角巩膜穿孔伤一期手术技巧探讨

Investigation on primary operation on corneoscleral perforation.

目的 探讨角巩膜穿孔伤一期急诊手术在视功能重建过程中的重要作用。方法 对168眼角巩膜穿孔伤进行回顾性分析,单纯角巩膜修补术3 6眼,角巩膜修补+虹膜复位术93眼,巩膜修补+热凝+硅胶外加压术2眼,角巩膜修补+白内障摘出2 4眼。角膜修补+白内障摘出+人工晶状体植入术13眼。结果 全部病例伤口均甲级愈合。术前视力无光感6眼,光感～0 . 0 4者84眼,0. 0 5～0 .2 5者71眼,0 . 3～1. 0者7眼。术后视力无光感4眼,光感～0. 0 4者3 9眼,0. 0 5～0. 2 5者92眼,≥0 . 3者3 3眼。脱盲率5 2 . 2 2 %。脱残率3 6. 62 %。结论 角巩膜穿孔伤一期手术水平决定了伤眼治疗结果,应把角巩膜伤口的缝合视为屈光手术。

Objective To investigate the significance of primary operation on perforating corneosclera l injury. Methods A retrospective analysis on clinical data was performed on 168 patients with per forating corneoscleral injury.Among all the cases,corneoscleral repair for 36 ey es.corneoscleral repair and iris reduction for 93 eyes,scleral repair with silic one buckling for 2 eyes,corneoscleral repair and ECCE for 24 eyes,and corneal re pair with ECCE and IOL for 13 eyes. Results Wound healing for all eyes achieved A grade.Preoperative visual acuity of all ey es were as follows:Non_light perception in 6 eyes,light perception to 0.04 in 8 4 eyes,0.05～0.25 in 71 eyes,And 0.3～1.0 in 7 eyes; postoperative visua l ac uity: non_light perception in 4 eyes,light perception to 0.04 in 39 eyes,0.05 ～ 0.25 in 92 eyes,≥0.3 in 33 eyes.52.22% eyes avoid blindness and 36.62% eyes avoid disability. Conclusion Primary operation on perforating corneosleral injury is important to the treatme nt results. The wound saturation should be regarded as refraction operation.