眼球穿孔伤伴外伤性白内障患者一期与二期前段玻璃体切除术的效果比较

目的探讨前段玻璃体切除在眼球穿孔伤所致的外伤性白内障手术中的应用价值。方法对于我院2008年1月-2009年2月收治的眼球穿孔伤伴后囊破裂型外伤性白内障58例（58眼）,其中32例行眼球清创缝合、一期白内障摘出联合前段玻璃体切除手术：26例行眼球清创缝合术,术后1周-1月行二期白内障摘出联合前段玻璃体切除手术。术后随访1-3月,观察两组的治疗效果。结果一期前段玻切组32眼,术后矫正视力0.1-0.8,其中1眼0.1,7眼0.2-0.3,24眼0.4-0.8。32眼中1眼术后眼压高,药物无法控制,行二期平坦部玻璃体切除术。二期前段玻切组26眼,术后矫正视力数指-0.8,其中3眼视力≤0.1,7眼0.2-0.3,16眼0.4-0.8,26眼中4眼因一期术后眼压高,1周内行二期手术,术后2眼眼压仍无法控制,行平坦部玻璃体切除术。一期前段玻切组的并发症较二期组少而且轻。结论对于眼球穿孔伤所致后囊破裂型外伤性白内障患者,于清创缝合时进行白内障摘出和一期前段玻璃体切除,可以减少并发症,并减少二期手术的难度及风险,获得较好的矫正视力。

The effect of anterior vitrectomy with different opportunity of operation in cataract from penetrable eye trauma

Objective Objective To explore the effects of anterior vitrectomy in cataract from penetrable eye trauma. Methods In 58 cases（58 eyes）of cataract with cracked posterior capsule caused by penetrable eye trauma（during Jan 2008-Feb 2009）,debridement and cataract extraction plus anterior vitrectomy were performed to 32 cases（32 eyes）; The other 26 cases（26 eyes）only underwent debridement,and cataract extraction plus anterior vitrectomy were performed 1 week-1 month later o The follow-up were 1 to 3 months.The best corrected visual acuity and the comlications wereanalyzed. Results In the 32 eyes group,the BCVA was 0.1～0.8,including of 1 eye 0.1,7 eyes 0.2～0.3,24 eyes 0.4～0.8.Only 1 eye underwent vitrectomy through pars plana because of high inner optic pressure o In the 26 eyes group,the BCVA was CF～0.8,including of 3 eye≤0.1,7 eyes 0.2～0.3,16 eyes 0.4～0.8.4 eyes underwent cataract extraction plus anterior vitrectomy in 1 week because of high inner optic pressure,and 2 of them continued vitrectomy through pars plana.The complications of group 2 were more and much severe than group 1. Conclusions Cataract extraction plus anterior vitrectomy is very effective for the cataract with cracked posterior capsule caused by penetrable eye trauma,and will reduce the complications,the difficulties and risks of later surgery thus achieve better BCVA and visual function.