玻璃体切割术在治疗伴有睫状体脱离的复杂眼外伤中的临床疗效观察

Observation of vitrectomy on complex ocular trauma with ciliary body detachment

目的探讨玻璃体切割在治疗伴有睫状体脱离的复杂眼外伤中的临床疗效。方法 7例（7只眼）严重眼外伤患者中,3只眼钝挫伤,外伤性瞳孔散大、晶状体脱位或半脱位,玻璃体出积,4只眼眼球破裂伤,清创缝合术后,合并视网膜脱、脉络膜脱离和脉络膜上腔出血。7只眼经超声生物显微镜（UBM）探查所有外伤眼睫状体360°全周脱离,离断口的范围在1~2个象限。术前视力光感至眼前手动,平均眼压（6.03±3.25）mm Hg。2只眼钝挫伤患者先行睫状体复位,二期施行玻璃体切割术＋晶状体切除＋硅油充填,另5只眼行玻璃体切割术＋晶状体切除＋硅油充填视网膜复位＋巩膜外穿刺放液等。结果硅油取出后随访UBM显示所有患眼睫状体复位。所有外伤眼术后视力较术前明显提高。眼压（19.33±5.05）mm Hg。结论对于合并睫状体脱离的严重眼外伤患者,分期或联合手术均可有效恢复眼球的解剖结构,并保存有效的的视功能。

Objective To investigate the clinical efficacy of vitrectomy in the treatment of complicated ocular trauma associated with ciliary body detachment.Methods 7 cases of severe ocular trauma was included.Amonty these 7 patients,3 cases were contusion,traumatic mydriasis,lens dislocation or subluxation and vitreous hemorrhage,4 cases were eyeball rupture,combined with retinal detachment,choroidal detachment,and subretinal or choroidal hemorrhage after debridement.7 cases of complicated ocular trauma were subjected to ultrasound biomicroscopy for determining ciliary body detachment which was 360 degrees,the range of tears was 1 ~ 2 quadrant.visual acuity（VA） ranged from light perception（LP） to hand movement（HM） Preoperative.The average intraocular pressures（IOP） was 6.03±3.25 mm Hg.Vitrectomy ＋ lens extraction ＋ silicone oil filling were operated on two cases of blunt trauma after ciliary body reattachment.And repair of the cyclodialysis cleft combined with vitrectomy,and also cataract removal,silicone oil filling,retina reattachment and sclera tapping were performed on the other five patients.Results After surgeries,the ciliary body reattached in all cases.VA was significantly improved Postoperatively.The mean IOP was 19.33±5.05 mmHg.Conclusion For ocular trauma with ciliary body detachment,combined vitrectomy and repair of the cyclodialysis cleft are effective to recover the anatomic structure and preserve the available visual function.