复杂性开放性眼球伤玻璃体切除手术时机的探讨

目的探讨复杂性开放性眼球伤玻璃体手术的时机。方法采用非随机对照研究,将45例（45只眼）复杂性开放性眼球伤患者分为早期手术组21例（21只眼）和晚期手术组24例（24只眼）,均采用一期眼球修补术和二期玻璃体切除手术治疗。早期手术组玻璃体切除术在外伤两周内进行,晚期手术组玻璃体切除术在外伤两周后进行施行,术后随访3～12个月,观察比较手术复杂程度、术后视力及术后并发症。结果早期手术组术中注入硅油者5只眼（23.8%）,晚期手术组术中注入硅油者13只眼（54.2%）,差异有统计学意义（χ2=4.300,P=0.038）。随访期末早期手术组脱盲率85.7%（18/21）,晚期手术组脱盲率58.3%（14/24）,差异有统计学意义（χ2=4.087,P=0.043）。早期手术组无视网膜脱离复发,晚期手术组2只眼视网膜脱离复发,1只眼再次手术后视网膜复位,1只眼硅油再次填充后未取出。结论玻璃体切除术治疗复杂性开放性眼球伤宜早期进行,有助于更好地提高术后视功能、减少手术复杂程度。

Timing of vitrectomy on complicated open injury of the eyeballs

Objective To investigate the timing of vitrectomy on complicated open injury of the eyeballs.Methods Analyzed 45 cases （45 eyes）with complicated open injury of the eyeball who underwent vitreous surgery as the primary method in our hospital from Aug.2006 to Mar.2010.The early-operation group enrolled 21 cases （2 weeks before who undergone bi-operation after the primary suture）,the advanced stage group enrolled 24 cases（2 weeks later who undergone bi-operation after the primary suture）.All cases were followed up 3~2 months to observe and compare the complexity of the vitreous surgrey. All the factors were analyzed with STATA11.0 statistical package,usingχ2 analysis,α=0.05 was used as the test standard.Results 5 cases （23.8%）who undergone the padding off silicone oil in the early-operation group and 13 cases （54.2%） in the advanced stage group,the incidence rate distinction had statistical significance（χ2=4.300,P=0.038）.The best corrected vision after the surgery：The vision of the two groups improved obviously,de-blind rate（the vision≥0.05）：the early-operation group was 85.7%（18/21）,the advanced stage group 58.3%（14/24）,the incidence rate distinction had statistical significance（χ2=4.087,P=0.043）.There were 2 eyes with retinal detachment after vitrectomy,of which was 0 eye in the early-operation group and 2 eyes in the advanced stage group.Conclusion The vitreous operation is the effective treatment method in the complicated open injury of the eyeballs.Early operation can improve the vision of the injury eye better and lower the complexity of the vitreous surgrey.