虹膜根部离断的闭合式缝线修复技法和观察

The technique and observation of closed stitching recovery for lridodialysis

目的虹膜根部离断是闭合性顿性眼外伤中较常见并发症。复位修复的方法是缝线法最有效。缝线法中有角巩膜缘切开法和闭合式缝线法两种。作者采用闭合式缝线法取得较好效果。方法虹膜根部离断病例中，多有前房出血，色素膜炎症等多种并发症，经治疗好转后，择期（术后3～7d）手术更好。在虹膜根部离断相对应的角巩膜缘作巩膜瓣下缝线固定术，根据离断范围长短，确定缝针数目（1-4针），结扎线头埋在巩膜瓣下，结膜瓣复位复盖。结论本院治疗虹膜根部离断病例32例，完全修复。术后瞳孔居中圆形26例，瞳孔居中略呈椭圆形者4例，瞳孔偏位者2例，房角后退眼压增高2例。术后矫正视力0．5-1．0，21例（65．6％）；0．3～0．4，6例；0．1～0．20，2例（6．2％），0．1以下者1例（3．1％）。视力差者有眼压增高，房角后退，玻璃体积血等多种病变。结论顿性闭合性眼外伤致虹膜根部离断，合理治疗后，择期作巩膜瓣下缝线固定术，效果良好，此法可推广。闭合式缝合法可减少对眼球的刺激，术后视力恢复快，瞳孔居中，园形或近园形较满意。但眼伤势过重，致玻璃体出血，房角后退，网膜病变，视神经外伤者，则视力恢复差。

Objective Iridodialysis is a common complication of closed incarcerated ocular trauma. Re- covery by reduction is the most effective stitching method. There are two methods of stitching： corneoseleral edge incision method and closed stitching method. The author has achieved better results with closed stitching meth- od. Methods In the eases of Iridodialysis, there are various types of complications, e. g. hyphema and pigmen- ted retina inflammation. The surgery is better performed after treatment in （3-7 days after treatment）. Perform stitching fixation beneath the selera flap on the corneoseleral edge of Iridodialysis. Based on the length of separation, determine the counts of stitching （ 1-4 stitches）, bury the end of stitches under the sclera flap, with the reduction and recovery of conjunctival flap. Results Our hospital has treated 32 cases of Iridodialysis, with com- plete recovery in each case. After the surgeries,26 cases were found with centralised pupils,4 cases with cent- ralised pupils slightly oval-shaped,2 cases with deviated pupils ,2 cases with angle recession and ocular hyper- tension. After sngeries,21 cases are found with adjusted vision of 0. 5-1.0 （65.6%） , 6 with 0. 3-0.4,2 with 0. 1-0. 2 （6. 2% ）, 1 with below 0. 1 （3.1%）. The cases with poor eye visions suffer from ocular hypertension, angle recession, vitreous hemorrhage, and etc. Conclusion For the Iridodialysis caused by incarcerated closed ocular trauma, the stitching fixation beneath sclera flap can be performed at an appropriate time after treatment to achieve desirable results. Therefore, this surgery method can be applied. The closed stitching method can mini- mise the stimulation to eye balls with rapid recovery of eye vision, and formation of a eentralised pupil in a satis- factory shape of round or near-round. However, recovery of eye vision is not as good for those cases with serious eye trauma resulting in vitreous hemorrhage, angle recession, retina mutation, and visual neuro trauma.