外伤性白内障13例手术体会

外伤性白内障并眼球内异物在眼球穿通伤中多见 ,手术难度大。近年来 ,我们共收治外伤性白内障并眼球内异物 1 3例 ( 1 3眼 ) ,经一次手术完成白内障摘除、人工晶体植入和眼球内异物取出 1 2例 ,改二期手术取出异物 1例 ,术后视力均提高。1临床资料1 1一般情况本组 1 3例中 ,男 8例 ,女 5例 ;年龄1 8～ 4 7岁 ,平均 32 5岁。磁性异物 9例 ,非磁性 4例。异物位于晶体 2例 ,眼球壁 3例 ,玻璃体内 8例。受伤距手术时间 2 1～ 1 83ｄ ,平均 1 0 2ｄ。入院时伴角膜白斑 6例 ,虹膜前粘连 3例 ,玻璃体内出血、混浊 4例。术前视力 :光感 9例 ,手动 …     

手术复位联合激光光凝治疗高度近视黄斑白孔性视网膜脱离

目的 探讨高度近视黄斑白孔性视网膜脱离手术联合倍频Nd:YAG激光(532 nm)治疗黄斑白孔的解剖复位和功能恢复.方法 高度近视黄斑白孔性视网膜脱离患者17例17只眼,行单纯玻璃体腔注气4例,玻璃体手术联合长效气体填充3例,联合硅油填充10例,硅油取出时间平均4.9个月;黄斑孔缘视网膜光凝法7例,黄斑孔底部色素光凝法10例.术后随访时间平均11个月.结果 一次手术后视网膜复位14例(82.4%),2-3次手术后视网膜复位3例(17.7%),随诊期间所有病例视网膜均复位,总复位率100%.术后视力提高者9例(9/17),占52.9%;不变者6例(6/17),占35.3%;下降者2例(2/17),占11.8%.黄斑孔缘视网膜光凝法治疗的患者中,视力提高者2例(2/7),占28.6%;视力不变者4例(4/7),占57.1%;视力下降者1例(1/7),占14.3%.黄斑孔底部色素光凝法治疗的患者中,视力提高者7例(7/10),占70.0%;视力不变者2例(2/10),占20.0%;视力下降者1例(1/10),占10.0%.结论 高度近视黄斑白孔视网膜脱离手术复位后联合Nd:YAG激光(532 nm)封闭黄斑白孔可提高手术成功率,维持或恢复视力.两种黄斑孔光凝法分别用于不同状态下的黄斑白孔均有较好疗效.     

眼外伤球内后段异物的手术处理

目的评价眼外伤球内后段异物的玻璃体切割术摘除法及后径摘除法的效果及影响因素。方法本组眼外伤球内后段异物共62例(62眼),其中32例行玻璃体切割术联合异物摘除术,30例行外伤后初期清创缝合联合后径异物取出术,前者采用常规睫状体平坦部三切口闭合式玻璃体切割,联合白内障晶状体切除或硅油填充或全氟丙烷(C3F8)气体填充或巩膜外加压术或环扎术,异物经前房或睫状体平坦部用异物镊夹出;后者异物的定位后从巩膜切口取出。结果玻璃体切割术组异物取出率100％;后径取出术组异物取出率86．67％(26／30)。术后视力：玻璃体切割术组提高或不变25例,下降7例;后径取出术组提高或不变13例,下降17例。结论玻璃体切割术可以准确有效地取出各种异物,而且损伤小,能最大限度地恢复视功能。后径取出术适合异物较小、晶状体玻璃体透明者。     

眼外伤球内异物玻璃体切割术的护理

眼外伤球内异物是眼科常见的危重眼病。异物进入眼内可造成眼部组织机械性损伤，引起眼内感染、白内障、继发性青光眼、虹膜睫状体炎及视网膜脱离等。若不及时取出异物，最终会引起眼球萎缩，视力丧失。因此，早期手术取出球内异物是挽救视力，减少伤残致盲率的有效治疗手段。同时，周到的精心护理，对确保手术疗效，预防并发症，促进患者早日康复，亦具有积极的临床意义。现将我院2003年1月～2006年6月行玻璃体手术取出球内异物的护理体会报告如下。     

小切口白内障摘除联合房角分离术治疗闭角型青光眼合并白内障疗效分析

目的探讨小切口白内障摘除联合房角分离术治疗闭角型青光眼合并白内障的临床疗效。方法闭角型青光眼合并白内障56例（56眼）,术前房角开放超过1800,均行小切口白内障摘除人工晶体植入联合房角分离术,术后随访8～12个月。观察手术前后视力、眼压、房角的变化。结果术前平均眼压（19．45±5．01）mmHg,术后平均眼压（10．11＋2．94）mmHg,差异有统计学意义（P〈0．05）。术前周边前房深度〈1,2CT者36例,术后周边前房深度≥1CT者43例,所有眼术后房角加宽,大部分开放,术前视力≤O．05者18眼,占32．14％,术后视力t〉0．3者35眼,占62．5％,患者满意度较高。结论房角开放超过180。的闭角型青光眼合并白内障患者单纯行小切口白内障摘除联合房角分离术可以较好地控制眼压,并提高视力。     

