玻璃体切除硅油填充术后前房消失的临床观察

Clinical observation of anterior chamber obliteration after silicone oil tamponade

目的探讨玻璃体切除硅油填充术后前房消失的发生原因及处理措施。方法回顾性分析玻璃体切除硅油填充手术2560例（2560眼），包括同时行晶状体切除并下方周边虹膜切除术1476例。术后前房消失者19例（19眼），占玻璃体切除硅油填充眼的0．74％（19／2560）。此19眼均为术中同时行晶状体切除并下方周边虹膜切除术者，占玻璃体切除晶状体切除硅油填充眼的1．29％（19／1476）。19眼中16眼术中周边晶状体囊完全切除，另3眼术中保留了周边晶状体囊。在发现硅油填充眼前房消失后立即以散瞳及缩瞳滴眼液交替滴眼，如前房仍不能形成则进行按压虹膜前房成形术。术后密切观察眼压。结果经药物治疗后13眼（68．42％）前房形成，6眼（31．58％）前房仍未形成，遂行按压虹膜前房成形术。6眼中5眼经1次按压虹膜前房成形术后前房形成，1眼经2次按压虹膜前房成形术并部分硅油取出术后形成前房。结论玻璃体切除硅油填充术后前房消失，可能与患眼虹膜括约肌功能差有关，术中气／液交换时间较长及周边晶状体囊完全被去除而使虹膜失去支撑等可能是危险因素，也可能与术后体位相关。硅油填充眼术后前房消失时，先应用散瞳及缩瞳滴眼液交替滴眼，必要时行按压虹膜前房成形术。

Objective To investigate the relevant factors and treatment methods of anterior chamber obliteration （obliteratio camerae anterior） after silicone oil tamponade in vitrectomy surgery. Methods A total of 2560 eyes of 2560 patients who received vitrectomy and silicone oil tamponade were retrospectively analyzed, including 1476 cases who underwent lensectomy and inferior peripheral iridectomy. Anterior chamber obliteration after silicone oil tamponade occurred in 19 eyes of 19 cases, accounting for 0.74% among all of the 2560 eyes, and accounting for 1. 29% among the patients who received vitrectomy, lensectomy and silicone oil tamponade. All those 19 eyes received lensectomy and inferior peripheral iridectomy. The peripheral lens capsule was completely removed in 16 eyes, and it remained in 3 eyes. If the anterior chamber disappeared after silicone oil tamponade, local mydriatic and miotic eyedrops was used alternatively. If anterior chamber could not form, the surgery of pressing iris and anterior chamber forming was performed. The intraocular pressure after the operation was observed closely. Results After the treatment with local mydriatic and miotic eyedrops, anterior chamber formed in 13 eyes （68.42%）. The other 6 eyes （31.58%） accepted surgery, in which anterior chamber formed in 5 eyes after once operation, and it formed after twice operations and partly removing silicone oil in one eye. Conclusion Anterior chamber obliteration after vitrectomy and silicone oil tamponade may be associated with weaker function of iris sphincter. Long duration of fluid-gas exchange, and the complete removal of lens capsule might be risk factors. It is effective to apply mydriatic and miotic eyedrops ahernatively for this situation. If necessary, the surgery of pressing iris and forming anterior chamber should be performed.