眼外伤硅油取出联合折叠型人工晶状体悬吊术的临床观察

Clinical observation on silicone oil removal combined with foldable intraocular suture fixation to treat ocular trauma with lens-vitrectomy and silicone padding

目的探讨复杂性眼外伤行晶状体玻璃体切除及硅油填充术后的硅油取出联合折叠型人工晶状体缝线固定术的手术方法，并评价其临床效果。方法选取矫正视力〉0．1于2012年8月至2014年8月在唐山市眼科医院收治的32例（32只眼），因复杂性眼外伤而行晶状体、玻璃体切除、硅油填充术的无晶状体硅油填充眼，均行硅油取出联合折叠型人工晶状体缝线固定术。探讨手术技巧、疗效及术后并发症。术后随访3-6个月，平均（5．2±0．5）个月。结果32只眼一次悬吊成功。术中前房维持正常，眼压稳定，无驱逐性出血、视网膜脱离等情况发生。术后2只眼发生脉络膜脱离，2只眼眼压升高。术后第1天，23只眼的裸眼视力为0．1～0．8，占71．88％（23／32），术后1周、3、6个月裸眼视力0．1-0．8者分别为27只眼（84．38％，27，32），30只眼（93．75％，30／32）和31只眼（96．88％，31／32）。术后3个月裸眼视力较术前最佳矫正视力，差异无统计学意义（t=0．6930，P〉0．05）。结论硅油取出联合应用人工晶状体植入系统行折叠人工晶状体缝线固定术，手术效果可靠，术中术后并发症少，是治疗因眼外伤无晶状体硅油填充眼屈光矫正的安全有效的手术方法。

Objective To examine the operative technique and its curative effect of silicone oil removal and using IOL Delivery System foldable intraocular lens with suture fixation to treat ocular trauma with lens-vitrectomy and silicone padding. Methods A total of 32 trauma eyes of 32 pa- tients with the corrected visual acuity was more than 0.1 were chosen, all eyes underwent silicone oil removal combined with foldable intraocular lens with suture fixation at ciliary sulcus. The opera- tive effect, technique and postoperative complication were examined. The postoperative follow-up peri- od was 3-6 months, averaged （5.2±0.5） months. Results Thirty-two eyes had successful operation at one time. Operation time was shortened obviously and no obvious complication was occurred intraop- eratively. Choroidal detachment was observed in 2 eyes and ocular hypertension was occurred in 2 eyes postoperatively. Uncorrected visual acuity 0.1-0.8 was achieved in 23 eyes （71.88%, 23/32） on the first day postoperatively. Uncorrected visual acuity 0.1-0.8 was achieved in 27 eyes （84.38%, 27/ 32）, 30 eyes （93.75%, 30/32）, and 31 eyes （96.88%, 31/32） at the 1-week, 3-month, and 6-month fol- low-up respectively. There was no clinical significant differences between visual acuity of pre-opera- tive and post-operative （t =0.6930, P 〉0.05）. Conclusions The method of using silicone oil remov- al and foldable intraocular implantation with suture fixation at ciliary sulcus is a safe and reliable method for correcting ocular trauma with lens-vitrectomy and silicone padding.