眼外伤迟发性继发青光眼75例临床分析

目的：探讨眼外伤迟发性继发青光眼的病因和治疗方法。方法：回顾性分析75例（75眼）眼外伤迟发性青光眼患者的临床资料。结果：75例眼外伤导致迟发性青光眼的原因分别为眼内积血（33例）、前房角挫伤（12例）、晶状体损伤（15例）、外伤性虹睫炎（7例）,单纯药物治疗8眼,药物联合各类手术治疗75眼,随访3～6个月,眼压〈21者68眼（90%）,视力有不同程度提高62眼（82.6%）。术后3例出现白内障,2例合并视神经萎缩加重,1例视网膜脱离。结论：眼外伤迟发性青光眼多由眼内积血、前房角挫伤、晶状体损伤等引起,应在降眼压等保守治疗基础上,给予相应的手术治疗。     

玻璃体切割术治疗眼外伤眼内异物存留的临床疗效观察

目的　探讨玻璃体切割术治疗眼外伤眼内异物存留的方法、效果和并发症。方法　分析 3 2例眼内异物玻璃体切割术的病例 ,采用常规睫状体平坦部三切口闭合式玻璃体切割联合巩膜外加压术或环扎术 ,异物经前房或睫状体平坦部取出。结果　异物取出率 10 0 %,术后视力提高明显 :视力 0 0 5～ 0 3由术前 4例提高到 15例 ,0 4以上者由 2例提高到 6例。结论　玻璃体切割术可以准确有效地取出各种异物 ,而且损伤小 ,能最大限度地恢复功能     

PDR患者二期行硅油取出联合白内障手术的临床观察

目的探讨增殖性糖尿病视网膜病变(PDR)二期患者硅油填充术后行硅油取出联合白内障手术的临床疗效。方法回顾性分析2008—2012年于我院行硅油取出联合白内障超声乳化、人工晶体植入术的PDR患者55例(61眼),术后视力恢复情况。结果术后1个月最佳矫正视力好于术前最佳矫正视力的40眼(74.07%),与术前相同的10眼(18.52%),低于术前最佳矫正视力的4眼(7.41%)。所有患者均无角膜内皮失代偿、人工晶体移位、复发性视网膜脱离等并发症发生。结论 PDR行玻璃体切除术后合并白内障的患者,取出硅油时联合白内障超声乳化、人工晶体植入术是经济、安全、有效的治疗方法。     

人工晶体取出24眼病因分析

1996～ 2 0 0 0年 ,我们对玻璃体病变行人工晶体取出 2 3例 (2 4眼 ) ,现将其原因进行分析。1　临床资料1 1　一般情况　 2 3例 (2 4眼 )中 ,男 12例 (12眼 ) ,女 11例 (12眼 ) ;年龄 32～ 81岁 ,平均 63岁。曾在外院接受白内障人工晶体植入术 15眼 ,我院 9眼。1 2　人工晶体取出原因　增殖性糖尿病性视网膜病变加重 9眼 (37 5 % )中 ,白内障术后发生新生血管性青光眼 6眼 ,玻璃体出血及视网膜脱离 2眼 ,因白内障术前无法详细观察眼底 ,术后见牵引性视网膜脱离 1眼。视网膜脱离 8眼 (33 4 % )中 ,高度近视眼 4眼 ,白内障手术时破囊 2眼。多…     

玻璃体手术治疗严重眼外伤的效果及预后相关因素分析

目的探讨玻璃体手术治疗严重眼外伤的疗效以及影响预后的相关因素。方法回顾性分析87例严重眼外伤行玻璃体切除手术的资料。结果手术成功80眼(91.95%),其中功能治愈38眼(43.68%),失败7眼(8.05%)。28眼球内异物均成功取出。术前视力0.01者手术成功率高于术前视力0.01者;术前合并视网膜脱离者治疗效果明显差于无视网膜脱离者;18岁患者手术成功率低于成人;在外伤后7～14天内接受玻璃体手术者手术成功率明显高于7天以内与14天以后手术者;闭合性眼外伤手术成功率高于开放性眼外伤;眼球破裂伤手术成功率低于穿通伤;伤口位置在Ⅲ区的眼外伤患者疗效明显差于伤口位于Ⅰ、Ⅱ区者。结论严重眼外伤经玻璃体手术治疗后大部分能解剖治愈,部分患者可功能治愈,伤眼的预后与初诊时的视力、有无视网膜脱离、手术时机、外伤类型、年龄及伤口位置有密切相关。     

