摘要
目的分析重度开放性眼外伤手术后，尝试性硅油取出失败的原因。方法对因重度开放性眼外伤而行玻璃体切除、≥270°视网膜切开切除联合硅油填充手术治疗后，符合尝试性硅油取出条件的16例（16眼）施行了硅油取出手术。通过回顾性复习首次修复和二期玻璃体视网膜手术的记录，结合硅油取出手术中对眼底和睫状体状况的观察以及手术后眼部的检查结果，分析硅油取出手术后的结果和低眼压发生的原因。结果7眼（43．75％）硅油取出手术后眼压为0—3．0mmHg并出现低眼压性眼部损害及明显睫状体原发性和继发性损伤；1眼失随访，6眼再次硅油填充或义眼台植入手术。9眼（56．25％）硅油成功取出，手术后眼压4．8—14．0mmHg，且无低眼压性眼部损害，无睫状体原发性损伤或较轻，术中见继发局限性损害，矫正视力为数指-0．6。结论对可尝试性硅油取出的重度开放性眼外伤患者，硅油取出后低眼压及低眼压性眼部损害的发生率高达43．75％。大面积视网膜的缺损、睫状体的原发性损伤和继发性损害是此类伤眼硅油取出手术后低眼压及其眼部损害发生的两个主要原因，而睫状体的严重受损是此类伤眼须再次硅油充填和丧失眼球的重要原因之一。
Objective To retrospectively analyze the outcomes of triable silicone oil removal in the patients with severe open ocular trauma after combined vitrectomy, large retinotomy and retinectomy, and silicone oil tamponade. Methods Sixteen eyes of 16 patients matched the triable criteria were selected for silicone oil removal. All eyes underwent vitrectomy, large retinectomy and retinotomy, and silicone oil tamponade because of severe open ocular trauma complicated with retinal incarceration and detachment. The outcomes of silicone oil removal and the causes ofhypotony were analyzed by review of the records of last 2 times of operation, intraoperative observation of the ciliary body status, and postoperative fingdings. Results Seven eyes （43.75%） had a postoperative IOP 0 - 3mmHg, obviously ocular pathologic changes linked to the hypotony occurred following silicone oil removal. Markedly ciliary body scar following primary injury and extensive fibrotic membrane was noted. 1 eye lost follow-up, hydroxyl appetite ocular prosthesis implant or silicone oil re-injection was performed in other 6 eyes. Nine eyes （ 56.25% ） had a postoperative IOP 4.8 - 14mmHg. There was no or only had a localized ciliary body injury record in these 9 eyes, no ciliary body scar or the scar and fibroticmembrane was noted within 1 - 2 o＇ clock, the best corrected visual acuity was finger counting - 0.6 Conclusion The incidence ofhypotony and hypotony induced ocular damage was 43.75% after triable silicone oil removal in the eyes with severe open ocular trauma after vitrectomy, large retinotomy and retinectomy and silicone oil tamponade.Large retinal defect and ciliary body damaging were the two causes ofhypotony, but the leading cause of silicone oil re-injection and eyeball lost was severe ciliary body damage.
出处
《眼外伤职业眼病杂志》
2010年第3期170-173,共4页
Journal of Injuries and Occupational Diseases of the Eye with Ophthalmic Surgeries
