眼球双穿孔伤的玻璃体手术治疗

目的：探讨玻璃体手术治疗眼球双穿孔伤的效果。方法：1997-02／2004-07收治的眼球双穿孔伤19例(21眼)先行角膜巩膜清创缝合后应用玻璃体手术进行球内、球壁异物取出；外伤性白内障切割；眼内电凝；眼内惰性气体和硅油填充；部分施行巩膜外环扎和加压术。结果：21眼球内球壁异物全部取出19眼，2眼雷管多发碎屑异物有残留。术后眼内炎控制4例，术后视网膜脱离复位5例，眼球萎缩3例。术后视力：视力提高9眼，视力不变4眼，视力下降8眼。结论：对于眼球双穿孔伤只有采取玻璃体手术才能有效的取出异物，修复伤眼，治疗并发症。     

玻璃体切割联合小直径球内异物取出术临床疗效

目的:探讨玻璃体切割联合球内异物取出术治疗眼球内异物伤(异物直径≤3mm)的临床疗效。方法:选择2006-01/2010-01来我院治疗的眼内异物伤患者25例25眼,采用玻璃体切割联合球内异物取出术,13例13眼术中部分或全部保留晶状体前囊膜。随访6mo,18例18眼二期植入人工晶状体或缝合固定,随访处理并发症。分析手术适应证,手术并发症,术后疗效。结果:患者25例25眼均一期成功取出球内异物。睫状体脱离1例药物治疗痊愈。视网膜脱离患者行玻璃体切割注硅油术后视网膜复位。随访6mo时视力提高者23眼,无变化2眼。结论:玻璃体切割联合球内异物取出术治疗眼球内异物伤(异物直径≤3mm)是有效的临床治疗方法。     

25G微创玻璃体切割术治疗球内异物的临床观察

目的　探讨25G微创玻璃体切割术治疗眼后段球内异物的临床疗效。方法　回顾性分析眼后段球内异物并接受25G微创玻璃体切割术联合球内异物取出术的21例21眼患者临床资料,其中17例17眼为磁性异物,4例4眼为非磁性异物。20例（20眼）并发白内障,3例3眼伴眼内炎,12例12眼伴视网膜脱离。根据不同的病情分别联合了白内障摘出、视网膜复位、硅油填充等操作,术后随访6个月,对其并发症和手术效果进行分析。结果　所有患眼均于完善术前检查后尽快行25G微创玻璃体切割手术联合球内异物取出术,Ⅰ期球内异物取出率为100%,眼内炎3眼炎症均得到控制,术中摘出混浊的晶状体,20例20眼球内异物由角膜切口取出,1例由巩膜切口取出。共19眼术后矫正视力较术前视力有所提高,14眼进行了II期人工晶状体植入,2眼硅油存留。术后未见与微创手术相关的并发症。结论　25G微创玻璃体切割术在眼后段球内异物取出术中显示出良好的临床效果,手术创伤小,视功能恢复快,并发症少,但要注意其适应证的选择。     

急诊玻璃体手术治疗眼后段异物伤的临床观察

目的:探讨急诊玻璃体手术治疗眼后段异物伤的临床疗效。方法:回顾性分析2005-01/2010-12在我院诊断为后段眼内异物的眼球穿通伤,急诊行玻璃体切割、异物取出术患者32例32眼的临床资料。结果:患者30例一次性取出异物。术后视力改善12例,视力不变的10例,视力下降的10例。术后继发性青光眼4例,视网膜脱离3例,眼球萎缩的2例。术中1例因角膜混浊、1例因眼内出血加重终止手术,择期手术成功取出异物。结论:急诊行玻璃体切割、异物取出术是治疗眼内异物的有效而及时的处理方法。     

