外伤性睫状体解离19例的诊断和治疗

目的：探讨外伤性睫状体解离及其并发症的临床治疗效果。方法：我院1993—01／2003—06共收治钝挫伤所致的外伤性睫状体解离19例(19眼)，男12例，女7例，年龄6～44(平均25)岁。就诊时眼压为0～10(平均2．42)mmHg。14例行睫状体显微缝合固定术，其中3例联合巩膜环扎局部冷凝；4例行改良的睫状体缝合固定术-平行于角巩膜缘、不切透深层巩膜，并重叠缝合。3例行保守治疗，2例行氩激光光凝。结果：在14例行睫状体显微缝合固定术病例中，一次手术成功9例(64．3％)；二次手术成功3例(21．4％)；三次手术成功2例(14．3％)。术后随访时间1月～8a，平均眼压11．24mmHg，较术前有明显提高(Wilcoxon—Mann—Whitney，P=0．0052)。最后随访视力较术前有明显提高(Wilcoxon signrank，P=0．012)。结论：睫状体缝合固定术是有效的治疗外伤性睫状体解离的手段：改良的手术方法可进一步提高成功率：超声生物显微镜可准确诊断外伤性睫状体解离，对手术成功有重要帮助。     

外伤性睫状体离断及其并发症的临床治疗

目的 探讨外伤性睫状体离断及其并发症的临床治疗效果。方法 我院1993年1月～2003年6月共收治钝挫伤所致的外伤性睫状体离断19例19眼，男12例，女7例，年龄6～44岁，平均25岁。就诊时眼压为0～10mmHg(1kPa=7．5mmHg)，平均2．42mmHg。14例行睫状体显微缝合固定术，其中3例联合巩膜环扎局部冷凝；4例行改良睫状体缝合固定术。3例行保守治疗，2例行氩激光光凝。结果 在14例行睫状体显微缝合固定术病例中，1次手术成功者9例；2次手术成功者3例；3次手术成功者2例。术后随访1个月～8a，平均眼压11．24mmHg，较术前有明显提高(P=0．0052)。最后随访视力较术前有明显提高(P=0．012)。结论 睫状体缝合固定术是有效的治疗外伤性睫状体离断的手段；改良的手术方法可进一步提高成功率；超声生物显微镜可准确诊断外伤性睫状体离断，对手术成功有重要帮助。     

Management of traumatic cyclodialysis cleft associated with ocular hypotony.

BACKGROUND AND OBJECTIVE: To evaluate the efficacy of direct cyclopexy for treatment of traumatic cyclodialysis cleft associated with ocular hypotony. PATIENTS AND METHODS: Eyes with traumatic cyclodialysis cleft were treated with direct cyclopexy or 1.0% atropine eyedrop. RESULTS: Five eyes with a large cyclodialysis cleft were treated with direct cyclopexy. Postoperatively, these eyes obtained normal intraocular pressure. Four of the 5 eyes had good visual acuity, and 1 eye that had preoperative subretinal hemorrhage in the macula had poor visual acuity. Of the 3 eyes treated with 1.0% atropine eyedrops, 1 had good visual acuity, and 2 with retinal folds had fairly good and poor visual acuity. CONCLUSION: The present study showed that direct cyclopexy is useful for the treatment of traumatic cyclodialysis cleft associated with ocular hypotony, and that the cyclodialysis should be surgically treated before irreversible retinal folds develop.     

外伤性睫状体脱离小瘘口的检查方法及手术复位

目的 探讨外伤性睫状体脱离小瘘口的检查与定位方法及手术复位的临床效果.方法 15例外伤性睫状体脱离患者经房角镜结合UBM检查以及缩瞳结合UBM检查,准确定位瘘口,根据瘘口的部位和范围选择手术方式,手术采取睫状体冷凝术与睫状体缝合术进行治疗.结果 15例外伤性睫状体脱离患者,均为360.的睫状体脱离.5例缩瞳后结合UBM检查发现隐匿的较小瘘口,其余均经房角镜结合UBM发现瘘口,且瘘口均小于1个钟位,其中,4例行单纯睫状体冷凝术,使睫状体复位,其余11例中5例先行睫状体冷冻术,后行睫状体缝合术,6例直接行单纯睫状体缝合术.术后视力不同程度提高,术后6眼一过性眼压升高,1眼术后1个月时眼压超过正常水平.结论 定位和封闭瘘口是睫状体脱离手术的目的和关键,瘘口的准确定位能较大程度地缩小手术范围.同时全面的缩瞳结合UBM检查,对于可疑瘘口的发现非常必要.     

