CAJ | 학술논문

目的观察眼内窥镜引导下彻底的玻璃体切割术治疗伴有角膜混浊的外源性眼内炎的临床特点. 方法回顾分析我院行眼内窥镜引导下行彻底的玻璃体切割术的伴有角膜混浊的外源性眼内炎连续20只眼的临床资料.其中,男18例,女2例.年龄5～79岁,平均年龄35.9岁.眼球穿通伤所致眼内炎16例,人工晶状体植入手术后眼内炎4例.手术前视力均≤数指,角膜均严重混浊.手术中均制造玻璃体后脱离,尽量彻底切割虹膜前后渗出膜、基底部和睫状体平部的玻璃体以及睫状体膜.入院到手术治疗的时间中位数为1.5 d.手术后平均随访23个月. 结果手术中取玻璃体样培养阳性者9例,占45%;6例取出眼内异物共7枚.手术中锯齿缘离断1处者2例,医源性视网膜裂孔1处和2处者各1例.手术后再次玻璃体内注药和玻璃体切割手术各2例.手术后视力≥0.05者10例,占50%.除1例视力下降低、3例视力无明显变化外,16例手术后视力有不同程度的提高,其中4例≥0.8.手术后11例角膜基本恢复清亮.9例硅油存留,其中2例眼压偏低,但均＞5 mm Hg(1 mm Hg=0.133 kPa),1例高眼压,药物控制;局限性视网膜脱离和可疑视网膜脱离各1例,未再手术.9只硅油填充眼随访末期视力均≤数指,无硅油存留的11只眼中仅1只眼未达到0.05.无眼球丧失.结论眼内窥镜引导下彻底的玻璃体切割手术为及时治疗伴有角膜混浊的外源性眼内炎的安全、可靠的新选择.
목적 관찰안내규경인도하철저적파리체절할술치료반유각막혼탁적외원성안내염적림상특점. 방법회고분석아원행안내규경인도하행철저적파리체절할술적반유각막혼탁적외원성안내염련속20지안적림상자료.기중,남18례,녀2례.년령5～79세,평균년령35.9세.안구천통상소치안내염16례,인공정상체식입수술후안내염4례.수술전시력균≤수지,각막균엄중혼탁.수술중균제조파리체후탈리,진량철저절할홍막전후삼출막、기저부화첩상체평부적파리체이급첩상체막.입원도수술치료적시간중위수위1.5 d.수술후평균수방23개월. 결과수술중취파리체양배양양성자9례,점45%;6례취출안내이물공7매.수술중거치연리단1처자2례,의원성시망막렬공1처화2처자각1례.수술후재차파리체내주약화파리체절할수술각2례.수술후시력≥0.05자10례,점50%.제1례시력하강저、3례시력무명현변화외,16례수술후시력유불동정도적제고,기중4례≥0.8.수술후11례각막기본회복청량.9례규유존류,기중2례안압편저,단균＞5 mm Hg(1 mm Hg=0.133 kPa),1례고안압,약물공제;국한성시망막탈리화가의시망막탈리각1례,미재수술.9지규유전충안수방말기시력균≤수지,무규유존류적11지안중부1지안미체도0.05.무안구상실.결론 안내규경인도하철저적파리체절할수술위급시치료반유각막혼탁적외원성안내염적안전、가고적신선택.
Objective To evaluate the clinical characteristics of endoscopically guided thorough vitrectomy in managing exogenous endophthalmitis with cloudy cornea. Methods The clinical data of 20 patients(20 eyes)suffered from exogenous endophthalmitis with cloudy cornea and underwent endoscopically guided total vitrectomy were retrospectively analyzed.The patients(18 males and 2females)aged from 5 to 79 years with the average age of 35.9 years.There were 16 post-trauma and 4post-cataract endophthalmitis.The cornea was cloudy with the visual acuity of not better than counting fingers in all eyes.During the operation,posterior vitreous detachment was induced,vitreous at the base and bands over the ciliary body was removed,and membrane at the anterior or posterior surface of the iris was also removed after lensectomy.The median of the duration of hospitalization to operation was 1.5days,and the follow-up period was 6～42 months(mean=23 months). Results Positive cultures were obtained in 9(45%)cases.Seven intraocular foreign bodies were extracted from 6 eyes.Ora serrata wasseparated at one place in 2 cases,iatrogenic retinal tear at one,two place in 1 case respectively.Vitrectomy and intravitreal injection were underway again in 2 cases respectively after surgery.Ten eyes (50%)retained useful vision(≥0.05).The visual acuity was decreased,maintained and improved in 1,3and 16 eyes,respectively,and 4 cases over than 0.08.Cornea was clear in 11(55%)eyes after operation;9 cases with silicon oiIin;ocular pressure was slanting low in 2 cases,but more than 5 mm Hg(1 mm Hg=0.1 33 kPa);intraocular hypertension in 1 case,controlled by medicine;local and questionable retinal detachment in 1 case respectively.without surgery again.The visual acuity of none of the 9 eyes with silicon oil in was lower than counting fingers,only one eye in 11 eyes without silicon oiljn was lower than 0.05 and no eye lost at the end of follow-up. Conclusion Endoscopically guided total vitreetomy is useful,safe and reliable for the management of exogenous endophthalmitis with cloudy cornea in time.