂的视网膜脱离复位,同时全部病例行部分穿透性角膜移植,使过去按传统方法需分次手术的复杂眼外伤通过一次手术恢复视力,随访5 ̄12个月,6例病人视力均较术前有不同  相似文献   

10.
目的探讨眼外伤角膜浑浊状态下玻璃体视网膜手术的手术时机、方法及技巧。方法对65例(67眼)眼外伤角膜浑浊(≥2/5面积)术中采用刮除角膜上皮、应用棱镜式接触镜、转动眼位及头位、巩膜外顶压及临时人工角膜等不同的手术方法和技巧,完成玻璃体视网膜手术。结果本组67眼全部顺利完成手术中各项操作,其中9眼眼内异物均在直视下摘出。术后有13眼(19.40%)视网膜脱离,其中6眼再次手术成功,7眼放弃手术。随访6~12个月,最终视力≥眼前数指者39眼(58.21%),眼球萎缩9眼(13.43%)。同时行穿透性角膜移植3眼,2眼植片透明,1眼植片浑浊。结论眼外伤角膜浑浊状态下,应尽量采取相应措施完成玻璃体视网膜手术,以挽救视功能或保留眼球。  相似文献   

11.
严重眼球破裂伤无光感眼合并角膜血染的手术治疗   总被引:7,自引:0,他引:7  
目的 探讨严重眼球破裂伤无光感眼合并角膜血染的手术治疗效果,并分析相关因素。 方法 7例患者7只眼因严重眼球破裂伤无光感合并角膜血染接受2期临时人工角膜下玻璃体切割联合角膜移植手术。2期手术前7只眼均角膜血染,前房及玻璃体积血,视网膜脉络膜脱离。1期与2期手术间隔时间平均18d(12~21d)。手术前视力均无光感,眼压平均3 mm Hg(1mm Hg=0.133 kPa)(2~5 mm Hg)。随访平均时间12个月(6~30个月)。 结果 5只眼恢复光感以上视力,矫正视力从光感至0.05。视网膜复位5只眼(5/7)。眼压平均12 mm Hg(5~15 mm Hg),明显高于手术前眼压(P<0.05)。并发症包括一过性高眼压(1 只眼),角膜新生血管(4只眼),角膜排斥反应(4只眼),眼球萎缩(2只眼)。 结论 临时人工角膜下玻璃体切割联合角膜移植手术是挽球严重眼球破裂伤无光感眼合并角膜血染的安全有效的方法。(中华眼底病杂志,2004,20:212-214)  相似文献   

12.
Purpose: To identify both the clinical features of eyes suffering penetrating ocular injury with intra-ocular foreign bodies (FB) impacting or embedded in the retina and the results of surgical outcome and complication rates. Methods: Thirty-eight consecutive cases of penetrating ocular injuries with intra-ocular FB impacting or embedded in the retina were retrospectively analysed. Results: The FB were metallic in 30 eyes (78.9%; 19 ferromagnetic) and were non-metallic in eight eyes (21.1%). Magnetic extraction was performed in 17 cases (44.7%) and instrumental extraction was performed in 21 cases (55.3%). In two cases, pars plana vitrectomy and FB removal was combined with penetrating keratoplasty, temporary keratoprosthesis and anterior segment reconstruction because of severe explosive injury to the eye. At the final postoperative examination, 32 eyes (84.2%) had completely attached retinas. Visual acuity (VA) improved postoperatively in 18 eyes (47.4%). A final VA of 0.5 or better was achieved in nine of 23 eyes (39.1%) with FB in the peripheral retina and in one of 15 eyes (6.7%) with posterior pole and/or optic nerve head involvement. There was no difference in the final VA regarding the time elapsed between trauma and the removal of the FB. Conclusion: The late anatomical and functional outcome in eyes with penetrating ocular injury and FB impacting or embedded in the retina is mostly uncertain, despite immediate and complex surgery. Final anatomical and functional outcome in the present study was influenced by location and extent of the initial damage to the posterior pole. The time that had elapsed between trauma and removal of the FB did not influence final visual function.  相似文献   

