眼前节网格状缝线对硅油的限制和角膜保护作用

The effect of silicone oil retention sutures on preventing silicone oil migration and protecting the corneal endothelium

目的探讨眼前节网格状缝线对眼内硅油的限制和角膜内皮保护作用。方法回顾性病例系列研究。收集2017年3月至2021年11月在首都医科大学附属北京同仁医院诊治的6例(6只眼)严重眼外伤患者的临床资料,6例患者均因晶状体虹膜隔损伤合并玻璃体视网膜损伤行玻璃体视网膜手术及眼前节网格状缝线和硅油填充。总结随访期间使用裂隙灯显微镜、超声生物显微镜和角膜内皮镜观察的硅油位置和角膜内皮情况。结果6例眼外伤患者均为男性,平均年龄为47岁(最大年龄73岁,最小年龄26岁),2例外伤眼为左眼,4例为右眼。5例为眼球破裂伤,1例为眼球钝挫伤。随访时间5~51个月,平均数为18.5个月。6例行眼前节网格状缝线和硅油填充后硅油均限制于缝线后,始终没有接触角膜内皮。4例至末次随访角膜保持健康透明,2例严重眼外伤患者分别在随访11、16个月时出现角膜带状变性(均非硅油接触角膜内皮所致),其中1例角膜带状变性患者随访51个月时出现角膜内皮失代偿。6例患者均无视物遮挡或炫光等不适主诉。所有患者术后体位相对自由,无需保持俯卧位。1例出现硅油乳化并在硅油乳化后阶段性眼压升高。结论眼前节网格状缝线可有效防止眼内硅油移位至前房,有效防止硅油接触角膜内皮。

Objective To observe the restriction effect of silicone oil retention sutures and their protective effect on the corneal endothelium.Methods Retrospective case series study.The clinical data of 6 patients(6 eyes)with lens-iris damage after severe ocular trauma were collected from March 2017 to November 2021 in Beijing Tongren Hospital.Their was combined retinal injury in each eye,so silicone oil retention sutures and silicone oil filling were performed.The silicone oil position was observed by slit lamp and ultrasound biomicroscopy.The corneal endothelium was examined by specular microscopy during the follow-up.Results All patients were male,with an average age of 47 years(range,26 to 73 years).The diseased eyes included 2 left eyes and 4 right eyes.Five eyes had ocular rupture,and 1 eye had ocular contusion.The follow-up time ranged from 5 months to 51 months,with an average of 18.5 months.In all 6 eyes,the silicone oil was completely located in the posterior segment and never touched the corneal endothelium.Four eyes maintained healthy and had a clear cornea during the follow-up,while 2 eyes developed band keratopathy at the 11 month and 16 month separately during follow-up,1 of which was found to suffer corneal decompensation at the last follow-up(51 month).Both band keratopathy and corneal decompensation were caused by severe anterior segment trauma and were not related to the silicone oil contact with the cornea.There were no complaints about occlusion or glare due to silicone oil retention sutures.All patients did not need to keep the prone position postoperatively.Silicone oil emulsification occurred in 1 eye and ocular hypertension occurred in this eye after silicone oil emulsification.Conclusion Silicone oil retention sutures can effectively prevent silicone oil from migrating to the anterior chamber or contacting the corneal endothelium.