严重巩膜破裂伤眼后段结构重建的临床研究

发布时间：2018-10-22 19:36

【摘要】：研究背景和目的严重巩膜破裂伤是目前眼科住院病人中眼球摘除率最高的一类眼科急症,也是最难处理的一类眼科疾病。随着眼科手术器械及手术技巧的不断进步,特别是玻璃体切除术(Pars plana vitrectomy,PPV)的出现,更大程度上提高了眼外伤的救治效果,使得以前频临摘除的患眼,避免了眼球摘除,不仅恢复了眼球的解剖结构,而且视力也得到不同程度的提高。眼外伤的治疗理念在不断探究中发展进步,仍有许多问题的解决方法有待探讨。而且眼外伤的分类、分级、分区及无光感外伤眼的救治,早期眼球萎缩的治疗方法,眼球摘除的适应症,眼外伤手术时机及多次治疗原因及方法等都是目前眼科医师探求和争议的焦点。本研究的目的在于探讨严重巩膜破裂伤的治疗方案及不同部位严重巩膜破裂伤眼后段结构重建术后的治疗效果。希望能够为以后此类病人的治疗提供科学的循证方法,并且能对此类疾病的治疗提供一些新的理念。使得严重巩膜破裂伤这种伤害能得到最大限度的治疗。方法收集2009年1月至2012年1月期间在我院行PPV的严重巩膜破裂伤病例共46例46眼,包括性别、年龄、职业、致伤原因等一般资料。所有患者根据其耐受程度选取全身麻醉或是局部麻醉手术治疗。术中根据眼部情况联合晶状体切除,重水辅助压平视网膜,剥除视网膜增生膜,水下电凝止血,光凝视网膜裂孔和变性区,视网膜切开或切除,眼内填充硅油或C3F8气体。随访时间大于3月。随访期间收集的资料包括：在院期间的视力、眼压、前房积血、视网膜复位、增殖性玻璃体视网膜病变(proliferative vitreoretinopathy,PVR)情况等,出院后1月、2月、3月及以后每次复查时最佳矫正视力(Best corrected visual acuity,BCVA)及眼压、视网膜复位、并发症等情况。所有数据采用SPSS15.0统计学软件包进行处理。结果 1.玻璃体切除术联合脉络膜和视网膜复位方法治疗严重巩膜破裂伤效果显著,视力均有不同程度的提高。术后最佳矫正视力NLP-HM者21眼,CF-0.04者7眼,0.05～1.0者18眼,其中术眼BCVA1.0者1眼,0.9者1眼。 2.不同部位巩膜破裂伤手术效果不同,伤口最后端超出角膜缘后l0mm的,视力提高的可能性仅15.38%,而且长期随访眼球萎缩率比较大,占30.77%。 3.玻璃体切除联术合眼内填充手术改善了术前低眼压的状况。术前眼压1OmmHg者44眼,眼压10～21mmHg者2眼；术后眼压＜10mmHg者6眼,眼压10～21mmHg者40眼,其中1眼术后早期眼压21mmHg, PPV术后2月行睫状体光凝术后眼压降至正常。 4.严重巩膜破裂伤通过行玻璃体切除手术及术中脉络膜、视网膜复位方法,避免了眼球摘除,降低了眼球萎缩及摘除比例,长期随访发现眼球萎缩比例为13.04%。结论严重巩膜破裂伤行PPV后,视网膜最终复位率、视力均得到不同程度的提高。不同区域的伤口及伤口长度,眼外伤预后差别很大。行玻璃体切除术后,能够改善术前的低眼压情况,降低了眼球萎缩的发生。对于能够缝合的眼球,应尽量缝合,以求眼球初期解剖结构恢复,不要轻易行眼球摘除,为Ⅰ期或Ⅱ期做PPV联合硅油注入术做准备。
[Abstract]:Background and purpose of study Severe scleral rupture is one of the most difficult ophthalmic emergencies in ophthalmic inpatients, and it is also the most difficult category of ophthalmology With the progress of ophthalmic surgical instruments and surgical techniques, especially the appearance of Pars plana vitrectomy (PPV), the treatment effect of ocular trauma is improved, so as to avoid eye removal, and not only the eyeball's anatomy is restored. The structure, and the vision is also different There are many problems to be solved in the treatment of ocular trauma, and there are still many problems to be solved. Objective: To explore the classification, classification, zoning of ocular trauma and the treatment of ocular trauma, the treatment of early eyeball atrophy, the indication of eyeball extirpation, the time of ocular trauma operation and the causes and methods of multiple treatments. The purpose of this study was to investigate the treatment regimen of severe scleral rupture and the post-operative reconstruction of the posterior segment of severe scleral rupture in different parts. It is desirable to provide a scientific evidence-based approach to the treatment of such patients and to provide a treatment for such diseases. Some new ideas. The damage to severe scleral rupture can be maximized. Limits Treatment. Methods 46 eyes, including sex, age and grade, were collected from January 2009 to January 2012 in severe scleral rupture of PPV in our hospital. General information such as industry, cause of injury, etc. All patients selected systemic anesthesia based on their tolerance Surgical treatment of intoxication or local anesthesia. Combined lens resection according to eye conditions, retinal detachment of retina, removal of retinal proliferative film, underwater electrocoagulation hemostasis, photocoagulation retinal breaks and degenerative areas, retinal incision or resection, eye Fill silicone oil or C3F8 Gas. Follow-up time was greater than 3 months. The data collected during follow-up included visual acuity, intraocular pressure, anterior chamber tenderness, retinal reset, proliferative vitreoretinopathy (PVR), etc. during the course of the hospital, and Best corrected visual acui for each review in January, February, March, and after discharge. ty, BCVA) and intraocular pressure, visual Metomental reduction, complications, etc. All data were SPSS15. 0 Series Results 1.Vitrectomy combined with choroid and retinal reposition to treat severe scleral rupture After operation, 21 eyes of NLP-HM, 7 eyes of CF-0.04 and 18 eyes of 0. 05 ~ 1. 0 were found. BCVA0.1 eyes, 0. 9, 1 eyes, 2. The surgical effect of scleral rupture in different parts was different, the final end of the wound was more than l0mm after the limbal edge, and the possibility of visual acuity improvement was only 15. 38%, and After long-term follow-up, the rate of eyeball atrophy was large, accounting for 30. 77%. Postoperative intraocular pressure (IOP) was 1OmmHg (44 eyes), intraocular pressure (IOP) was 10 ~ 21mmHg (2 eyes), intraocular pressure (IOP) was <10mmHg (6 eyes), intraocular pressure (IOP) was 10 ~ 21mmHg (40 eyes). g. The intraocular pressure after cyclophotocoagulation in 2 months after PPV was decreased to normal. 4. Severe scleral rupture was removed by vitrectomy and choroid and retinal reposition. contraction The ratio of extirpation and long-term follow-up showed that the proportion of eyeball atrophy was 13.04%. After scleral rupture, the retinal final reduction rate and visual acuity were determined after PPV. There was a significant difference in the prognosis of wound and wound in different regions. After vitrectomy, it is possible to improve the low intraocular pressure before operation and reduce the occurrence of atrophy of the eyeball. For the eyeball that can be sewn, the suture should be as close as possible, so that the initial anatomical structure of the eyeball can be restored.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R779.6

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