玻璃体切除手术中角膜上皮刮除后其术后恢复情况观察

Postoperative recoverment observation of corneal epithelium scaled off from vitrectomy

目的:观察在玻璃体切除术中被刮除的角膜上皮在术后的恢复情况。方法:随机选取2005-04/2008-10我院玻璃体切除手术患者135例147眼。手术采用经典的经睫状体平坦部常规三通道玻璃体切除手术。术中因角膜上皮发生水肿混浊而被迫用虹膜恢复器刮除角膜中央区上皮约7～8mm直径大小范围,保留角膜缘上皮细胞。正常完成玻璃体切除手术。术后给予抗生素眼凝胶4次/d涂眼,术后前3d半球后注射妥布霉素10mg+地塞米松3mg抗炎治疗。结果:术后第1d147眼(100%)中央区角膜上皮缺失,但缺失面积比术中明显缩小。术后第2d有57眼(38.8%)角膜上皮基本修复,其中糖尿病患者修复率为18.8%。术后第3d有137眼(93.2%)角膜上皮基本恢复,其中糖尿病患者修复率为89.6%。术后第5d有11眼在局部加用激素眼液后再次出现角膜上皮小片状剥脱,均为糖尿病患者,更改用药后均于术后第8～10d基本修复。术后第10d只有3眼角膜上皮仍有缺损。术后2wk复查时,只有2眼角膜上皮仍未修复。结论:对于非糖尿病患者玻璃体切除术中刮除的角膜上皮是安全的;但对于糖尿病患者,术中刮除角膜上皮应慎重,刮除后有角膜上皮延迟愈合的危险。

AIM： To observe the postoperative recoverment of corneal epithelium scaled off from vitrectomy. METHODS： One hundred and thirty-five cases 147 eyes of vitrectomy were selected randomly in our hospital from Apr. 2005 to Oct. 2008. Surgery was performed using classical routine vitrectomy through the pars plana. Corneal epithelium was scaled off about 7-8mm in diameter size due to edema turbidity during the operation, and limbal epithelium was saved. The vitrectomy was completed normally. After surgery, antibiotic gel was be used q. i. d, tobramycin 10mg plus dexamethasone 3mg was given by peribulbar injection 3 days postoperatively. RESULTS. The first day after surgery, 147 eyes（100%） were the absence of central corneal epithelium, but the size of lack was significantly reduced compared with surgery. On the second day, 57 eyes （38.8%） regained corneal epithelium roughly, among them, regained rate in diabetes was 18.8%. On the third day, 137 eyes （93.2%） regained corneal epithelium, among them, regained rate in diabetes was 89.6%. After the first 5 days, 11 eyes recurred small pieces of corneal epithelial exfoliation, they were all diabetic. With changed treatment, they regained at postoperative 8 to 10 days. After the first 10 days, there were stil defect. After 2 weeks epithelium was not yet only 3 eyes＇ corneal epithelia of review, only 2 eyes＇ corneal regained.CONCLUSION： Scraping corneal epithelium is safe for the non-diabetic vitrectomy; but for diabetic patients, surgery should be carefully performed to scrape corneal epithelium, corneal epithelium has the risk of delayed healing.