玻璃体切割联合眼内硅油填充术治疗脉络膜脱离型视网膜脱离临床疗效观察

目的 评价玻璃体切割联合眼内硅油填充术治疗脉络膜脱离型视网膜脱离的手术效果.方法 对17例行玻璃体切割联合眼内硅油填充术的脉络膜脱离型视网膜脱离患者进行回顾性分析.分析术前与术后最佳矫正视力、眼压,术后最终视网膜复位率,复发性视网膜脱离发生率等情况.结果患者玻璃体切割联合眼内硅油填充术初次手术复位率为47.0％,复发性视网膜脱离发生率为53.0％,最终视网膜复位率为82.4％.患者术前平均LogMAR视力2.54,术后平均视力1.90,手术前后视力有明显提高.患者术前平均眼压8.41 mm Hg,术后平均眼压13.88 mm Hg,手术前后有明显改善.除白内障及一过性眼压升高外无其他并发症.结论 玻璃体切割联合眼内硅油填充术治疗脉络膜脱离型视网膜脱离是安全有效的手术方法.     

玻璃体切割术治疗异物引起的眼球贯通伤

目的评价异物引起的眼球贯通伤行玻璃体切割术的治疗效果,探讨异物取出的手术路径和玻璃体切割手术时机的选择。方法回顾性系列病例研究。由异物导致的眼球贯通伤56例（56眼）。根据CT和B超检查结果联合定位,分为球壁异物组（24例）和眶内异物组（32例）。24例球壁异物在伤后1周内均通过玻璃体视网膜手术取出异物。32例眶内异物中有22例先行眶内异物取出联合后巩膜伤口缝合术。10例因异物位于后极部或眶深部未行取出术。所有眶内异物组患眼均于伤后2周左有行玻璃体视网膜手术修复眼内组织。随访3-12个月,观察术后视力和并发症。以卡方检验分析影响术后视力的冈素。结果玻璃体切割术后,50例（89％）患者视力较术前提高,34例（61％）术后最佳矫正视力≥0．05。异物人口位置（X^2=7．69,P=0．01）、出口位置（X^2=21．83,P〈0．01）、视网膜脱离（X^2=-16．64,P〈0．01）、脉络膜脱离（X^2=7．73,P=0．01）以及眼内感染（X^2=6．89．P=0．01）对术后视力影响较大。术后6例发生视网膜脱离,2例低眼压,12例发生黄斑前膜或皱褶。结论根据异物的位置和眼内情况选择恰当的手术路径和玻璃体切割的手术时机,最大限度地减少手术对视网膜组织的损伤及预防增殖性玻璃体视网膜病变是成功治疗眼球贯通伤的关键。     

玻璃体视网膜联合术治疗复杂眼球穿通伤伴眼内异物

目的：探讨玻璃体视网膜联合术治疗复杂眼球穿通伤伴眼内异物的疗效。方法：应用玻璃体切割术、眼内异物取出术、外伤性白内障摘除术、眼内光凝、眼内充填术,部分病例结合巩膜外加压术等玻璃体视网膜手术治疗复杂眼球穿通伤伴眼内异物41只眼。结果：41只眼异物均一次手术取出,术后视力高于术前者36只眼（87．80％）,等于术前者4只眼（9．76％）,下降者1只眼（2．44％）。3个月至3年随访期间,无一便发生复发性视网膜脱离。结论：复杂眼于穿通伤伴眼内异物常导致眼内多种组织的严重损伤。玻璃体切割、异物取出等联合手术是准确、安全、有效的治疗方法,可挽救患者一定视功能。     

金属异物致眼球贯通伤的临床特点及治疗体会

目的 探讨金属异物致眼球贯通伤的临床特点、治疗措施、手术时机、手术技巧及其疗效.方法 对15例(16眼)金属异物致眼球贯通伤的临床资料进行回顾性分析.结果 随诊2周～2年.2眼未手术,视力0.8未见下降.14眼手术术后视力不同程度改善.12眼首次玻璃体视网膜手术视网膜复位,2眼二次玻璃体视网膜手术视网膜复位.眼球壁异物摘出2眼,眶内异物摘出3眼,异物存留者11眼,随诊期内未发现并发症.结论 金属异物致眼球贯通伤,创口自闭伴轻度的玻璃体积血可予观察,伴严重的玻璃体积血者,宜伤后7～14 d行玻璃体视网膜手术,伴有视网膜脱离或出现感染征象者宜尽早手术.后巩膜创口可用明胶海绵填塞.根据玻璃体状态、视网膜情况选择惰性气体或硅油填充.     

