睫状体复位联合玻璃体手术治疗复杂眼外伤

Combined vitrectomy and repair of the cyclodialysis cleft for complicated ocular trauma

目的评价睫状体复位联合玻璃体手术在治疗伴有睫状体脱离的复杂眼外伤中的临床疗效。方法对严重钝挫伤患者20例（20只眼），超声生物显微镜（UBM）探查所有外伤眼睫状体360°全周脱离，离断口的范围在3～5个钟点，其中6例伴有不同程度的房角后退。术前眼压4～17mmHg，12例IOP≤6mrnHg。伴随症状包括外伤性扩瞳、浅前房、前房积血、虹膜根部离断、品状体脱位或半脱位、外伤性白内障、玻璃体混浊、视网膜脱离、脉络膜脱离等。所有患眼施行玻璃体视网膜手术联合睫状体修补术。结果术后UBM检查睫状体脱离消失，离断口封闭。术后1月眼压13-21mmHg，平均（17±3．15）mmHg。随访所有外伤眼视网膜在位，屈光间质清晰。结论对于复杂眼外伤，尤其是伴有低眼压的患者，术前应常规行UBM检查。对于睫状体离断口范围超过2个钟点的，在行玻璃体视网膜手术的同时要联合睫状体修补术。

Objective To evaluate the clinical effect of combined vitrectomy and repair of the cyclodialysis cleft for complicated ocular trauma.Method 20 cases of complicated ocular trauma, Ultrasound biomicroscopy（UBM）revealed ciliary body detachment of 360 degrees associated with 3--5 o＇clock cyclodialysis, 6 cases of them also had recession of anterior chamber angle.Intraocular pressures （IOP）ranged from 4 to 17 mmHg before surgery, 12 cases had the lOP under 6 mmHg.Simultaneous phenomenon included mydriasis shallow of anterior chamber,hyphema,detachment of iris root,luxation or semiluxation of the lens,traumatic cataract,vitreous opacity,detachment of retina or choroids.Result Postoperative UBM showed that ciliary body detachment disappeared and cyclodialysis clefts closed in all cases.After 1 month, IOP ranged from 13 to 21mmHg（mean 17 ± 3.15 mmHg）.During the follow-up,no detachment of retina was founded and the refracting media remained clear.Conclusion For complicated ocular trauma, especially with hypotony, it is necessary to receive UBM examine before surgry.The combined therapy is effective for the complicated ocular trauma with above 2 o＇clock cyclodialysis.