13.
OBJECTIVE: To evaluate the effects of treatment of severe ocular injury with blood-stained cornea and no light perception by combined penetrating keratoplasty and vitreoretinal surgery, and to analyze the relevant factors. METHODS: Records of 7 severely injured eyes of 7 patients with blood-stained cornea and no light perception who underwent penetrating keratoplasty combined with vitrectomy using a temporary keratoprosthesis were evaluated retrospectively. The preoperative visual acuity was no light perception in all injured eyes with a mean intraocular pressure of 3 mm Hg and a range from 2 to 5 mm Hg. The average interval from emergency wound closure to vitrectomy was 18 days with a range from 12 to 21 days. The mean follow-up was 28 months with a range from 26 to 30 months. RESULTS: The postoperative visual acuity was better than light perception in 5 eyes with the best corrected visual acuity from light perception to 0.06. The retina was attached in 5 eyes. The postoperative intraocular pressure ranged from 5 to 15 mm Hg with a mean of 12 mm Hg; it was significantly higher than the preoperative one (p < 0.05). The postoperative complications mainly included temporary intraocular elevation (1 eye), corneal neovascularization (4 eyes), corneal rejection (4 eyes), retinal detachment (2 eyes) and ocular atrophy (2 eyes). CONCLUSION: Penetrating keratoplasty combined with vitrectomy using a temporary keratoprosthesis is a safe and effective method in treating severe ocular injury with blood-stained cornea and no light perception.  相似文献   

14.
The Landers-Foulks temporary operating keratoprosthesis was used in the treatment of a severe double perforating injury involving both the cornea and retina in a 12-year-old boy. The use of the keratoprosthesis permitted surgical intervention at the optimal time for successful treatment of the retina and vitreous, providing the patient with useful visual acuity. The temporary keratoprosthesis is an excellent device for the subacute management of massive ocular trauma involving both anterior and posterior segments.  相似文献   

15.
The aim of our study is to present own observations with Eckardt temporary keratoprosthesis, during combined pars plana vitrectomy and corneal transplantation. We operated on two aphakic patients with unclear corneas and retinal detachment--I case, phthisis bulbi after recurrent uveitis--II case. Eckardt temporary keratoprosthesis was sutured to the corneal bed with 4 or 6 Ethilon 10.0 bites, pars plana vitrectomy was performed followed by corneal transplantation and silicone oil tamponade. We obtained good transplant clarity only in the I case, in the II case because of hipotony and persistent contract of silicone oil with cornea, transplant was cloudy and collapsed with small exception in the central area. After 3-rd month we noticed local retinal detachment in the periphery, which was suppressed with laser photocoagulations. We think, that Eckardt temporary keratoprosthesis gives possibility to do vitrectomy in patients with undear cornea, which was in the past impossible. However, combined procedure requires surgical skills in both: anterior and posterior segments of the eye.  相似文献   

16.
M Muraine  A Collet  G Brasseur 《Cornea》2001,20(8):897-901
PURPOSE: To report on the feasibility of combined deep lamellar keratoplasty and vitreoretinal surgery in one patient with corneal opacity associated with retinal detachment. METHODS: A 35-year-old man presented with a major hematocornea and retinal detachment after experiencing a right ocular trauma with corneoscleral wound 1 month earlier. We elected to perform deep lamellar keratoplasty to perform vitreoretinal surgery through the bared Descemet's membrane within the same surgical procedure. RESULTS: Deep lamellar keratoplasty offered perfect visibility of the anterior and posterior segments of the eye through the bared Descemet's membrane during the 4-hour operation. Descemet's membrane was resilient enough to maintain remarkable tightness of the anterior chamber throughout vitreoretinal surgery procedures (vitrectomy, peeling of epiretinal membranes, encircling scleral buckling). Unfortunately, despite our efforts and extended operative time, the retina could not be restored to its position because of the high baseline level of ocular impairment. CONCLUSION: The combined procedure (deep lamellar keratoplasty and pars plana vitrectomy) appeared to be a good and feasible alternative to the temporary keratoprosthesis usually applied in that situation.  相似文献   

17.
The Landers-Foulks temporary keratoprosthesis was used to combine penetrating keratoplasty, pars plana vitrectomy, and scleral buckling in the management of 13 eyes with opaque cornea and posterior segment abnormalities. In seven cases, trauma precipitated the ocular disease. Complications of cataract surgery resulted in anterior and posterior segment pathology in six cases. The corneal graft was initially clear in all cases. However, corneal edema complicated phthisis bulbi in four cases and followed homograft reaction in two cases. Eight eyes with retinal detachment (RD) preoperatively were successfully reattached. In five eyes, the retina redetached as these eyes became phthisical. Visual function improved in six cases. In general, eyes with a history of trauma had a much poorer outcome than did eyes with anterior and posterior segment problems related to previous cataract surgery.  相似文献   

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