复杂性眼外伤视网膜大范围切开硅油填充后远期疗效

目的:观察复杂性眼外伤视网膜大范围切开/切除联合硅油填充术后的远期临床效果,以及硅油取舍对眼球、眼压及视功能的影响。方法:回顾分析2006-01/2010-01收治的复杂性开放性眼外伤伴视网膜嵌顿而行视网膜大范围切开/切除联合硅油填充治疗的28例28眼患者的临床资料。 男27例,女1例,年龄19~57岁。术中行180°或360°视网膜切开及部分切除,激光光凝及硅油填充。10例视网膜360°视网膜切开,视网膜切至赤道部;18例180°视网膜切开部分视网膜切除。硅油取出条件:硅油填充6mo以上,眼压＞10mmHg,视网膜复位良好,视网膜切开边缘封闭良好。术后观察2~5a。结果:视网膜切开/切除硅油填充后,早期视网膜均复位。10例视网膜360°切开眼中有8眼(80%)取出硅油, 2眼（20%）因眼压低(＜5 mmHg)成为硅油支持眼。取出硅油的8眼中有2眼的眼压在正常范围内,视力均为指数;6眼的眼压在3~7mmHg范围内,角膜水肿浑浊,脉络膜水肿,有3眼伴玻璃体出血,其中5眼出现眼球萎缩,二期行义眼台植入。18眼180°视网膜切开眼行硅油取出后,17眼的矫正视力为指数~0.3,眼压均在正常范围;1眼（5.5%）出现眼球萎缩。结论:复杂性重度眼外伤视网膜嵌顿后,视网膜大范围切开/切除后联合硅油填充,虽然早期视网膜复位率高,但远期低眼压和眼球萎缩率较高。我们应该严格掌握手术指征。     

复杂性眼球穿通伤伴眼内异物的玻璃体手术治疗

目的　评价玻璃体手术治疗复杂性眼球穿通伤伴眼内异物的效果。方法　回顾性分析 1998年 9月～ 2 0 0 2年 3月间应用玻璃体切割术、眼内异物取出术、外伤性白内障摘除术、眼内光凝、眼内充填术 ,部分病例结合巩膜外加压术等联合手术 ,治疗 5 9例 (6 3只眼 )复杂性眼球穿通伤伴眼内异物的临床资料。结果　 6 2只眼成功取出异物 ,成功率为 98.4 %。术后视力提高 4 8只眼 (76 .2 % ) ;不变 10只眼 (15 .9% ) ;下降 5只眼 (7.9% )。视力 >0 .0 2者 4 9只眼 (77.8% ) ,其中视力≥ 0 .1者 15只眼 ,最佳矫正视力 0 .8。术后有 16只眼视网膜脱离复位(72 .7% )。结论　玻璃体手术治疗可有效地取出复杂性眼内异物 ,提高术后视力     

穿透性角膜移植术后创口裂开的临床观察

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.     

