CAJ | 학술논문

目的：评价玉期玻璃体手术联合睫状体缝合治疗合并睫状体离断的复杂眼外伤的临床治疗效果。 　　方法：观察2011-01-01/2014-10-31期间连续收治严重眼外伤合并睫状体离断患者13例13眼。其中2眼钝挫伤,7眼穿通伤和4眼破裂伤,伴随症状有角膜裂伤、角巩膜缘裂伤、巩膜裂伤、前房积血、虹膜根部离断、瞳孔括约肌撕裂、晶状体破裂或脱位、玻璃体积血、视网膜挫伤、视网膜脱离、脉络膜挫伤、脉络膜上腔出血、球内异物等。术前检查视力无光感~手动/眼前。术前UBM或三面镜检查或术中发现睫状体离断,脱离范围2：00~6：00。钝挫伤患者眼压分别5.4 mmHg和10.2 mmHg。手术时间为伤后6h~3d,主要操作包括关闭角膜巩膜伤口、切除玻璃体、切除晶状体、清除积血、视网膜复位、缝合方法复位脱离睫状体。脉络膜出血采用巩膜外穿刺切开放液处理。眼内采用惰性气体或硅油填充。 　　结果：术后检查13例脱离睫状体均复位。术后1mo,患眼视力有不同程度提高,检查最佳矫正视力手动/眼前~4.7,眼压9.8~24.5mmHg(除外严重角膜裂伤缝合术后角膜水肿1眼),术后三面镜或UBM检查睫状体复位, B超或眼底镜检查视网膜复位。 　　结论：对于合并睫状体离断复杂眼外伤眼,采用玉期玻璃体手术联合睫状体缝合治疗可有效恢复眼球解剖结构,并有效保存视功能。
목적：평개옥기파리체수술연합첩상체봉합치료합병첩상체리단적복잡안외상적림상치료효과。 　　방법：관찰2011-01-01/2014-10-31기간련속수치엄중안외상합병첩상체리단환자13례13안。기중2안둔좌상,7안천통상화4안파렬상,반수증상유각막렬상、각공막연렬상、공막렬상、전방적혈、홍막근부리단、동공괄약기시렬、정상체파렬혹탈위、파리체적혈、시망막좌상、시망막탈리、맥락막좌상、맥락막상강출혈、구내이물등。술전검사시력무광감~수동/안전。술전UBM혹삼면경검사혹술중발현첩상체리단,탈리범위2：00~6：00。둔좌상환자안압분별5.4 mmHg화10.2 mmHg。수술시간위상후6h~3d,주요조작포괄관폐각막공막상구、절제파리체、절제정상체、청제적혈、시망막복위、봉합방법복위탈리첩상체。맥락막출혈채용공막외천자절개방액처리。안내채용타성기체혹규유전충。 　　결과：술후검사13례탈리첩상체균복위。술후1mo,환안시력유불동정도제고,검사최가교정시력수동/안전~4.7,안압9.8~24.5mmHg(제외엄중각막렬상봉합술후각막수종1안),술후삼면경혹UBM검사첩상체복위, B초혹안저경검사시망막복위。 　　결론：대우합병첩상체리단복잡안외상안,채용옥기파리체수술연합첩상체봉합치료가유효회복안구해부결구,병유효보존시공능。
AIM: To evaluate the clinical effect of vitrectomy combined with cyclodialysis repair on primary stage for complicated ocular trauma with cyclodialysis. METHODS: The 13 consecutive cases ( 13 eyes ) of complicated ocular trauma with cyclodialysis from January 1, 2011 to October 31, 2014, were treated and studied, including 2 contusions, 7 penetrating injuries and 4 rupture injuries. The concomitant symptoms were corneal laceration, limbus laceration, scleral laceration, hyphema, iridodialysis, mydriasis, traumatic cataract or lens dislocation, vitreous hemorrhage, retinal contusion, retinal detachment, choroid contusion, suprachoroidal hemorrhage, intraocular foreign body, etc. The preoperative visual acuity ( VA ) ranged from light perception (LP) to hand movement (HM) or before eye ( BE) . The cyclodialysis was determined by ultrasound bio-microscopy ( UBM ) , three-mirror contact lens or was found in operation. The limits of cyclodialysis were about 2: 00 ~ 6 : 00 o'clock. Intraocular pressures ( IOP ) of contusion eyes before surgeries were 5. 4mmHg and 10.2mmHg. The operation opportunity was 6h ~3d after injuries and the main operation stages included closing wound in cornea and sclera, vitrectomy, lensectomy, and/or removal of intraocular blood, retinal reattachment, cyclodialysis repair by suturing. The external scleral puncture and draining were carried out in suprachoroidal hemorrhage. Inert gas or silicon oil was tamponaded. RESULTS: The ciliary body reattached in all cases determined by UBM and three-mirror contact lens. The BCVA was improved to HM/BE ~ 4. 7 and the IOP was 9. 8 ~24. 5mmHg at 1mo after surgeries, except that one eye was corneal edema after corneal laceration sutura. Retinal reattachment was determined by ultrasound or ophthalmoscope examination. CONCLUSION: For complicated ocular trauma with cyclodialysis, the vitrectomy with cyclodialysis repair on primary stage is effective to recover the anatomic structure and preserve the available visual function.