双直针直接缝合法治疗虹膜根部离断的临床观察

Clinical observation of repairing the iridodialysis with double-armed straight needle

目的 :观察双直针直接缝合法治疗虹膜根部离断的疗效。方法 :14例虹膜根部离断患者 ,合并外伤性白内障 10例 ,晶状体脱位 6例 ,继发性青光眼 4例 ,睫状体脱离 1例。 14例行双直针直接缝合法修复虹膜根部离断 ,同时联合晶状体玻璃体切割 5例 ,白内障囊外摘除及人工晶状体植入 2例 ,睫状体脱离复位 1例 ,小梁切除术 1例。通过角膜缘穿刺口 ,向前房注入粘弹剂 ,离断的虹膜被推回原位。 10 -0聚丙烯双直针分别自同一角膜缘穿刺口或玻璃体切割三切口 ,潜行于虹膜与晶状体之间或虹膜与角膜之间 ,在距虹膜根部 0 5～ 1mm穿针 ,自角膜缘后 1mm房角处穿出角膜缘并打结 ,可将线结埋藏于三角形巩膜瓣下或转入眼内或于球结膜下。打结松紧要适度 ,缝合的针数可根据虹膜离断的范围确定 ,以虹膜复位、瞳孔复圆为度。结果 :14例离断的虹膜都得到较为满意的修复 ,基本恢复了虹膜的位置和瞳孔形态 ,使视力及外观明显改善。结论 :双直针直接缝合复位法修复虹膜根部离断是一种微创、安全、简便、有效的手术方式 。

Objective:To observe the therapy effect of 17mm double armed straight needle with 10-0 mm polypropylene suture for repairing the iridodialysis directly.Methods:Of 14 patients with iridodialysis,10 patients also had traumatic cataract,6 had lens dislocation,4 had secondary glaucoma,1 had traumatic ciliary body detachment.In all 14 cases,the disinserted iris was sutured to the anterior chamber angle by using 17mm double armed straight needle with 10-0 polypropylene suture.5 cases combined with lensectomy and vitrectomy,2 cases with extracapsular cataract extraction and intraocular lens implantation,1 case with reattachment surgery of ciliary body detachment and 1 case with trabeculectomy.After viscoelastic substance was injected into anterior chamber,the first straight needle with suture was inserted into anterior chamber through corneoscleral limbus,180 degrees away from the iridodialysis,then pushed forward to engage the disinserted iris root and out of eye under the partial thickness scleral flap.The second needle entered anterior chamber through the same entry site,the iris base and eye ball were stabbed adjacent to the previous site as needle exited the eye.Suture was tired and the knot was buried under scleral flap.The procedure was repeated at another point according to the range of the iridodialysis.Results:The technique was effective in 14 cases with traumatic iridodialysis.The iris was reattached and the pupil was reformed.Conclusions:To repair iridodialysis with 17mm double armed straight needle with 10-0 polypropylene is a simple,safe,effective and minimal surgical manipulation.It is worthy to be used in clinic.