早期玻璃体切除联合硅油填充术治疗开放性眼外伤合并视网膜脱离的疗效观察

Effects of early vitrectomy combined with silicone oil on open-globe injuries with retinal detachment

目的探讨早期玻璃体切除联合硅油填充术治疗开放性眼外伤合并视网膜脱离的临床疗效。方法回顾性分析我科治疗的26例(26只眼)开放性眼外伤合并视网膜脱离的临床资料,所有患者均于伤后72 h内行常规三通道玻璃体切除联合硅油填充术,根据病情联合其它术式。观察术后视网膜状态、视功能及并发症。结果术后随访末次最佳矫正视力0.12～0.3者3例(11.54%),指数～0.1者16例(61.54%),光感～手动者5例(19.23%),无光感者2例(7.69%)。所有患者第1次玻璃体切除术后随访复发性视网膜脱离4例(15.38%),再次手术治疗后视网膜复位。眼球萎缩1例(3.85%)。术后无眼内炎及严重增生性玻璃体视网膜病变(PVR)并发症发生。结论早期玻璃体切除联合硅油填充术治疗开放性眼外伤合并视网膜脱离可有效的控制眼球萎缩,复位视网膜,挽救一定的视力,且术后并发症少。

Objective To examine the outcomes of early vitrectomy with silicone oil tamponade in open-globe inju- ries with retinal detachment. Methods Retrospective analysis of 26 patients （26 eyes ） with open-globe injuries and retinal detachment were conducted. All patients underwent vitrectomy and silicone oil tamponade within 72 hours of the trauma. Other necessary surgical procedures were done according to the clinical situations. The retina morphology, visual acuity and surgical complications were recorded. Results The postoperative best corrected visual acuity at the last fellow-up visit was 0.12 to 0.3 in 3 eyes （ 11.54% ）, counting fingers to 0. 1 in 16 eyes （ 61.54% ）, LP to HM in 5 eyes （ 19.23% }, and NLP in 2 eyes （ 7.69% ）. Recurred retina detachment was found in 4 cases （ 15.38% ） during the follow-up, and was suc- cessfully treated with a second surgery. There was 1 case where ocular atrophy occurred （ 3.85% ）. There was no postoper- ative endophthalmitis or ~vere proliferative vitreoretinopathy （PVR）. Conclusion Early vivrectomy with silicone oil tam- ponade for opelgiobe injuties complicatec with retinal detachment is an effective way to reduce the risk of ocular atrophy, to restore the retina morphology, and to save vision. Surgical complications are few and tolerable, uld effectively control oc- ular atrophy, reset the retina to save a certain vision, and fewer complications.