二次玻璃体手术治疗复杂眼外伤

目的探讨二次玻璃体视网膜手术治疗复杂性外伤性视网膜脱离的疗效并分析首次手术失败的原因。方法分析复杂眼外伤26眼在玻璃体视网膜手术后因出现视网膜前膜或视网膜脱离,在术后7d～6月分别再次行玻璃体视网膜手术等2次以上手术,并对第2次手术原因进行分析。结果术后增生性玻璃体视网膜病变复发、视网膜裂孔封闭不良、首次手术玻璃体切除不彻底是第1次玻璃体手术失败的主要原因。第2次手术后26眼中视网膜完全解剖复位23眼,2眼因局限性视网脱离分别再行玻璃体切除联合巩膜环扎或视网膜切开术,另1眼失败,复位率88.46%。术后视力提高者20眼（76.92%）,术后视力与手术前比较,差异有统计学意义（U=-3.397,P〈0.001）。结论彻底清除PVR增生组织、恢复视网膜活动度、选择合适封孔方式及眼内填充物,方能够复位视网膜,并恢复部分视力。

Exploration of treating complicated ocular trauma by secondary vitreoretinal surgery

Objective To observe effects of secondary vitreoretinal surgery（VRS） on complicated ocular trauma and investigate the causes of failure of the primary vitrectomy.Method 26 eyes retinal frontal membrane or retinal detachment occured after vitreoretinal surgery,so secondary surgery was performed on them respectively during the 7 days to 6 monthes postoperatively.Results The main causes of failure of the primary vitrectomy were postoperative recurrence of proliferative vitreoretinopathy（PVR）,unwell closed retinal breaks,residue of vitreous.The retina was attached completely in 23 eyes,partly in 2 eyes and never in 1 eyes.The to-tal effect rate was 89.29%.The postoperative visual acuity increased in 20 of 26 eyes（76.92 %）,the difference was significant（U = -3.397,P〈0.001）.Conclusion The keys to the success of secondary vitreous surgery are to restore the mobility for retina by eliminating the PVR completely,and choosing the appropriate closure procedure for retinal breaks and the suitable intraocular tamponades,secondary vitreoretinal surgery can reattach retinal detachment and recover sight.