合并角膜血染的开放性眼外伤玻璃体手术预后分析及治疗策略探讨

Investigation on surgical outcomes and treatment strategy of open globe injury with corneal blood staining

目的分析合并角膜血染的开放性眼外伤患者在历经临时人工角膜辅助下的玻璃体手术及血染角膜原位缝回手术后的不同转归。方法开放性眼外伤接受玻璃体手术硅油填充，术中因角膜血染应用临时人工角膜，术毕将自体血染角膜原位缝回，手术后随访时间超过2年者16例（16眼）。依据术中及术后填写的眼外伤登记表回顾性分析患者的外伤类型，伤眼的基本状况，手术后伤眼的不同转归情况。结果16例中男15例，女1例，年龄20一53岁，平均（32．3±9．5）岁。手术距受伤时间平均8～57d，平均（18．8±12．3）d。破裂伤15例，穿孔伤1例，1例合并眼内异物。全部为开放3区损伤。术中探查1例视网膜完全流失，另外15例视网膜全脱离，其中11例为闭合漏斗状视网膜脱离，13例存在视网膜嵌塞，4例合并脉络膜断离。术后随访24—60个月，平均（37．9±11．7）个月。14例1次手术视网膜复位，1例经2次手术复位。末次复查视力：4眼无光感，5眼为光感～手动，3眼为数指一0．08，4眼I〉0．1。3例因眼球萎缩行眼球摘除；7例因低眼压需长期硅油支撑；其余6例硅油取出，其中3例血染明显消退未行角膜移植，1例行自体双眼角膜互换，2例接受了二期角膜移植。结论合并角膜血染的开放性眼外伤具有多种不同转归和预后，其中只有一小部分病例有实施角膜移植的价值和／或必要性。

Objective To investigate on different outcomes of the opening injured eyes with corneal blood staining after vitreoretinal surgery using temporary keratoprosthesis and replacement of the blood stained cornea. Methods From January 2002 to June 2008, medical records of 16 eyes undergoing vitreo- retinal surgery using temporary keratoprosthesis for opening globe injury and corneal blood staining were stud- ied. The blood stained corneas were sutured back at the end of the surgery and the eyes were tamponade with silicone oil. Only patients with ≥24 months follow -up were included. Data retrieved from the eye injury registry chart including the types of the eye trauma, the status of the eye after the trauma, the intraoperative findings, and the different outcomes and prognoses of the injured eyes were reviewed. Results Among the 16 patients, 15 were male and 1 was female. Mean age was （32.3 ＋ 9.5） years （20 -53years）, mean length of time between the injury and the primary vitreoretinal surgery was （ 18.8 ~ 12.3 ） days （ 8 57days）. Subtypes of the injury include 15 globe rupture, 1 penetrating injury, 1 intraocular foreigen body. All eyes were suffered from zone 3 open globe injury. Intraoperative findings include 1 total retinal loss, 15 total retinal detachment, 11 funnel shape retinal detachment, 13 retinal incarceration, 4 choroidal dialysis. Mean follow - up time was （37.9 ± 11.7 ）months （24 - 60months）. Retinal reattachments were achieved in 14 eyes and 1 eye underwent a second reattachment surgery. Final visual outcome include 4 eyes with no light perception, 5 eyes with light perception hand motion, 3 eyes with finger count - 0.08, 4eyes with ≥ 0.1. The overall outcomes were as follows： 3 eyes were enucleated, 7 eyes needed long term silicone oil temponade, silicone oil were removed in 6 eyes, among them, blood stained cornea were largely resolved in 3 eyes and keratoplasty were not needed, 1 patients underwent bilateral corneal exchange, only 2 eyes finally received penetrating keratoplasty. Conclusion Open globe injury with corneal blood staining may have dif- ferent outcomes, only a small portion of eyes is worth of undergoing keratoplasty.