Vitreoretinal surgery in war injuries of the eye

Results of vitreoretinal surgeries of 647 severe penetrating injuries of the eye, sustained during the war operations in the territory of former Yugoslavia, in the period from 01.07.1991. to 31.12.1998. were analyzed in the paper. A total of 558 pars plana vitrectomies, 459 intrabulbar foreign bodies' extractions and 360 surgeries of traumatic retinal detachments (89 in the conventional way) were performed at the Clinic of Ophthalmology--Department for Vitreoretinal Surgery of the Military Medical Academy. Certain innovations in the surgical treatment of the severely injured eye with the damage of posterior eye segment, as well as the lens, were presented. In those cases, (simultaneously with pars plana vitrectomy, and extraction of retained intrabulbar foreign body), the primary intraocular lens (IOL) implantation was also performed, particularly posterior chamber IOL implantation following lensectomy, as well as phacoemulsification.     

36例外伤性眼内炎临床分析

目的探讨外伤性眼内炎的临床治疗效果。方法回顾性分析笔者医院2011年1月~2015年10月收治的外伤性眼内炎患者36例36眼患者眼外伤特征、病原微生物情况、治疗方法、疗效及术后并发症情况,其中男性34例34眼,女性2例2眼,年龄3~72岁,平均46.2岁。结果随访1~36个月,平均9.8个月。36例36眼外伤性眼内炎患者中22例22眼有球内异物,其中25例25眼患者行玻璃体切割术,10例10眼行清创缝合联合玻璃体腔注药术,1例1眼患者行眼内容物剜除术。经治疗后患者视力有不同程度提高,脱盲(最佳矫正视力≥0.05)10眼,占27.8%。结论早期诊断、及时进行玻璃体腔注药或玻璃体切割手术能有效挽救外伤性眼内炎患者的视功能。     

Endophthalmitis in war and peace penetrating eye injuries

BACKGROUND/AIM: Nowadays, eye injuries are a leading cause of one-eye disease or blindness worldwide. The aim of this study was to comparatively analyze the frequency of endophthalmitis following war and peace eye injuries. METHODS: All the patients went throught the detailed ophthalmologic examinations, prophylactic antibiotic treatment, and pars plana vitrectomies (VPP), or other required surgical interventions. RESULTS: Inside the period from 1991 to 1998, 647 patients with eye injuries were hospitalized, out of which 500 with penetrating eye injuries. In the period 1999-2004, 611 patients with eye injuries, were treated, out of which 297 had penetrating eye injuries. Out of 500 patients with war penetrating eye injuries, in 286 of the cases intrabulbar foreign bodies (IFB) were detected. The signs of endophthalmitis were observed in 26 eyes (5.2%) at admission. Out of totally 297 peace penetrating eye injuries, 196 (66%) were IBF. In 25 eyes (8.4%) endophthalmitis was observed. CONCLUSION: In our study, the frequency of posttraumatic endophthalmitis following penetrating war eye injuries was relatively low, even lower than the frequency of endophthalmitis following peace eye injuries.     

驻黎维和中国二级医院第七批51例眼外伤l临床分析

目的分析联合国驻黎巴嫩临时维和部队（UNIFIL）中国二级医院眼科眼外伤的致伤原因、特点,以预防和减少眼外伤的发生。方法对UNIFIL中国二级医院眼科第七批医疗队2011年3月1日～10月20日任务期内眼科门诊及住院眼外伤患者病例进行回顾性分析。结果 51例（55眼）眼外伤中,男46例,女5例;年龄9～48岁,平均30.15岁;右眼25例,左眼22例,双眼4例;维和军人34例,当地及国际雇员16例,当地学生1例;国籍：黎巴嫩16例,西班牙9例,法国6例,尼泊尔4例,中国3例,坦桑尼亚3例,韩国3例,马来西亚2例,葡萄牙2例,意大利1例,德国1例,印度1例;受伤至就诊时间：24 h以内30例,1～7 d 17例,7 d以上4例;受伤分类：眼球钝挫伤占45.09%,其他各类眼外伤（如电光性眼炎、角膜结膜异物、角结膜烫伤化学烧伤、角膜擦伤等）占54.91%;受伤原因：工作中受伤30例,运动中受伤7例,拳击伤6例（均为外国军人）,各种意外伤7例。在二级医院接受治疗48例（门诊43例,住院治疗5例）,1例角膜白斑未治,送三级医院遣返回国手术治疗2例。结论眼外伤是维和人员常见的眼病,应加以重视并积极预防,一旦发生,及时到专科诊治,减少并发症的发生。     

