严重眼外伤玻璃体切除术后人工晶状体植入临床观察
【摘要】 目的：为了使严重的眼外伤玻璃体切除术后无晶状体眼患者获得视功能的重建。进行了人工晶状体睫状沟缝线固定术，并进行临床观察。方法：从2000/2005年我们对玻璃体切除手术后无晶状体眼的患者进行术前检查，对矫正视力有提高的患者进行了人工晶状体睫状沟缝线固定手术。并跟踪随访3mo～2a的有19例19眼。结果：术后5眼有低眼压，3～7d恢复。3眼玻璃体腔有少量积血，1～2wk吸收。3眼术后角膜水肿，经对症处理3～5d消失；术后3mo矫正视力0.4者8眼；0.5～0.7者7眼；0.8以上4眼。未发生有视网膜脱离等并发症。 结论：玻璃体切除术后人工晶状体植入手术，比一般人工晶状体植入手术有一定的难度，因为没有了玻璃体对眼球壁的支撑作用。眼球的压力波动会很大。因此，术中保持眼压平稳很重要。因为是外伤引起，患者都是单眼。这种手术可以帮助患者获得视功能的重建。
Clinical observation of the intraocular lens implantation after vitrectomy treatment for patients with serious ophthalmic traumas。
Abstract AIM: Along with increasing skill of vitrectomy, many patients with serious ophthalmic traumas were treated and avoided removing eyeball. Sutured IOL in the sulcus was performed in 9—36 months after the operation in order to achieve the reconstruction of visual function. METHODS: We had tested the patients without lens after vitrectomy from 2000 to 2005. Sutured IOL in the sulcus was performed to the patients that had improved corrected acuity. Nineteen cases (19 eyes) were followed up for 3 months to 2 years after surgery.RESULTS: After surgery, 5 eyes had lower intraocular pressure that returned to normal in 3—7 days. Three eyes had small amount of vitreous hemorrhage that were absorbed in 1—2 weeks. In 3 months after surgery, the corrected acuity achieved 0.4 in 8 eyes, 0.5—0.7 in 7 eyes, 0.8 or better in 4 eyes. No complications such as retinal detachment were seen during the follow—up. CONCLUSION: It is more difficult to implant the IOL after vitrectomy. The eye pressure fluctuated strongly without supporting of the vitreous. So it is very important to maintain the IOP during the operation. Patients have only one eye because of the ocular traumas. The operation can help them reconstruct visual function.
· KEYWORDS:serious ophthalmic traumas ; vitrectomy ; intraocular lens implantation。
0引言。
随着玻璃体切除手术技术的不断提高。很多严重的眼外伤得到了救治[1,2]。获得视功能的重建。2000/2005年我们对因严重眼外伤玻璃体切除手术后无晶状体眼的患者进行了人工晶状体植入手术，随访3mo~2a资料完整的有19例19眼。现报告如下。
1对象和方法。
1.1对象 本组病例均为眼外伤玻璃体切除手术后无晶状体眼19例19眼。男14例女5例。年龄9~53（平均36.7）岁。病程：玻璃体切除手术后9~36mo。病史：9眼因球内异物行玻璃体切除联合晶状体切除、异物取出术；6眼为外伤后眼内炎行玻璃体切除术；4眼为外伤后玻璃体积血行玻璃体切除术。其中有8眼为硅油取出术后。术前视力；手动/眼前5眼；数指/眼前6眼；0.02~0.08者6眼；0.1者2眼。术前矫正视力0.3~0.4者17眼；0.5~0.7者2眼。瞳孔均有不同程度的变形。角膜均有大小不等的瘢痕；2眼眼底有不同程度脉络膜破裂。角膜内皮细胞检查：7眼2 000~2 500个/mm2；12眼2 600个/mm2以上。视电生理检查ERG—b波幅值均有不同程度降低。3眼在100μV以下； VEP—P10011眼时值延长；8眼幅值降低。