超声生物显微镜对外伤性睫状体分离缝合复位术的临床应用价值

目的探讨超声生物显微镜对外伤性睫状体分离的诊断以及缝合复位术治疗的临床意义。方法回顾性分析51例（51眼）外伤性睫状休分离缝合复位术的临床资料,并对有关数据进行统计学分析。结果经超声生物显微镜检查,病例均被确诊为外伤性睫状体分离。缝合复位术后,视力明显提高（P=0．000）。睫状体分离范围与术后眼压恢复至正常范围所需时间以及术后最佳矫正视力提高水平均存在相关性（P=0．002,P=0．011）。睫状体分离病程持续时间与术后最佳矫正视力提高水平存在相关性（P=0．000）,而与术后眼压恢复至正常范围所需时间无相关性（P=0．161）。结论超声生物显微镜检查对外伤性睫状体分离的诊断、手术治疗、术后随访以及预后视力评估具有重要的临床应用价值。     

外伤性睫状体脱离缝合复位术临床观察

目的 探讨外伤性睫状体脱离的手术治疗。方法25例术前均行超声生物显微镜(UBM)检查确诊为外伤性睫状体脱离导致长期低眼压，随后行睫状体缝合复位术治疗。结果18例术后1周～6月眼压恢复正常，其中3例术后3月分别进行了第2次手术或氩离子激光光凝而痊愈。结论睫状体脱离缝合复位术是一种简单、有效的方法治疗外伤性睫状体脱离，超声生物显微镜(UBM)检查对诊断及指导手术具有重要的价值。     

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。     

外伤性睫状体脱离缝合复位术效果的临床分析

目的探讨外伤性睫状体脱离缝合复位术的手术治疗效果。方法 分析18例（18眼）外伤性睫状体脱离缝合复位术的临床病例资料并评价其疗效。结果 15眼在术后3天内眼压恢复正常或短暂增高后恢复正常，1眼在术后3周内眼压逐渐恢复正常，2眼手术后眼压仍较低：16眼术后视力不同程度提高。2眼出现囊样黄斑水肿。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，及早手术有利于恢复眼压，保护视功能．     

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.     

Phacoemulsification, persistent hypotony, and cyclodialysis clefts

A retrospective noncomparative case-note analysis of 3 men presenting with persistent hypotony after routine phacoemulsification cataract surgery was performed. All patients had a previous history of significant blunt ocular trauma. All patients had surgical repair of the cyclodialysis clefts, 1 with cleft cryopexy and 2 with formal cleft closure with a limbal-based double scleral flap technique. All patients achieved closure of the cyclodialysis clefts following surgical intervention with complete resolution of hypotony. Mean preoperative intraocular pressures improved from 3, 4 and 3 mm Hg in the 3 cases to 11, 16, and 17 mm Hg postoperatively. Visual acuities improved from preoperative readings of counting fingers, 6/36 and 6/24 in the 3 cases to 6/6, 6/9, and 6/9 postoperatively. Persistent hypotony because of possible activation of a preexisting doormant cyclodialysis cleft following routine atraumatic phacoemulsification cataract surgery in previously traumatized eyes has not been reported.     

Diagnosis and management of traumatic cyclodialysis cleft

A 48-year-old man presented with hyphema, iridocyclitis, iridophacodonesis, and maculopathy after a contusive trauma. Ultrasound biomicroscopy identified a 90-degree cyclodialysis cleft with severe damage of the zonular fibers. Echographic B-scan examination revealed intravitreal hemorrhage and a 360-degree choroidal detachment. One month later, phacoemulsification was performed and a single-piece poly(methyl methacrylate) intraocular lens was inserted into the ciliary sulcus, with the haptic rotated toward the cyclodialysis cleft area. Postoperatively, the visual acuity improved and the intraocular pressure returned to normal. Ultrasound biomicroscopy showed closure of the cleft by reattachment of the ciliary body to the scleral spur. Optical coherence tomography revealed complete resolution of the macular and choroidal folds. Ultrasound biomicroscopy is a useful method for appropriate management of traumatic cyclodialysis cleft. In cases of small cyclodialysis clefts, with the surgical method we describe, the lens haptics apply directional force toward the sclera, fostering adherence of the ciliary body fibers.     

