临时人工角膜下穿透性角膜移植联合玻璃体切除手术治疗眼球前、后节外伤的远期疗效

目的 评价临时人工角膜下穿透性角膜移植联合玻璃体切除手术治疗眼球前、后节外伤的远期疗效.方法 对11例(11只眼)眼球前、后节外伤的男性患者,年龄7～46岁,其中,成人患者6例(6只眼),儿童患者5例(5只眼), 施行临时人工角膜下穿透性角膜移植联合玻璃体切除手术.术后观察视网膜,角膜移植片,眼压,视力等.结果 随访4～68个月,平均24.6个月.随访期间,5例成人患者(5只眼,占45.5%) 的眼球得以保留.视力:1例为手动,2例分别为0.05,1例为0.08,1例为0.2 ;眼压:1例患者眼压25 mmHg, 用0.5%噻吗心胺眼液治疗,眼压控制在21 mmHg以下,其余4例患者眼压正常.6例患者(6只眼,占54.5%)眼球萎缩,其中, 5例年龄≤12岁的患儿伤眼都出现萎缩, 另1例成人患者因继发性青光眼,经巩膜的睫状体激光光凝治疗后眼球发生萎缩.结论 临时人工角膜下穿透性角膜移植联合玻璃体切除手术是治疗眼球前、后节外伤的安全和有效方法,眼部的损伤程度可能是影响伤眼预后的主要因素,儿童眼前、后节外伤后联合手术的预后不良.

Long-term effect of penetrating keratoplasty and pars plana vitrectomy under temporary keratoprosthesis on severe traumatic ocular injury of anterior and posterior segment

Objective To evaluate the long-term effect of penetrating keratoplasty (PKP) and pars plana vitrectomy (PPV) under temporary keratoprosthesis on severe traumatic ocular injury of anterior and posterior segment. Methods Combined PKP and PPV under temporary keratoprosthesis were performed in 11 eyes of 11 male patients (6 adults, 5 children), aged from 7 to 46. Visual acuity, graft transparency, intraocular pressure and retinal anatomic status were examined during follow-up. Results The follow-up period ranged from 4 to 68 months with a mean of 24.6 months. Five adult patients (5 eyes, 45.5%) were successfully cured. Of the five eyes, visual acuity of one eye reached hand motion, two eyes 0.05, the other two eyes 0.08 and 0.2 respectively. Intraocular pressure as high as 25 mmHg in one eye was successfully managed with topical application of 0.5% timolol. Intraocular pressure of the other 4 eyes were in normal range. Six atrophic eyes developed in 6 patients (54.5%), including 5 children below 12 years old, and one adult with secondary glaucoma treated with transscleral cyclophotocoagulation. Conclusion Combined PKP and PPV under temporary keratoprosthesis is safe and effective for severe injury of anterior and posterior segment caused by ocular trauma. The main cause of failure is the severity of eye injuries, and traumatic eyes in children have a much poorer outcome after the combined surgery than in adult patients.