23G玻璃体切除术及硅油辅助取出眼内巨大异物的临床观察

目的：研究23G微创玻璃体切除术及硅油辅助下取出眼内巨大异物的手术效果及并发症。

方法：回顾性分析2012-02/2015-03在长沙爱尔眼科医院接受治疗、需填充硅油的眼内巨大异物的患者12例12眼,其中男11例11眼,女1例1眼。术前视力光感～0.1,12眼术前均合并视网膜脱离。所有患者均接受23G微创玻璃体切除手术,在切除玻璃体和修复损伤的视网膜后,先行硅油填充,再扩大巩膜切口取出眼内巨大异物。术后6mo取硅油,部分患者联合人工晶状体植入。

结果：患者12眼眼内巨大异物均一次性取出,未出现再次跌落损伤视网膜现象,切口无视网膜脱出,不损伤角膜。术后视网膜均复位,未出现术后眼内炎。术后6mo硅油均顺利取出,视力均提高,脱盲率达67%,脱残率达到25%。

结论：23G微创玻璃体切除术及硅油辅助下取出眼内巨大异物是一种安全有效的方法。     

Long-term results after epilenticular intraocular lens implantation following traumatic cataract

BACKGROUND: The purpose of this study was to analyze the late postoperative outcome and complication rate after lensectomy with primary epilenticular intraocular lens (IOL) implantation for traumatic cataract. Material and Methods: We retrospectively reviewed the data of 11 patients who were operated on for traumatic cataract after penetrating or blunt ocular trauma between 1997 and 2002. One patient developed cataract due to a large rupture of the posterior capsule after blunt trauma. Ten patients sustained a penetrating ocular injury with (7 eyes) or without (3 eyes) intraocular foreign body (IOFB). In all patients the IOL was implanted at the beginning of the operation into the ciliary sulcus in front of the opaque lens followed by pars-plana lensectomy and vitrectomy. RESULTS: The mean follow-up was 27.4 months. Eight eyes (72.7 %) achieved a final visual acuity of 0.5 or better. Major causes of limited visual acuity were central corneal scars causing irregular astigmatism. In all patients the IOL was safely and easily implanted into the ciliary sulcus. During the subsequent pars-plana lensectomy and vitrectomy as well as during the follow-up period all IOLs remained anatomically stable and well centered. In one patient PVR retinal detachment had to be treated by pars-plana vitrectomy with silicone oil tamponade. CONCLUSIONS: Epilenticular IOL implantation followed by pars-plana lensectomy is an easy and safe method to treat traumatic cataract in the setting of penetrating ocular trauma repair. It is associated with a favorable visual outcome and a low rate of postoperative complications.     

Primary implantation of posterior chamber lenses after traumatic cataract peneration

PURPOSE: To analyze the postoperative outcome and complication rate after phacoemulsification, lens aspiration or lensectomy with primary intraocular lens (IOL) implantation after traumatic cataract penetration. METHODS: We retrospectively reviewed the data of 15 patients who were admitted to our hospital from 1997 to 2001 because of traumatic cataract with corneal laceration with and without intraocular foreign body (IOFB). In all patients phacoemulsification, lens aspiration or lensectomy and primary IOL implantation were performed. Removal of IOFB was performed in 6 patients. RESULTS: The mean follow-up was 19.6 months, 8 eyes (53%) achieved a final visual acuity of 20/40 or better and 12 eyes achieved 20/100 or better final visual acuity. One patient (final visual acuity=1/40) had an additional macular pathology. Due to irregular astigmatism two patients achieved a final vision of less than 20/100. Major causes of limited visual acuity were central corneal scars and in one patient a photopic maculopathy. Four eyes (25%) developed secondary cataract and underwent YAG laser capsulotomy. In one patient PVR retinal detachment had to be treated by pars-plana vitrectomy with silicone oil tamponade. CONCLUSIONS: Primary implantation of posterior chamber lenses after penetrating ocular trauma is associated with a favourable visual outcome and a low rate of postoperative complications.     