玻璃体切除术联合巩膜外环扎治疗脉络膜脱离型视网膜脱离

目的：探讨玻璃体切除联术合巩膜外环扎治疗脉络膜脱离型视网膜脱离的临床疗效。

方法：回顾性分析2014-01/2018-02在我院行玻璃体切除术联合巩膜外环扎治疗的脉络膜脱离型视网膜脱离患者19例19眼,术后3～12mo行玻璃体腔硅油取出术。观察患者术后视网膜复位率、眼压、视力恢复及并发症情况。

结果：本组患者术后视网膜均复位,术后3mo患眼玻璃体腔硅油填充状态下眼压(16.09±3.58mmHg)、硅油取出术后6mo眼压(14.69±3.10mmHg)均高于术前(6.78±1.90mmHg)(均P<0.05)。硅油取出术后6mo,15眼患者视力较术前提高。术后无低眼压及眼球萎缩等并发症发生。

结论：玻璃体切除术联合巩膜外环扎治疗脉络膜脱离型视网膜脱离是相对安全有效的,视网膜复位率高,术后并发症少,再次手术率低。     

Expanded indications for transconjunctival trabeculectomy flap suturing: postoperative choroidal effusion and dysesthesia

ObjectiveTo assess the efficacy of transconjunctival trabeculectomy flap suturing (TTFS) in improving choroidal effusions and bleb dysesthesia resulting from overfiltration after trabeculectomy.DesignRetrospective review.ParticipantsThe study involved 15 eyes of 15 patients.MethodsPatients underwent TTFS for choroidal effusions and bleb dysesthesia following trabeculectomy using mitomycin C. The scleral flap was sutured through the conjunctiva as an outpatient clinic procedure.ResultsThere were 11 patients who had choroidal effusions and 4 patients were identified with dysesthesia. The average duration of choroidal effusion prior to TTFS was 2.1 ± 2.3 months and 3 ± 2 months in the dysesthesia group. At the final follow-up (25 ± 17 months) the mean intraocular pressure improved from 4.1 ± 2.1 mm Hg before suturing to 8.1 ± 3.6 mm Hg (p < 0.007) for the patients with choroidal effusion and from 4.2 ± 0.6 mm Hg to 8. 7 ± 3.5 mm Hg (p = 0.05) for the patients with dysesthesia. In both groups, resolution of the signs and symptoms was achieved in all cases. The mean time to resolution of choroidal effusions was 5.5 ± 8.6 weeks and the mean time to resolution of dysesthesia was 2 ± 0.8 weeks. None of the patients had serious complications such as failure of the trabeculectomy or visual loss.ConclusionsTransconjunctival suturing of the trabeculectomy scleral flap is a simple and effective surgical method for the treatment of cases of choroidal effusions or dysesthesia resulting from trabeculectomy.     

Treatment of a cyclodialysis cleft by means of ophthalmic laser microendoscope endophotocoagulation

PURPOSE: To report on the repair of a cyclodialysis cleft by means of endolaser photocoagulation. METHOD: Case report. We describe treatment of a cyclodialysis cleft by means of endolaser photocoagulation with a diode laser. RESULTS: In a 8-year-old boy with pseudophakia and secondary glaucoma in the right eye, combined trabeculectomy/trabeculotomy was performed. Ten months later, the patient was seen with persistent hypotony with a flat filtration bleb. The hypotony was unresponsive to all forms of medical therapy. Reformation of the anterior chamber along with synechialysis revealed a 2.5 clock-hour cyclodialysis cleft by means of gonioscopy. A laser microendoscope probe was used and laser was applied to both the internal scleral and external ciliary body surfaces within the depths of the cleft. Within 3 weeks after treatment, intraocular pressure increased to 15 mm Hg and has remained at that level as of 9 months after the endolaser photocoagulation procedure. CONCLUSION: Endolaser photocoagulation with the ophthalmic laser microendoscope may be an appropriate procedure, after failure of medical therapy, for the diagnosis and repair of a cyclodialysis cleft, especially in the pediatric population.     

睫状体缝合复位术的临床观察及护理

目的:探讨适合睫状体缝合复位术病人的护理方法。方法:对34例(34只眼)因外伤致睫状体分离和脱离导致低眼压,随后行睫状体缝合复位术的病人进行观察和护理。结果:32只眼术后1周至6个月眼压恢复正常,其中5只眼术后2～5个月内分别进行第二次手术或氩离子激光光凝而痊愈。视力改善者21例,无变化者13例。结论:睫状体缝合复位术是治疗外伤性睫状体分离和脱离的有效方法。术前行超声生物显微镜(UBM)检查、术后密切观察眼压变化并给予正确处理、做好心理护理和出院指导是确保手术成功的重要措施。     

New method of surgical repair for 360-degree cyclodialysis

A 44-year-old man suffered traumatic 360-degree cyclodialysis in the left eye complicated by persistent hypotony, disc edema, maculopathy, and cataract. Treatment was removal of the cataract with phacoemulsification followed by insertion of a capsular tension ring with 2-point scleral suture fixation with polypropylene in the ciliary sulcus. A foldable acrylic posterior chamber intraocular lens was implanted in the capsular bag through the 4.1 mm corneal tunnel incision. The intraocular pressure responded well with resolution of hypotony, choroidal detachment, disc edema, and maculopathy. Ultrasound biomicroscopy showed complete closure of the cyclodialysis cleft.     

