严重眼后段外伤玻璃体手术中气液交换的应用

The application of fluid-air exchange during vitreoretinal surgery for severe posterior segment ocular trauma

目的 探讨联合气液交换下玻璃体视网膜手术治疗严重眼后段外伤的临床效果.方法 30例（30只眼）严重眼后段外伤,在联合气液交换下进行玻璃体视网膜手术,观察术中眼内操作情况、手术时长、术前术后视力、视网膜和脉络膜复位情况及术后并发症.术后随访6个月.结果 30例玻璃体视网膜手术操作均在联合气液交换下顺利完成,术中止血效果佳,视野清晰,手术时间为50～ 90 min,平均（62.84±10.15） min.术后眼B超检查,视网膜和脉络膜均复位.术后末次随访时眼底检查,27只眼视网膜复位佳,3只眼复位不良.术后角膜水肿9只眼,前房积血6只眼,前房炎性反应13只眼,继发性青光眼7只眼,视网膜前或视网膜下增生26只眼,硅油依赖眼8只眼.术后视力无光感2只眼,光感4只眼,手动11只眼,数指及以上13只眼,术后视力较术前显著提高,差异有统计学意义（x2=24.79,P=0.000）.结论 采用联合气液交换下玻璃体视网膜手术提高了术中视野清晰度,便于术中止血,顺利完成手术.并为严重眼后段外伤的进一步治疗创造了条件,避免了眼球摘除.

Objective To evaluate the clinical outcomes of the vitreoretinal surgery combined with fluid-air exchange for severe posterior segment ocular trauma.Methods Thirty eyes of 30 cases of severe posterior segment ocular trauma were involved in this study.Vitreoretinal surgery combined with fluid-air exchange were performed on these eyes.The intraocular conditions during the surgeries,the operating time,the pre-and postoperative visual acuity,retinal and choroidal reattachment,and postoperative complications were recorded.The patients were followed up for 6 months.Results The operations of vitreoretinal surgery combined with fluid-air exchange were performed successfully in all 30 eyes which provided effective condition of hemostasis and clear surgical field.The operation time ranged from 50 to 90 minutes,mean （63.84± 11.13） min.B-scan ultrasonography were taken after operation and showed that the retina and choroid became reattached in all cases.The last follow-up examination of the fundus after the surgery showed that retinal reattachment succeeded completely in 27 eyes but in 3 eyes incompletely.Postoperative complications included corneal edema in 9 eyes,hypema in 6 eyes,anterior chamber inflammation in 13 eyes,secondary glaucoma in 7 eyes,epiretinal membranes or subretinal proliferation in 26 eyes,and so-called silicone oil dependency in 8 eyes.The visual acuity was no light perception in 2 eyes,light perception in 4 eyes,handmovement in 6 eyes,and counting finger or better in 8 eyes.The postoperative visual acuity was significantly better than the preoperative one,and the difference was statistically significant （x2 =24.79,P =0.000）.Conclusion The vitreoretinal surgery combined with fluid-air exchange could provide convenient surgical field and facilitate hemostasis,which is an improved technique for the treatment of severe posterior segment ocular trauma in order to avoid evisceration of the eye.