Vitrectomy combined with silicone oil tamponade in the treatment of severely traumatized eyes with the visual acuity of no light perception

AIM: To evaluate the efficacy of surgical treatment of vitrectomy combined with silicone oil tamponade in the treatment of severely traumatized eyes with the visual acuity of no light perception (NLP).METHODS: This was a retrospective uncontrolled interventional case-series of 19 patients of severely traumatized eyes with NLP who underwent vitrectomy surgery at the Affiliated Hospital of Medical College, Qingdao University (Qingdao, China) during a 3-year period. We recorded perioperative factors with the potential to influence functional outcome including duration from the injury to intervention; causes for ocular trauma; open globe or closed globe injury; grade of vitreous hemorrhage; grade of endophthalmitis; grade of retinal detachment; size and location of intraocular foreign body (IOFB); extent and position of retinal defect; grade of proliferative vitreoretinopathy (PVR); type of surgery; perioperative complications and tamponade agent. The follow-up time was from 3 to 18 months, and the mean time was 12 months.RESULTS: After a mean follow-up period of 12 months (3-18 months) 10.53% (2/19) of eyes had visual acuity of between 20/60 and 20/400, 52.63% (10/19) had visual acuity less than 20/400 but more than NLP, and 36.84% (7/19) remained NLP. Visual acuity was improved from NLP to light perception (LP) or better in 63.16% (12/19) of eyes and the rate of complete retinal reattachment was 73.68% (14/19). Good visual acuity all resulted from those patients of blunt trauma with intact eyewall (closed globe injury). The perioperative factors of poor visual acuity prognosis included delayed intervention; open globe injury; endophthalmitis; severe retinal detachment; large IOFB; macular defect; a wide range of retinal defects and severe PVR.CONCLUSION:The main reasons of NLP after ocular trauma are severe vitreous hemorrhage opacity; refractive media opacity; retinal detachment; retinal and uveal damages and defects, especially defects of the macula; PVR and endophthalmitis. NLP after ocular trauma in some cases does not mean permanent vision loss. Early intervention of vitrectomy combined with silicone oil tamponade and achieving retinal reattachment of the remaining retina, may make the severely traumatized eyes regain the VA of LP or better.     

Intraocular foreign bodies. Factors influencing final visual outcome.

PURPOSE: To identify the prognostic factors of poor visual outcome (visual acuity < or =6/240) in eyes with intraocular foreign bodies. METHODS: The records of 95 consecutive patients were retrospectively reviewed for 6 years (1990-1995). All eyes underwent a primary surgical repair and foreign-body removal (electromagnet or vitrectomy). The mean follow-up period was 25 months (6-72 months). Single analysis and multiple logistic stepwise regression analysis were performed to determine predictors of poor vision. RESULTS: Thirty patients (31.6%) showed 6/240 or worse vision at the end of their follow-up period. Three significant predictive factors had independent and combined effects on post-operative visual outcome: a corneo-scleral entry wound (odds ratio (OR)=14.5, p=0.001), largest diameter of IOFB (OR=1.21, p=0.01) and the presence of secondary retinal detachment (OR=9.48, p=0.0002). Post-operative complications included traumatic cataracts (51%), retinal detachments (28%) and phthisis bulbi (8%). CONCLUSION: Using multivariate analysis, corneo-scleral entry wound, largest diameter of foreign body and secondary retinal detachment were found to be predictors of poor visual outcome after intraocular foreign body removal. Our results suggest that patients with high-risk intraocular foreign body trauma should be candidates for pars plana vitrectomy rather than electromagnet procedure.     

玻璃体手术联合人工晶体植入治疗经选择的复杂眼外伤103例

目的：观察累及眼球前后节的复杂外伤患者施行玻璃体手术联合人工晶体植入的视力效果。方法：对１０３例（１０４只眼）复杂眼外伤经一次玻璃体手术联合人工晶体植入的病例进行回顾性研究。结果：本组眼内异物３５例,眼球穿通伤３７例,无眼内异物的爆炸伤９例（１０只眼）,眼球钝挫伤２２例。除３例儿童视力不能检查外,在１００例１０１只眼中,手术前视力为无光感～指数的８８只眼（８７．１％）;手术后９４只眼（９３．１％）     