Surgical treatment of cyclodialysis

PURPOSE: Cyclodialysis is a rare complication following blunt traumatic bulb injuries or surgical interventions. When treatment with cycloplegics or steroids is ineffective in attaching the ciliary body, cyclodialysis should be surgically treated. However, for reliable diagnosis and surgical therapy, an exact identification (size and extent) of the cyclodialysis cleft is imperative. Ultrasound biomicroscopy (UBM) provides the appropriate information. CASE REPORT: Four patients (19 to 65 years old, mean 45 years) with a detached ciliary body are described. Three patients had suffered an injury, and one patient presented with a prior trabeculotomy. The diagnosis was established with UBM. The location of the cyclodialysis cleft ranged between 2 and 3 o'clock (mean 2.4 o'clock). In spite of an intense treatment with cycloplegics and steroids no reattachment of the cyclodialysis took place. Therefore, a surgical intervention was performed. The span between the injury and trabeculotomy, respectively, and the cyclodialysis operation ranged from 3 to 30 months (mean 12 months). On average, visual acuity was increased from 0.3 preoperatively to 0.6 postoperatively, and the intraocular pressure was 6 mm Hg before and 15 mm Hg after operation. Symptoms preoperatively found without exception (choroidal detachment, papilledema "e vacuo", macular edema) had a complete recovery after operation. CONCLUSION: In cases where drug therapies are unsuccessful in attaching the ciliary body, an operative fixation is recommended. UBM is a very useful tool for making an exact diagnosis and defining the location of cyclodialysis as well as for follow-up of surgical treatment.     

改良硅油取出联合巩膜扣带术治疗硅油填充术后视网膜脱离

目的：探讨改良硅油取出联合巩膜扣带术治疗硅油填充状态下视网膜脱离的效果。

方法：回顾性研究。选取2021-01/2023-02于我院治疗的硅油填充状态下视网膜脱离的患者14例14眼,采用改良硅油取出联合巩膜扣带术进行治疗。硅油取出方法采用自制的23 G抽吸器,即将一次性输血器的针管取出,靠近乳头端剪至2.5-3.0 mm,另一端连接已去除推注手柄的10 mL注射器,注射器另一端连接玻璃体切割器的负压系统,进行硅油取出; 巩膜扣带术中外加压块采用外加压复合体; 术后未重新注入硅油。随访6 mo,观察术后视网膜复位、最佳矫正视力(BCVA)、眼压和并发症等情况。

结果：术后6 mo,视网膜完全复位13眼,视网膜复位率达93%,BCVA(LogMAR)较术前改善(0.95±0.18 vs 1.15±0.21,P=0.002)。术后1 d出现一过性高眼压6眼,药物控制后恢复正常。术中未见视网膜出血、嵌顿、医源性裂孔等并发症,术后未出现眼内炎、脉络膜脱离等并发症。

结论：改良硅油取出联合巩膜扣带术可以有效治疗硅油填充状态下视网膜脱离,促使视网膜再复位。     

缝合复位术在外伤性睫状体分离中的临床应用

目的 探讨外伤性睫状体分离缝合复位术的手术治疗效果.方法 分析18例(18眼)外伤性睫状体分离缝合复位术的临床病例资料并评价其疗效.结果 15例在术后3 d内眼压恢复正常及短暂增高后恢复正常,1例在术后3周内眼压逐渐恢复正常,2例手术后眼压仍然低.16例术后视力不同程度提高.2例出现黄斑囊样水肿.结论 睫状体分离缝合复位术是治疗眼挫伤后睫状体分离的有效方法,及早手术有利于恢复眼压,保护视功能.     

Treatment of traumatic cyclodialysis with vitrectomy, cryotherapy, and gas endotamponade.

An aphakic patient with severe chronic hypotony had an alternative treatment of a traumatic cyclodialysis cleft: a 3-port pars plana vitrectomy, cryotherapy of the cleft, and fluid-gas exchange with subsequent supine positioning. The therapeutic principle was mechanical apposition of the detached ciliary muscle to the scleral spur by the gas bubble and scar induction by cryotherapy. Intraocular pressure increased to within normal ranges, and visual acuity improved over a 15 month follow-up.