玻璃体手术联合曲安奈德在眼后段外伤的应用

The application of vitrectomy combined with triamcinolone acetonide injection in posterior eye trauma

摘要目的探讨玻璃体视网膜手术联合曲安奈德（TA）玻璃体腔注射治疗眼后段外伤的疗效。方法眼后段外伤患者设联合组30例30眼、单纯组35例35眼。两组患者新鲜穿通伤首先清创缝合，1w～2w后行玻璃体切割术。合并白内障先切除混浊晶状体，有异物者取异物，伴有网脱者行气液交换或重水展平视网膜，裂孔厅眼内光凝或冷凝，C3F8或硅油填充。在关闭切口前联合组患者加用TA4mg玻璃体腔注射。结果眼后段损伤有玻璃体积血、视网膜出血、异物（联合组20例、单纯组21例）、视网膜脱赢两组发生率（P〉0.05）。两组患者眼后段异物均能取出。术后视力分别提高、不变、下降，联合组为76．7％、16．7％、6．7％；单纯组为60.0％、28.6％、11．4％。联合组比单纯组要好（P〈0．05）。术后并发症：第1天前房反应2＋以上联合组56.7％低于单纯组85．7％（P〈0．05）;高眼压和白内障发生率差异不明显（P〉0．05）；视网膜脱离联合组低于单纯组（P〈0.05）。结论玻璃体视网膜手术联合TA玻璃体腔注射比单纯手术治疗眼后段外伤疗效要好。

Objective To explore the effects of vitrectomy combined with triameinolone acetonide （TA） injection in vitreous cavity on posterior eye trauma. Methods The patients with posterior eye trauma were divided into two groups. The patients in group Ⅰ underwent triameinolone acetonide （TA） injection in vitreous cavity, and the patients in group Ⅱ did not. All the patients had some of following procedures, including suture the eyeball wounds, lensectomy, foreign body extraction, air-fluid exchange, retinal reattachment with perfluorocarbon liquids, intraocular laser photocoagulation or cryotheropy and filling of C3F8 or silicon oil. The patients in group Ⅰ had TA 4 mg injection before incision closure. Results The incidence of posterior eye trauma including vitreous hemorrhage, retinal hemorrhage, intraocular foreign body （20 cases in group Ⅰ, 21 cases in group ID and retinal detachment was no difference in two groups （p〉0.05）. All the foreign bodies were removed. Postoperative visual acuity improved in 76.7%, unchanged in 16.7%, and decreased in 6.7% in group Ⅰ, and 60.0%, 28.6% and 11.4% in group Ⅱ conespondingly. In group Ⅰ the postoperative visual acuity improvement was better than it in group Ⅱ （p〈0.05）. Anterior chamber inflammation was grade 2 or above in 56.7% cases of group L and 85.7% cases in group Ⅱ at 1 day after surgery. It had statiscally significant differences in two groups （p〈0.05）. The incidence of postoperative high intraocular pressure and complicated cataract bad no difference in two groups （p〉0.05）. The incidence of postoperative retinal detachment was in group Ⅰ, and in group Ⅱ It had statistically significant differences in two groups （p〈0.05）. Conclusions Triamcinolone acetonide （TA） injection had a good effect in vitretomy for posterior eye tranma.