玻璃体切割联合硅油填充治疗球内异物的随访观察

目的 评价玻璃体切割联合硅油填充术对严重球内异物伤眼的治疗效果.方法 回顾性研究18例严重球内异物伤眼的临床资料.所有患眼均行玻璃体切割术取出异物,硅油填充,术后平均随访27.8个月.随访项目包括最佳矫正视力、PVR发生情况、青光眼、角膜变性、白内障、低眼压及眼球萎缩等.结果 术后3、6、12及24个月功能成功(VA≥0.02)率分别为88.9%、100%、100%及100%,与术前27.8%相比明显升高(P<0.05);脱盲(VA≥0.05)率分别为44.4%、72.2%、77.8%及77.8%与术前0相比明显升高(P<0.05);脱离低视力(VA≥0.3)率分别为11.1%、27.7%、33.3%及33.3%与术前0相比明显升高,除术后3个月外,均有统计学意义(P<0.05).术后12个月时,硅油眼PVR的发生率为28.6%,明显低于无硅油眼的90.9%(P<0.05).术后24个月时,硅油填充≥12个月眼的PVR的发生率为42.9%.明显低于硅油填充<12个月眼的90.9%(P<0.05).61.1%眼发生暂时性眼压升高,16.7%眼发生角膜变性,11.1%眼发生低眼压,未发生白内障和眼球萎缩.结论 玻璃体切割联合硅油填充术是治疗严重球内异物伤眼的有效手段,在无严重硅油填充并发症的情况下,适当延长硅油填充时间可以明显降低PVR发生的风险.     

玻璃体切除术拯救外伤后无光感眼

目的观察外伤后无光感眼采用玻璃体切除术治疗的效果。方法回顾性分析10例（10眼）行玻璃体切除术的眼外伤后无光感眼的临床资料。开放性眼外伤8例,闭合性眼外伤2例。术前并发症有视网膜脱离10眼、脉络膜脱离8眼、睫状体脱离4眼、玻璃体积血10眼、无晶状体5眼、无虹膜3眼及角膜血染1眼。所有病例均为硅油填充者。随访6个月以上。结果术后9眼视网膜解剖复位。5眼硅油填充眼压正常,2眼硅油填充眼压低,2眼取硅油后眼压正常,1眼眼球萎缩行眼球摘除术。术后视力5眼仍为无光感。2眼为手动,1眼为数指,1眼为0．05,1眼最佳矫正视力为0．2。结论玻璃体切除术可以拯救部分外伤后早期无光感眼,甚至可以恢复部分视功能。     

Primary silicone oil tamponade in the management of severe intraocular foreign body injuries: an 8-year follow-up

PURPOSE: To evaluate the long-term outcome of pars plana vitrectomy and primary silicone oil tamponade in patients with severe intraocular foreign body (IOFB) injuries and high risk of proliferative vitreoretinopathy (PVR). METHODS: This retrospective consecutive study included 23 patients with severe IOFB injuries who had extensive lacerations including sclera, choroid, and retina, and were complicated by predictive factors for elevated proliferative activity and an unfavorable outcome. All patients underwent pars plana vitrectomy, removal of the IOFB, and primary silicone oil tamponade and were followed up for a mean 8.9 years. Main functional outcome was assessed as final best-corrected visual acuity. Anatomic success was defined as permanent retinal attachment. RESULTS: PVR occurred in 70% of all eyes and required 16 revisions. Silicone oil was removed in 78% of the eyes after a mean tamponade duration of 9.1 months. Complete retinal attachment was achieved in 83% of the eyes. Three eyes developed a persisting hypotony that was stabilized under permanent silicone oil. Functional stabilization was observed in the third year resulting in a final visual acuity of 20/630. Useful vision of better than 20/400 could be preserved in 55% of the patients. Only one eye underwent a late enucleation after 6.8 years. CONCLUSIONS: Primary silicone oil stabilizes the retina during the critical period of active PVR and may limit the visual loss in selected high-risk eyes in the long term.