内窥镜下角膜浑浊者硅油取出术

Clinical observation of endoscope-assisted silicone oil removal in patients with cornea opacity

目的探讨角膜浑浊情况下硅油取出的方法。方法回顾26例（26只眼）角膜浑浊的硅油填充眼的临床资料，术前三面镜及直间接检眼镜、B型超声等无法检查眼底情况和判断是否应取出硅油。所有患者均在局部麻醉下行三通道巩膜穿刺，先用眼内窥镜检查眼底情况，决定宜取出硅油后，在眼内窥镜下进行硅油取出，气液交换，必要时再行膜剥离、视网膜再复位、气体或硅油填充。术后定期复查，B超检查眼底情况，记录术后并发症和视网膜保持复位情况。结果术后平均随访时间（9．4±3．2）月。26例中，5例（19．2％）术中行膜剥离、视网膜再复位和硅油填充术，其中重硅油填充3例；6例（23．1％）行膜剥离和C3F8填充。其余15例行硅油取出后眼内灌注液填充。术后早期短暂性低眼压及前房渗出3例（11．5％），视网膜脱离需手术复位1例（3．8％）。结论对角膜浑浊者，内窥镜下硅油取出术简单、安全，避免普通手术显微镜下硅油取出的盲目性，减少医源性损伤的发生。

Objective To discuss the method of silicone oil removal in case of cornea opacity. Methods The clinical data of 26 eyes of 26 patients with severe cornea opacity who had received silicone oil removal were retrospected and analyzed. After local anesthesia, ocular fundus examination, silicone oil removal, air - fluid exchange and other necessary manipulations were carried out assisted by endoscope. The peri - operative retinal situation and complications were recorded. Results Mean follow - up time was （ 9.4 ± 3.2） months. Of the 26 patients, 5 （ 19.2% ） received additional membrane peeling, retinal reattaching and new silicone oil temponade （ with heavy silicone oil temponade in 3 eyes）, and 6 （23.1% ） received additional membrane peeling, and C3Fs temponade intraoperatively. The postoperative complications included early transient hypotension and anterior chamber exudation in 3 eyes （ll. 5% ）, and retinal redetachment in 1 eye （3.8 % ）. Conclusion Endoscope - assisted silicone oil removal is simple, safe and effective in patients with cornea opacity.