伴脉络膜损伤的外伤性视网膜脱离玻璃体手术预后观察

Observation of prognosis of traumatic retinal detachment combined with choroidal damage treated by vitreous surgeries

目的评价玻璃体手术治疗合并脉络膜损伤的外伤性视网膜脱离的效果。方法对1995年至2005年间经玻璃体手术治疗1075只外伤眼进行回顾性分析,外伤性视网膜脱离合并浆液性脉络膜脱离、出血性脉络膜脱离(含外伤性脉络膜分离)或视网膜下出血在内的不同类型脉络膜损伤共41例41只眼(3.8%),采用闭合式玻璃体手术进行治疗,统计比较手术预后。结果视网膜复位38只眼(92.7%),最终视力大于0.1者10只眼(24.4%);手术后视力提高者共29只眼(70.7%),其中合并视网膜下出血组14只眼(87.5%,14/16),合并浆液性脉络膜脱离组12只眼(75.0%,12/16),合并出血型脉络膜脱离组3只眼(33.3%,3/9),三组患眼的视力提高率χ2=8.394,P=0.015,P<0.05。最终黑朦6只眼,均为出血型脉络膜脱离者。17只低眼压眼中8只眼(47.1%)需持续硅油填充,出血型脉络膜脱离5只眼(55.6%,5/9)。结论合并脉络膜损伤的外伤性视网膜脱离玻璃体手术处理得当可获得较好的结果,其中合并视网膜下出血者手术预后较好;合并出血型脉络膜脱离眼预后较浆液型明显差,但也并非眼球摘除适应证。严重外伤性脉络膜分离眼预后较差常为低眼压需长期硅油填充。

Objective To evaluate the effect of vitrectomy on traumatic retinal detachment combined with choroidal damage. Methods The data of 1 075 traumatic eyes which underwent vitrectomy from 1995 to 2005 were retrospectively analyzed. Forty one patients （41 eyes, 3. 8%） with different kinds of choroidal injuries, including traumatic retinal detachment combined with serous choroidal detachment, hemorrhagic choroidal detachment （including traumatic separation of choroid and sclera） or subretinal hemorrhage, underwent closed vitrectomy. The operative prognosis in different groups were analyzed statistically. Results The retina reattached in 38 eyes （92. 7%0）, including 10 with the final visual acuity 〉 0. 1（24.4%）;the visual acuity improved postoperatively in 29 （70. 7%）,including 14 in subretinalhemorrhage group（87.5%, 14/16）,12 in serous choroidal detachment group（75.0%, 12/16） and 3 in hemorrhagic choroidal detachment（33.3%, 3/9） （X^2=8.394, P=0.015）; amaurosis was found in 6 cyes, all of which were with hemorrhagic choroidal detachment preoperatively. In 17 eyes with ocular hypotension, a persistent silicone oil tamponade was needed in 8（47. 1%）, in which 5 were in the hemorrhagic choroidl detachement group （55. 6%, 5/9）. Conclusions Appropriate vitrectomy is helpful for traumatic retinal detachment combined with choroidal damage, and the operative prognosis of the patients combined with subretinal hemorrhage is good. The operative prognosis of hemorrhagic choroidal detachment is worse than that of the serous choroidal detachment. However, it doesn＇t mean that all the hemorrhagic choroidal detachment eyes need ocular enucleation. The prognosis of eyes with severe traumatic choroidal detachment was poor, and the eyes are with ocular hypotension which needs a long-term silicone oil tamponade.