Surgery of eye injuries in an eight-year period

BACKGROUND: Eye injuries constitute a leading problem in eye surgery worldwide, as well as at our department. Their treatment is very complex, and requires a wide surgical knowledge and surgical skills supported by the material and the equipment. AIM: To analyze the results of vitreoretinal surgery on 647 patients with severe penetrating eye injuries in the period from 1991 to 1998. METHODS: The study included a retrospective analysis of the treatment of 647 injuries, out of which 500 were penetrating, and 147 were severe contusion injuries. Attention was payed to the penetrating injuries with intraocular foreign body (IOFB), to the number of the performed pars plana vitrectomies (VPP), to the number of the extirpated foreign bodies, as well as to the number of the conventional retinal ablation surgeries. Also significant proved the consequences of contusion injuries, and the method of their complete surgical management--the surgery combined with the implantation of intraocular lens, as well as their functional results. RESULTS: Inside the said period, 558 VPPs were performed, 60 conventional retinal ablation surgeries, and 29 combined anterior/posterior segment surgeries. VPP was applied in 286 (51.3%) of the cases with penetrating injuries with IOFB, and in 58 (10.4%) of the cases with contusion injuries. VPP in one eye was applied in 464 (83%) of the cases, in both eyes in 65 (11.8%) of the cases, and in a single eye in 29 (5.2%) of the cases. Following VPP, silicone oil tamponade was done in 352 (63%) of the cases, air tamponade in 123 (22%) of the cases, and Ringer-BSS tamponade in 83 (15%) of the cases. Laser photocoagulation (LFC) was performed in 484 (87%) of the cases, cryocoagulation in 45 (8%), while neither of them was done in 29 (5%) of the cases. In all of the cases of the conventional retinal ablation (n = 60), a placement of a serclage was applied and exocryocoagulation was performed, while in the 52 cases a placement of a scleral flap was applied. Combined surgery--lensectomy, VPP, and an anterior chamber intraocular lens (AC IOL), was applied in 16 of the cases, and phacoemulsification, VPP and a posterior chamber intraocular lens (PC IOL) in 13 of the cases. CONCLUSION: Vitrectomy was the most frequently applied surgery in solving the complex eye injuries. The eye injuries treated in our department were with the IOFB, and the retinal ablation. The IOFBs in our patients were almost completely extirpated. The applied combined anterior/posterior segment surgeries had the potential to safely and successfully condense those separate procedures in one surgery. A relatively high incidence of endophthalmitis was recorded in the injuries treated in our department.     

招飞体检中低角膜曲率眼角膜地形图分析（摘要）

目的探讨招飞体检中角膜地形图的应用。方法对招飞体检中发现的低角膜曲率23例461g进行Astramax角膜地形图检查,分析角膜地形图获得的角膜形态及测量参数,包括中央角膜曲率、Q值（瞳孔中心4．5mm直径范围）、高阶像差数据等。结果确诊5例10眼进行过准分子激光角膜屈光手术,4例8tg可疑接受过角膜塑形术治疗。结论在招飞体检中角膜地形图检查是筛查异常角膜的有效方法之一。     

CT诊断眼球异物

目的:提高球内细小异物检出的准确性.材料和方法:对31例球内异物进行回顾性分析.结果:l)最大异物为4.1×4.2mm;最小仅0.2×0.4mm;2)岩石异物9例,铜屑1例,钙粒1例,铁屑20例.结论:CT对眼球异物的诊断明显优于常规X线,且定位准确.     

染料激光治疗眼底病83例87眼初步分析

目的　总结国产眼科染料激光治疗机治疗眼底病的疗效。方法　用国产染料激光治疗机治疗眼底病８３ 例８７ 眼,其中黄斑全层裂孔３４ 眼,中心性浆液性脉络膜视网膜病变２６ 眼,单纯糖尿病性视网膜病变１１ 眼,中心性渗出性脉络膜视网膜炎９ 眼,视网膜静脉分枝阻塞和视网膜干孔各２ 眼,外层渗出性视网膜病变、视网膜血管瘤、创伤性黄斑病变各１ 眼。结果　治疗前视力＞０－３ 者２６ 眼（２９－９％ ）,视力＞１－０ 者３ 眼（３－４ ％） 。治疗后视力＞ ０－３ 者２８ 眼（３２－２％ ）,视＞ １－０ 者２１ 眼（２４－１％ ）。结论　国产眼科染料激光机治疗眼底病效果良好,治疗时应根据病灶部位调整不同的激光能量和光斑。为获得较好的视力恢复,应早期发现和治疗眼底病。