玻璃体切除术治疗严重眼挫伤所致玻璃体积血

Efficacy of vitrectomy for contusive vitreous hemorrhage caused by severe ocular contusion

目的观察玻璃体切除术治疗严重眼挫伤所致大量玻璃体积血的效果。方法回顾性分析76例（76只眼）严重眼外伤所致大量玻璃体积血玻璃体切除术的术前及术后情况。结果76只眼中术后视力提高者73只眼。术前无光感的4眼中术后仍无光感1只眼，光感2只眼，1只眼视力恢复至0．6。22只眼视网膜脱离者中，21只眼成功复位，复位率为95．45％。外伤性晶状体脱位28只眼，玻璃体术后一期人工晶状体植入5例。外伤性黄斑孔4只眼，3只眼玻璃体切除术中联合内界膜剥离，术后黄斑孔闭合。1例因黄斑区视网膜下大量积血，内界膜未剥离，孔未闭合，进行激光光凝，以防止孔周围视网膜脱离。结论严重眼挫伤所致大量玻璃体积血，均可在外伤后及时进行玻璃体切除术治疗，对于术前无光感眼，当眼B超显示玻璃体团块状回声，未能分清视网膜及脉络膜结构者，需待玻璃体机化后，经过恰当的玻璃体切除术联合其他相应的治疗措施，大多能解剖治愈，部分患者可功能治愈。

Objective To investigate the clinical efficacy of vitrectomy for vitreous hemorrhage caused by severe ocular contusion. Methods Vitrectomy was performed on 76 eyes of 76 patients with vitreous hemorrhage caused by severe ocular trauma. The preoperative and postoperative conditions of patients were retrospectively analysed. Results In 76 eyes, the postoperative visual acuity was improved in 73 eyes. In 4 eyes with no light perception, after surgery the visual acuity was still no light perception in 1 eye, light perception in 2 eyes and 0.6 in 1 eye. In 22 cases with retinal detachment, the retina was reattached successfully in 21 eyes and the reattachment rate was 95.45%. In 28 eyes with traumatic lens dislocation, the intraocular lens were implanted after vitrectomy in 5 eyes. In 4 eyes with traumatic macular hole, vitrectomy combined with internal limiting membrane peeling was performed in 3 cases and the hole was closed after surgery. The internal limiting membrane was not peeled and the hole was not closed in 1 eye because of maeular subretinal massive hematocele. This patient was treated by laser treatment around the hole to prevent retinal detachment. Conclusion Vitrectomy can be performed timely for vitreous hemorrhage caused by severe ocular contusion. For the eyes with vision of no light perception, if the ultrasound examination reveals lumps echo in vitreous and the retina and ehoroid structure can not be distinguished, the proper vitrectomy combined with other treatments should be performed after the vitreous organization has formed. After these treatments, most patients can be cured anatomically and some patients can be cured functionally.