玻璃体切除联合晶状体超声粉碎在合并晶状体脱位眼外伤中的应用研究

Study on the application of vitrectomy combined with the ultrasonication of crystalline lens in ocular injury with lens dislocation

目的:探讨玻璃体切除联合晶状体超声粉碎在合并晶状体脱位眼外伤中的应用。方法:选择我院眼科中心2a余接受不同手术方式治疗眼外伤合并晶状体脱位的40例40眼受术者资料,并对其术中并发症,术后视力、眼压等进行统计分析。术后随访时间3mo～2a;结果:行"玻璃体切除联合晶状体经角膜缘取出术"19例19眼中1例1眼因视神经挫伤术后矫正视力不提高未植入人工晶状体,其余18例18眼均植入后房型人工晶状体,其中疗效显著者8例8眼(44%),有效者5例5眼(28%),效果欠佳者5例5眼(28%)。行"玻璃体切除联合晶状体超声粉碎术"21例21眼中2例2眼因视神经挫伤术后矫正视力不提高未植入人工晶状体,其余19例19眼均植入后房型人工晶状体,其中疗效显著者16例(84%),有效者2例2眼(11%),效果欠佳者1例1眼(5%)。两组疗效显著者比较具有统计学意义(χ2=4.787,df=1,P=0.029<0.05),术中无并发症发生。"玻璃体切除联合晶状体经角膜缘取出术"中并发症视网膜损伤,5例5眼(26.32%),两组比较具有统计学意义(χ2=4.193,P=0.042<0.05),球内出血3例3眼(16%),两者比较具无统计学意义。结论:"玻璃体切除联合晶状体超声粉碎术"可使眼外伤合并晶状体脱位患者眼球在密闭条件下进行手术,且可将对眼球组织的损伤进一步减小,从而很大程度上挽救和提高了患者的视力。

AIM：To investigate the application of vitrectomy combined with the ultrasonication of crystalline lens in ocular injury with lens dislocation.·METHODS： The data of 40 cases 40 eyes with ocular injury with lens dislocation treated by different ways of surgery in our Eye Center for 2 years were selected, and the complication after surgery, sight after surgery, intraocular tension, and so on were analyzed. The follow-up period was 3 months to 2 years.·RESULTS：In 19 cases 19 eyes with ＂vitrectomy com-bined with lens removal through limbus of cornea＂, corrected vision of 1 case 1 eye was not improved due to optic nerve contusion and it was not implanted intraocular lens. The rest 18 cases 18 eyes were all implanted posterior chamber intraocular lens, in which 8 cases 8 eyes had significant therapeutic effect accounted for 44%, 5 cases 5 eyes had therapeutic effect, accounted for 28%, 5 cases 5 eyes was ineffective, 28%. In 21 cases 21 eyes with ＂vitrectomy combined with the ultrasonication of crystalline lens ＂, corrected vision of 2 cases 2 eyes were not improve due to optic nerve contusion and they were not implanted intraocular lens. The rest 19 cases 19 eyes, were all implanted posterior chamber intraocular lens, in which 16 cases 16 eyes had significant therapeutic effect, accounted for 84%, 2 cases 2 eyes had therapeutic effect, accounted for 11%, 1 case 1 eye was ineffective, accounted for 5.26%. The comparison of significant therapeutic effect between two groups had statistical significance（χ2=4.787,df=1,P=0.0290.05）,No complications occurred. 5 cases 5 eyes complicated retina damage, accounted 26.32% in ＂vitrectomy combined with lens removal through limbus of cornea＂, and the comparison accounted for between two groups had statistical significance（χ2=4.193,P=0.0420.05）. 3 cases 3 eyes complicated with the interior of eyeball hemorrhage, accounted for 15.79%,and the comparison between two groups had no statistical significance.·CONCLUSION： The eyeballs of patients with ocular injury with lens dislocation can be operated under the airtight condition by ＂vitrectomy combined with the ultrasonication of crystalline lens ＂, which make the damage of eyeball tissue further reduced.Thereby, patient＇s sight is remedied and improved in a very large extent.