复杂性眼外伤视网膜大范围切开硅油填充后远期疗效

Long-term effect after large range retinotomy and silicone oil tamponade for the treatment of complex ocular trauma

目的:观察复杂性眼外伤视网膜大范围切开/切除联合硅油填充术后的远期临床效果,以及硅油取舍对眼球、眼压及视功能的影响。方法:回顾分析2006-01/2010-01收治的复杂性开放性眼外伤伴视网膜嵌顿而行视网膜大范围切开/切除联合硅油填充治疗的28例28眼患者的临床资料。男27例,女1例,年龄19～57岁。术中行180°或360°视网膜切开及部分切除,激光光凝及硅油填充。10例视网膜360°视网膜切开,视网膜切至赤道部;18例180°视网膜切开部分视网膜切除。硅油取出条件:硅油填充6mo以上,眼压>10mmHg,视网膜复位良好,视网膜切开边缘封闭良好。术后观察2～5a。结果:视网膜切开/切除硅油填充后,早期视网膜均复位。10例视网膜360°切开眼中有8眼(80%)取出硅油,2眼(20%)因眼压低(<5mmHg)成为硅油支持眼。取出硅油的8眼中有2眼的眼压在正常范围内,视力均为指数;6眼的眼压在3～7mmHg范围内,角膜水肿浑浊,脉络膜水肿,有3眼伴玻璃体出血,其中5眼出现眼球萎缩,二期行义眼台植入。18眼180°视网膜切开眼行硅油取出后,17眼的矫正视力为指数～0.3,眼压均在正常范围;1眼(5.5%)出现眼球萎缩。结论:复杂性重度眼外伤视网膜嵌顿后,视网膜大范围切开/切除后联合硅油填充,虽然早期视网膜复位率高,但远期低眼压和眼球萎缩率较高。我们应该严格掌握手术指征。

AIM：To study the long-term clinical efficacy of large range retinotomy and silicone oil tamponade for the treatment of complex ocular trauma, and to investige the influence of silicone oil choice to eye ball, intraocular pressure（IOP） and visual function.METHODS：Retrospectively analyzed the clinical data of 28 cases （28 eyes）with complex open ocular trauma with retinal incarceration treated by large range retinotomy combined with silicone oil tamponade. There were male 27 cases, female 1 case, aged 19-57 years old. The 180 degrees-360 degrees retinotomy and partial excision, laser photocoagulation and silicone oil tamponade were performed intraoperatively. Ten cases performed 360 degrees retinotomy to ambitus, 18 cases performed 180 degrees retinotomy and partial retinectomy. Silicone oil removal conditions：silicone oil tamponade for more than 6 months, the IOP10mmHg, retinal reattachment well, retinotomy edges closed well. Postoperative follow-up was 2-5 years.RESULTS：Afterretinotomy, retinectomy and silicone oil tamponade, the early retina all reset. In 10 cases of 360 degrees retinotomy, 8 eyes （ 80%） removed silicone oil, 2 eyes （ 20%） became silicone support eyes due to the IOP5mmHg. In 8 eyes of silicone oil removal, 2 eyes with IOP in the normal range, vision as counting fingers. In other 6 eyes, the IOP was in 3-7mmHg with corneal edema turbidity, choroidal edema, in which 3 eyes associated with vitreous hemorrhage and 5 eyes appeared eyeball atrophy, eye fetal implanted in second stage. In 18 eyes of 180 degrees retinectomy, open line after removal of silicone oil, 17 eyes＇ corrected visual acuity was from counting fingers-0.3, the IOP in the normal range, 1 eye （5.5%） occurred eyeball atrophy.CONCLUSION：Complex severe ocular trauma retinal incarceration treated by large rangeretinotomy, retinectomy combined with silicone oil tamponade, although early retinal reattachment rate is high, but the long-term rate of low IOP and eyeball atrophy is also high. We should strictly control the operation pointer.