中华眼外伤职业眼病杂志
中華眼外傷職業眼病雜誌
중화안외상직업안병잡지
Chinese Journal of ocular trauma and occupational eye disease
2015年
6期
419-423
,共5页
吴利安%王从毅%杨文%杨新光
吳利安%王從毅%楊文%楊新光
오리안%왕종의%양문%양신광
内皮,角膜%移植%后弹力层脱离%光学相干断层成像,眼前段%前房注气术
內皮,角膜%移植%後彈力層脫離%光學相榦斷層成像,眼前段%前房註氣術
내피,각막%이식%후탄력층탈리%광학상간단층성상,안전단%전방주기술
Endothelium,corneal%Transplantation%Descemet's membrane detachment%Optical Coherence Tomography,anterior segment,ocular%Anterior chamber gas tamponade
目的 探讨内眼手术后角膜后弹力层脱离的原因及治疗措施.方法 回顾性分析术后角膜后弹力层脱离15例(15只眼),其中11只眼为晶状体超声乳化术后,1只眼为白内障囊外摘出术后,2只眼为抗青光眼小梁切除术后,1只眼为硅油取出术后.15只眼均经眼前段光学相干断层成位(眼前段OCT)确定诊断为角膜后弹力层脱离.其中轻度脱离10只眼,中度脱离2只眼,重度脱离3只眼.12只眼轻、中度后弹力层脱离者于术后3d内行前房注气术(其中1只眼硅油取出后脱离者注入20％ C3F8,其余11只眼为消毒空气).3只眼重度脱离者,1只眼于术后2个月半行前房注气术,1只眼术后3个月行角膜内皮移植术,另1只眼重度脱离伴部分后弹力层脱失患者放弃手术.结果 12只眼轻、中度脱离者中10只眼于术后3d内后弹力层复位,2只眼2次注气术后逐渐复位.3只眼重度脱离者中1只眼于术后1d角膜后弹力层复位,角膜基本透明;1只眼行角膜内皮移植术后内皮植片、植床贴附良好,角膜恢复部分透明;另1只眼重度脱离伴部分后弹力层脱失由于患者放弃手术治疗,发展为大疱性角膜病变.结论 前段OCT是确诊的有效检查方法,角膜后弹力层复位的关键是实施有效的前房注气术,及彻底清除层间积液.角膜内皮移植术是有效的治疗方法.
目的 探討內眼手術後角膜後彈力層脫離的原因及治療措施.方法 迴顧性分析術後角膜後彈力層脫離15例(15隻眼),其中11隻眼為晶狀體超聲乳化術後,1隻眼為白內障囊外摘齣術後,2隻眼為抗青光眼小樑切除術後,1隻眼為硅油取齣術後.15隻眼均經眼前段光學相榦斷層成位(眼前段OCT)確定診斷為角膜後彈力層脫離.其中輕度脫離10隻眼,中度脫離2隻眼,重度脫離3隻眼.12隻眼輕、中度後彈力層脫離者于術後3d內行前房註氣術(其中1隻眼硅油取齣後脫離者註入20％ C3F8,其餘11隻眼為消毒空氣).3隻眼重度脫離者,1隻眼于術後2箇月半行前房註氣術,1隻眼術後3箇月行角膜內皮移植術,另1隻眼重度脫離伴部分後彈力層脫失患者放棄手術.結果 12隻眼輕、中度脫離者中10隻眼于術後3d內後彈力層複位,2隻眼2次註氣術後逐漸複位.3隻眼重度脫離者中1隻眼于術後1d角膜後彈力層複位,角膜基本透明;1隻眼行角膜內皮移植術後內皮植片、植床貼附良好,角膜恢複部分透明;另1隻眼重度脫離伴部分後彈力層脫失由于患者放棄手術治療,髮展為大皰性角膜病變.結論 前段OCT是確診的有效檢查方法,角膜後彈力層複位的關鍵是實施有效的前房註氣術,及徹底清除層間積液.角膜內皮移植術是有效的治療方法.
목적 탐토내안수술후각막후탄력층탈리적원인급치료조시.방법 회고성분석술후각막후탄력층탈리15례(15지안),기중11지안위정상체초성유화술후,1지안위백내장낭외적출술후,2지안위항청광안소량절제술후,1지안위규유취출술후.15지안균경안전단광학상간단층성위(안전단OCT)학정진단위각막후탄력층탈리.기중경도탈리10지안,중도탈리2지안,중도탈리3지안.12지안경、중도후탄력층탈리자우술후3d내행전방주기술(기중1지안규유취출후탈리자주입20％ C3F8,기여11지안위소독공기).3지안중도탈리자,1지안우술후2개월반행전방주기술,1지안술후3개월행각막내피이식술,령1지안중도탈리반부분후탄력층탈실환자방기수술.결과 12지안경、중도탈리자중10지안우술후3d내후탄력층복위,2지안2차주기술후축점복위.3지안중도탈리자중1지안우술후1d각막후탄력층복위,각막기본투명;1지안행각막내피이식술후내피식편、식상첩부량호,각막회복부분투명;령1지안중도탈리반부분후탄력층탈실유우환자방기수술치료,발전위대포성각막병변.결론 전단OCT시학진적유효검사방법,각막후탄력층복위적관건시실시유효적전방주기술,급철저청제층간적액.각막내피이식술시유효적치료방법.
Objective To discuss the causes and therapeutic measures for Descemet's membrane detachment after intraocular operation.Methods A retrospective analysis of 15 eyes of 15 cases of postoperative Descemet' s membrane detachment who had undergone phacoemulsification (11 eyes) , extracapsular cataract extraction (1 eye), trabeculectomy (2 eyes) and removal of silicone oil(1 eye).The diagnosis of Descemet's membrane detachment were confirmed by anterior segment OCT, included 10 mild cases(10 eyes), 2 moderate cases (2 eyes) and 3 severe cases (3 eyes).Twelve patients of mild and moderate detachment underwent anterior chamber gas tamponade 3 days after operation (1 case with 20％ C3F8).In 3 cases of severe detachment, anterior chamber gas tamponade was performed in 1 case two months after surgery, Descemet' s stripping automated endothelial keratoplasty (DSAEK) was performed in 1 case 3months after the surgery, and one case abandoned further treatment.Results In 12 cases of mild and moderate Descemet' s membrane detachment reseted in 10 cases within 3 days, and it reseted in 2 cases after a second time of gas injection.In 3 cases of severe detachment, 1 case got descemet membrane reset and cornea transparent partly one day after gas injection.Corneal graft attached to graft bed in 1 case.The case abandoning treatment developed bullous keratopathy.Conclusion Anterior segment OCT is an effective examining method for the diagnosis of Decemet' s membrane detachment.The key to Descemet' s membrane reattachment is to implement anterior chamber gas injection and thoroughly remove the intedaminar effusion.DSAEK is an effective treatment method.
