复杂外伤性白内障的手术治疗

目的探讨复杂外伤性白内障手术的最佳时机、手术方法及临床效果。方法对41例（41眼）复杂外伤性白内障进行回顾性研究,分析术前B型超声像图特征,根据术中眼内情况比较两者的一致性;观察术后视力和并发症,并探讨影响术后视力恢复的相关因素。结果各种合并损伤术前B超检查符合率分别为：玻璃体浑浊100.00%,视网膜脱离88.89%,眼内异物81.82%,晶状体脱位80.00%,脉络膜脱离50.00%。术后视力〈0.05者3眼,0.05～0.25者13眼,0.3～0.5者18眼,0.6～1.0者7眼。角膜瞳孔区瘢痕、严重散光、继发性青光眼、虹膜缺损、瞳孔变形移位、瞳孔前膜、晶状体后囊浑浊是影响术后视力恢复的危险因素（P=0.00,0.01,0.02,0.02,0.01,0.00,0.02）。术后并发症主要有明显葡萄膜炎症反应者20眼、角膜水肿24眼、瞳孔前膜5眼、晶状体后囊浑浊12眼、人工晶状体移位2眼。结论复杂外伤性白内障选择手术时机及采取适当的手术方式,可取得很好的疗效,而术前B超检查为手术的选择提供良好的依据。

Clinical observation of the surgical treatment of complex traumatic cataract

Objective To discuss the best surgical time,surgical method and clinical effect of complex traumatic cataract surgery.Methods 41 cases（41 eyes） complex traumatic cataract patients were analyzed retrospectively.Their preoperative B-mode ultrasonogram were compared with the results during the surgery.The postoperative visual acuity and complications were observed and the relative risk factors affecting the postoperative visual acuity were analyzed.Results The corresponding rate of vitreous opacity,retinal detachment,intraocular foreign body,lens dislocation and choroidal detachment diagnosed by B-scan were 100%,88.89%,81.82%,80% and 50% respectively.Postoperative visual acuity〈 0.05,0.05 ～ 0.25,0.3 ～ 0.5 and 0.6 ～ 1.0 were 3 eyes,13 eyes,18 eyes and 7 eyes respectively,the postoperative visual acuity was affected by pupil zone corneal scar,serious astigmatism,secondary glaucoma,iridoschisis,dyscoria,prepupillary membrane and posterior capsular opacification（P = 0.00,0.01,0.02,0.02,0.01,0.00 and 0.02,respectively）.The complications included obviously uveal inflammatory response（20 eyes）,corneal edema（24 eyes）,prepupillary membrane（5 eyes）,posterior capsular opacification（12 eyes） and intraocular lens（IOL） shift（2 eyes）.Conclusion The complex traumatic cataract can achieve good results taking the appropriate surgical timing and surgical approach.The preoperative B-mode ultrasonic examination will contribute to select the appropriate surgery.