摘要
目的 :探讨玻璃体手术治疗眼外伤出血性脉络膜脱离的手术时机、处理方法及临床效果。方法 :对 4例、4眼严重眼外伤合并出血性脉络膜脱离患者 ,于伤后 7～ 2 0d ,平均 13d行玻璃体手术。术前视力为光感～眼前指数 ,眼压 3.7～ 7.0mmHg ,术中先用 30号针头自角膜缘注入灌注液 ,指测眼压Tn -T+ 1,在常规扁平部三切口处 ,先穿透巩膜 ,引流脉络膜上腔血液 ,引流后再行闭合式玻璃体切除术 ,术中彻底切除玻璃体 ,同时联合剥膜 ,气液交换 ,行眼内激光及视网膜复位术。 2只眼术中应用重水 ,2只眼注入硅油 ,4眼均行晶状体切除。结果 :随访 4～ 5个月 ,矫正视力分别为 0 .4、0 .2 5、0 .0 4、光感。眼压 12～ 19mmHg。 4眼视网膜在位 ,1眼术后 3个月取出硅油 ,术后 1个月视网膜在位。结论 :严重眼外伤合并出血性脉络膜脱离应于伤后 7～ 15d行玻璃体手术。术中充分引流液化的脉络膜积血 ,彻底切除玻璃体 。
Objective:To evaluate the operation opportunity,treatment programs and efficacy of vitreous surgery in patients with traumatic hemorrhagic choroidal detachment.Methods:The vitreous surgery were performed on 4 patients (4 eyes) with severe ocular injury and hemorrhagic choroidal detachment postinjury 7～20 days (average 13 days).Preoperative vision was from light perception to counting fingers before eye,and intraocular pressure were 3.7～7.0 mmHg.During the opration,perfusate was filled into the eye from cornea limbus at first,then penetrated the sclera at the routine incisions to drain the blood of epichoroidal spaces,after that,the occlusion vitrectomy was performed combined with stripping of membranes,gas-liquid change,intraocular laser coagulation and reattachment of retina.Deuteroxide was used on 2 eyes and silicone oils was filled on 2 eyes.Lensectomy were performed on all 4 eyes.Results:The patients were followed-up for 4～5 months.Corrected vision were 0.4,0.25,0.04,light perception respectively.Intraocular pressure were 12～19 mmHg.The retina were in situ on 4 eyes.The silicone oil was extracted on one eye after 3 months,now 1 month later from that,the retina has been in situ.Conclusions:Vitreous surgery should be performed postinjury 7～15 days on patients with severe ocular injury and hemorrhagic choroidal detachment.Exhaustive drainage of liquefactive choroidal hematocele and vitrectomy may be effective to traumatic hemorrhagic choroidal detachment.
