眼前节开放性损伤的早期玻璃体手术

Early vitreous surgery on open anterior segment injury

目的 探讨早期玻璃体切除术治疗眼前节开放性损伤的疗效.方法 回顾性分析2006年1月至2009年2月间住院的72例（72只眼）眼前节开放性损伤患者的病例资料,均先后行以玻璃体切除为主要方式的手术治疗.其中早期手术组32例（一期缝合术后1～3周行二期手术）,晚期手术组40例（一期缝合术后1～4月行二期手术）.观察比较其疗效.随访3～18个月,平均6.8个月.用SPSS13.0统计软件包分析,采用X2检验,以a=0.05为检验水准.结果 （1）损伤Ⅱ区中巩膜伤道内口玻璃体嵌顿情况（分级参照刘文等的巩膜穿刺内口玻璃体嵌顿的分级方法）：Ⅱ级以上早期手术组73.7%（14/19）,晚期手术组81.0%（17/21）;Ⅲ级以上早期手术组10.5%（2/19）,晚期手术组57.1%（12/21）,Ⅲ级以上差异有统计学意义（X 2=9.53P=0.002）.（2）玻璃体手术复杂程度及硅油填充情况：早期手术组行复杂的玻璃体视网膜手术2例（6.3%）,晚期手术组13例（32.5%）,差异有统计学意义（X2=7.427P=0.006）;早期手术组硅油填充4例（12.5%）,晚期手术组14例（35.0%,）,差异有统计学意义（X2=4.80 P=0.028）.（3）术后（3月）最佳矫正视力：两组术后视力明显提高,脱盲率（视力≥0.05）早期手术组87.5%（28/32）,晚期手术组67.5%（27/40）,差异有统计学意义（X2=3.943 P=0.047）.（4）术后并发症：早期手术组视网膜脱离1例,硅油填充未取出1例,无眼球萎缩病例.晚期手术组视网膜脱离8例,硅油填充未取出4例,眼球趋于萎缩2例.结论 玻璃体手术是治疗眼前节开放性损伤的有效方法,早期手术能更好地改善伤眼的结局及视力预后.

Objective To investigate the effect of the early vitrectomy on open anterior segment injury.Methods Analyzed 72 cases （72 eyes） with open anterior segment injury who underwent vitreous surgery as the primary method in our hospital from Jan.2006 to Feb.2009 retrospectively.The early-operation group enrolled 32 cases （1-3 weeks later who undergone bi-operation after the primary suture）,the advanced stage group enrolled 40 cases （1-4 months later who undergone bi-operation after the primary suture）.All cases were followed up 3-18 months,averaged 6.8 months to observe and compare the effect.All the factors were analyzed with SPSS13.0 statistical package,using X2 analysis,a=0.05 was used as the test standard.The classification of the sclera wound tract endostoma was in accordance with the method of the vitreous incarceration of sclerotic puncture endostoma of Liu-wen,etc.Results 1.The vitreous incarceration of the sclera wound tract endostoma （the grade Ⅱ border damage）：Above the grade Ⅱ of the early-operation group was 73.7%（14/19）,the advanced stage group 81.0%（17/21）;Above grade Ⅲ of the early-operation group 10.5% （2/19）,the advanced stage group 57.1%（12/21）,the incidence rate distinction above grade Ⅲ had statistical significance （X2=9.53,P=0.002）.2.The complexity of the vitreous surgery and the padding of silicone oil：There were 2 cases （6.3%） who undergone complex vitreo-retinal surgery in the early-operation group,13 cases（32.50%）in the advanced stage group,the incidence rate distinction had statistical significance（X2=7.427,P=0.006）;4 cases （12.5%） who undergone the padding off silicone oil in the early-operation group and 14cases （35.0%） in the advanced stage group,the incidence rate distinction had statistical significance （x2=4.80,P=0.028）.3.The best corrected vision after the surgery （3months）：The vision of the two groups improved obviously, de-blind rate （the vision≥ 0.05 ）： the early-operation group was 87.5% （28/32）, the advanced stage group 67.5% （27/40）, the incidence rate distinction had statistical significance （X2=3.943, P=0.047）. 4. Postoperative complications： 1 case had retinal detachment in the early-operation group, 1 did not take out the filled silicone oil, and there were no cases of atrophia bulbi. The advanced stage group had 8 cases of retinal detachment, 4 cases who filled with silicone oil did not take out, and there were 2 cases of atrophia bulbi. Conclusions The vitreous operation is the effective treatment method in the open anterior segment injury. Early operation can improve the outcome and vision of the injury eye better.