360°视网膜切除治疗重症眼球破裂伤

Retinectomy with 360° for severe ocular rupture

目的 探讨 36 0°视网膜切除在救治重症眼球破裂伤中的应用价值 ,评估影响预后的相关因素。 方法 对我院 1999年 1月～ 2 0 0 2年 10月收治的重症眼球破裂伤 2 8例 ,2 8只眼进行回顾性分析 ,其中男 18例 ,女 10例 ,年龄 16～ 5 8岁 ,平均年龄 2 9岁。根据机械性眼外伤国际分类 ,伤口位于 区 5例 ,5只眼 , ～ 区 8例 ,8只眼 , 区 3例 ,3只眼 , ～ 区 5例 ,5只眼 , 区 7例 ,7只眼。伤后视力分级 : 级 (0 .0 2～光感 ) 19例 , 级 (无光感 ) 9例。 2 8例中 13例术前虹膜及晶状体全部缺失 ,10只眼虹膜缺失大于 1/2 ,晶状体混浊或破碎 15只眼。超声生物显微镜 (ultrasound bomicroscopy UBM)及 B型超声提示睫状体脉络膜脱离 17只眼 ;全部病例 B型超声均提示玻璃体积血及视网膜脱离 ,眼压在 5～ 11mm Hg(1m m Hg=0 .133k Pa)之间。手术均为同一位手术者操作 ,采用常规巩膜三通道闭合式玻璃体切除 ,巩膜外环扎 ,合并晶状体切除 15例 ,赤道前 36 0°视网膜切开及切除 16只眼 ,赤道后切开及切除 12只眼 ,全部病例手术中均行眼内激光光凝 ,硅油填充。 结果 手术中证实全部病例均有严重的玻璃体积血及视网膜脱离 ,其中合并出血性睫状体脱离 9只眼 ,合并脉络膜上腔积血 12只眼 ,视网膜呈喇叭花茎样扭曲 11只?

Objective To investigate the effect of retinectomy 360° for severe ocular rupture and evaluate the related factors associated with prognosis. Methods We retrospectively analyzed 28 consecutive patients (28 eyes), 18 men and 10 women, with severe ocular rupture admitted to the Chinese PLA General Hospital between January 1999 and October 2002. The patient′s ages ragned from 16 to 58 years, mean 29 years. According to the internation standardized classification of ocular trauma, the injuries located in zone Ⅰ in 5 eyes, zone Ⅰ-Ⅱ in 8 eyes,zone Ⅱ in 3 eyes, zone Ⅱ-Ⅲ in 5 eyes, zone Ⅲ in 7 eyes, zone Ⅱ in 3 eyes, zone Ⅱ-Ⅲ in 5 eyes and zone Ⅲ in 7 eyes. The presenting visual acuity was in grade 4 (0. 02 to light perception) in 19 eyes, and grade 5 in 9 eyes. In 28 patients, 13 had the total absence of iris and lens, 10 had iris deletion more than 1/2, and 15 had lens opacity or rupture. Ultrasound biomicroscopy and B-scan revealed ciliochoroidal detachment in 17 eyes. The B-scan revealed vitreous hemorrhage and retinal detachment in all paitents. The intraocular pressure was from 5 to 11 mm Hg in all patients. The therappeutic operative procedures which were performed by one surgeon in all of the affected eyes included standard 3-port pars plana vitrectomy with scleral encircling buckle, endophotocoagulation and tamponading with silicone oil in all patients; lensectomy in 15 eyes; 360° retinotomy and retinectomy at anterior equator in 16 patients, and posterior equator in 12 eyes. Results During the operation, all patients were confirmed with vitreous hemorrhage and retinal detachment, including hemorrhagic ciliary body detachment in 9 eyes, suprachoroidal hemorrhage in 12 eyes, retinal twisting like morning glory in 11 eyes, and retinal incarceration in 17 eyes. Postoperative follow-up In 26 eyes who were followed up postoperatively from 6 months to 46 months, retinal reattachment was found in 20 patients (76. 9%) in whom the retina of 3 was reattached after revitrectomy and the silicone oil of 8 was removed at the fourth month after operation. In 20 eyes with reattached retina, 14 (70. 0%) had corrected visual acuity of 0. 02 or more, including 7 (35. 0%) had 0. 05 or more, 3 had 0. 1 or more, and 1 had the best visual acuity of 0. 3. Conclusion Retinectomy may improve the prognosis of severe ocular rupture and save the visual function of some patients.