玻璃体腔填充C3F8气体在复杂性开放性眼外伤Ⅰ期中的应用

目的:评估玻璃体腔填充C3F8气体在复杂性开放性眼外伤Ⅰ期救治中应用的安全性及有效性.方法:选取2012-01/2014-12复杂性开放性眼外伤患者54例54眼,满足以下条件:眼球复杂性开放性外伤,累及角巩膜,眼内容多量流失,眼内出血严重,眼压低.对以上患者行清创缝合及眼前段/眼内灌洗,玻璃体腔注入适量C3F8气体,术后观察1 ～2wk,根据病情行Ⅱ期手术.结果:所有患者Ⅱ期行玻璃体手术时玻璃体腔仍见不等量气体填充,眼压正常41眼,13眼眼压偏低;角膜不同程度水肿,无角膜血染;玻璃体大部分丢失,积血少;54眼均有视网膜裂孔形成,可见不同程度脉络膜视网膜脱离.所有患者行玻璃体切割+硅油填充术,术后矫正视力提高32眼(59％),矫正视力不变17眼(31％),矫正视力下降5眼(9％).结论:玻璃体腔填充C3F8气体在复杂性开放性眼外伤Ⅰ期救治应用安全有效,对止血、维持眼压、预防角膜血染及预防视网膜大范围脱离后粘连等有一定效果,为Ⅱ期手术创造条件.

Application of C3F8 filling in the vitreous chamber using in primary surgery of complexity of open eye injury

AIM: To evaluate the application of C₃F₈ filling in the vitreous chamber using in primary surgery of complexity of open eye injury.

METHODS: A total of 54 patients(54 eyes)with complexity of open eye injury from Jan. 2012 to Dec. 2014. The following conditions were complexity of open eye injury, wound involving cornea and sclera, loss of a large number of eye content, low intraocular pressure(IOP), intraocular hemorrhage. All patients underwent one stage operation, including debridement, anterior chamber irrigation and intravitreal injection of C₃F₈ gas. After 1-2wk follow-up, they underwent two-stage operation.

RESULTS: During the two stage operation, we found different dose of C₃F₈ gas in the vitreous chamber in all patients. Forty-one patients with IOP were normal, and 13 patients were low. The cornea was edema and no blood staining. Most of the vitreous body were lost and hematocele were less. All patients were found rhegmatogenous retinal detachment and choroidal detachment. All patients underwent vitrectomy and filling of silicone tamponade. After operation, best corrected visual acuity of 32 eyes(59%)improved, 17 eyes(31%)of them were not changed, and 5 eyes(9%)of them were worse.

CONCLUSION: C₃F₈ filling in vitreous chamber in one stage operation of open eye injury can stop bleeding, maintain intraocular pressure, prevent blood staining of cornea and prevent the retinal detachment and proliferation and create conditions for the two stage operation.