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。     

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.     

外伤性白内障伴睫状体脱离的联合手术

目的探讨外伤性白内障伴睫状体脱离的联合手术方法。方法回顾分析2006年8月～2007年8月我院所行联合手术治疗外伤性白内障伴睫状体脱离的26例（26眼）,分析其临床特征、手术方法及效果,进行初步总结。结果26眼行白内障摘出、人工晶状体植入联合睫状体脱离间断缝合术,6眼联合前段玻璃体切除术。术后视力：0．06～1．0,眼压正常,超声生物显微镜随访睫状体复位,人工晶状体在位。结论合并外伤性白内障的睫状体脱离行一期白内障摘出,人工晶状体植入联合睫状体脱离间断缝合术,可获得良好的视力结果及睫状体复位效果,可避免了多次手术带来的手术风险。     

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.     

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。     

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.     

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。     

改良的睫状体缝合术治疗外伤性睫状体断离

目的 观察一种改良的睫状体缝合术治疗外伤性睫状体断离的临床效果.方法 回顾性分析改良的睫状体缝合术治疗外伤性睫状体断离13例(13眼)的临床资料.手术改进之处是缝合时留一处较宽的针距.术后随访3～12月(平均6月).结果 所有13眼均顺利完成手术.术后均未发生一过性或持续性眼压增高(眼压>25 mmHg).随访结束时眼压范围为8～19 mmHg,视力均较术前提高.结论 改良的睫状体缝合术可有效避免传统的睫状体缝合术后一过性高眼压的发生,是一种安全有效的治疗外伤性睫状体断离的手术方法.     

Continuous Suture Reattachment Surgery for Traumatic Cyclodialysis and an Observation of Its Effect

Objective: To evaluate the clinical effects of internal continuous suture reattachment surgery for traumatic cyclodialysis. Methods: This was a retrospective case series study. Thirteen patients (13 eyes) with traumatic cyclodialysis that was complicated by other internal trauma of the eye underwent internal continuous suture reattachment surgery with lentectomy and vitrectomy. Analysis was performed on the clinical curative effect, advantages of surgery and matters that needed attention. Results: Ultrasound biomicroscopy and gonioscope examination showed that the ciliary bodies were reattached well and ultrasound B and ophthalmoscope examination showed that there was no retinal detachment during the postoperative follow-up period. IOP was normal in all eyes during the postoperative follow-up period except for 2 eyes with symptoms of transient high IOP 2-3 days postoperatively. BCVA improved to varying degrees postoperatively. There was no case with related complications during or after surgery. Conclusions: The internal continuous suture reattachment surgery for cyclodialysis is a less traumatic surgery and is effective. It can be performed simultaneously with surgery of the iris, lens, vitreous, etc.     

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。     

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.