开放性眼外伤视网膜脱离并脉络膜脱离的玻璃体切除术

Vitrectomy for retinal detachment with choroidal detachment after eye laceration

目的：探讨严重开放性眼外伤视网膜脱离合并脉络膜脱离的患者，行玻璃体切除手术效果。方法：回顾性分析2000／2005年因严重开放性眼外伤缝合术后，在我院行眼球Ⅱ期手术的21例患者共21眼的详细临床资料，手术选择闭合式玻璃体切除加长效气体或硅油充填术。结果：眼球摘除2眼，视网膜复位19眼（90％），其中6眼使用300mL／L C3F8气体充填，1例短期再次脱离，13眼使用硅油充填，取硅油后1眼出现脱离再次硅油充填。19眼全部随访，随访3～15mo，术后10眼（48％）视力不同程度提高，17眼最终复位，视力大于0．1者2眼（9％），眼压13．8～21．3mmHg，2例因低眼压再次出现脱离需硅油长期充填。结论：开放性眼外伤视网膜脱离合并脉络膜脱离时，病情复杂，预后常不佳。及时合理的Ⅱ期玻璃体切除手术治疗，可使伤眼获得较理想的解剖学复位，并可提高部分视力。

AIM： To investigate the effects of vitrectomy for patients with retinal detachment combined with choroidal detachment after serious open ocular trauma. METHODS： Detailed clinical data of 21 patients （21 eyes）, who were performed phase Ⅱ eyeball operation after severe open ocular trauma and suture from 2000 to 2005 in our hospital, were analyzed retrospectively. Closed vitrectomy with long-term silicone oil or gas tamponade was adopted. RESULTS： Two eyes were enucleated; the retina was reattached in 19 eyes （90%）, of which 6 eyes were given 300mL/L C3F8 tamponade, 1 eye had retinal detachment again within the short term, 13 eyes underuent silicone oil tamponade, retinal detachment occurred in 1 eye after silicone oil was removed and it was filled again with silicone oil, All 19 eyes were followed up for 3 to 15 months. After the operation, the vision of 10 eyes （48%） was improved to different extent, 17 eyes had final reposition; the visual acuity of 2 eyes （10%） was above 0. 1 and their intraocular pressure ranged from 13, 8mmHg to 21.3mmHg, 2 eyes had retinal detachment again due to low intraocular pressure and needed silicone oil filling for a long time. CONCLUSION： The condition is usually complex and the prognosis is often poor when open ocular trauma results in retinal detachment combined with choroidal detachment. Reasonable phase Ⅱ vitrectomy in time can make injured eyes obtain better anatomic reduction, and visual acuity may be improved in some eyes.