眼球钝挫伤的玻璃体视网膜手术临床分析

Clinical analysis of vitreoretinal surgery for blunt ocular trauma

目的 观察玻璃体视网膜手术治疗严重眼球钝挫伤的疗效 ,分析手术失败原因。方法 57例 57眼严重眼球钝挫伤行玻璃体视网膜手术治疗 ,回顾性分析受伤至手术时间与手术疗效的关系 ,以及手术并发症的处理。结果 玻璃体视网膜手术治疗严重眼球钝挫伤术后随访视力较术前明显提高 ,差异有显著性意义 (P <0 0 1 ) ,伤后各时间段的手术效果的差异无显著性意义 (P>0 0 5)。术前不合并视网膜脱离的 2 8眼最终全部痊愈 ;合并视网膜脱离的 2 9眼中 ,术后 5眼因增生性玻璃体视网膜病变 (Prolifer ativevitreoretinopathy ,PVR)、1眼因新裂孔致视网膜再脱离 ,行二次玻璃体切除手术后 4眼视网膜复位 ,2眼失败。手术主要并发症是高眼压 (高于 30mmHg占 36 8% ,2 1 / 57)和复发性视网膜脱离 (2 0 7% ,6/ 2 9)。结论 严重眼球钝挫伤后玻璃体视网膜手术疗效显著 ,PVR是手术失败的主要原因 。

Objective To summarize the visual outcomes of patients with severe blunt ocular trauma treated with vitreoretinal surgery. Methods A retrospective study of 57 cases (57 eyes) undergoing pars plana vitrectomy and the follow up ranging from 2 to 24 months. Results The final visual acuity was improved during follow up observation ( P <0.01), and there was no obvious difference among different injury operative periods. All the patients without retinal detachment made a recovery after operation (28/28, 100%). Of 29 patients with retinal detachment, 27 had successful operation finally (27/29, 93%). The main complications included development of recurrent traumatic proliferative vitreoretinopathy (20.7%,6 of 29) and glaucoma (beyond 30 mmHg, 36.8%,21 of 57). Conclusion Timely vitreoretinal surgery is of benefit in the eyes with severe blunt trauma. PVR and glaucoma are frequent and refractory complications of this kind of cases.