眼前节异常眼的玻璃体手术特点和疗效  

Characteristics and effectiveness of vitreous surgery in patients with history of anterior segment abnormity

作　　者：李毓敏[1] 许叶圣[1] 沈丽萍[1] 楼定华[1] 冯琦蓉[1] 

机构地区：[1]浙江大学医学院附属第一医院眼科中心,杭州310003

出　　处：《中国实用眼科杂志》2004年第10期815-818,共4页Chinese Journal of Practical Ophthalmology

摘　　要：目的　探讨眼前节异常眼的玻璃体手术特点并评价临床疗效。方法　回顾性分析 96例 96眼伴有角膜或 /和晶状体异常的复杂性玻璃体视网膜病变患者 ,其中按术前主要诊断分为视网膜脱离 60眼 ,玻璃体积血 2 2眼 ,糖尿病视网膜病变Ⅵ期 2眼 ,球内异物 6眼 ,人工晶体脱位 2眼 ,化脓性眼内炎 4眼 ,均在角膜触镜下行玻璃体手术。眼前节异常包括 :角膜混浊 63眼 ,晶状体异常 47眼 ;其中 14眼并存角膜和晶状体的异常。随访期 2～ 3 9个月 ,平均 5 2 9± 6 99月。结果　视网膜脱离 60眼中 ,术后 41眼网膜全复位 (68 3 3 % )。非视网膜脱离 3 6眼中 ,术后 9眼继发视网膜脱离 ,最终网膜平伏率 2 8眼 (77 78% )。术后视力提高≥ 1行者为网脱组 5 6 14 %和非网脱组 65 63 %。结论　玻璃体手术对治疗大多数伴有眼前节异常的严重玻璃体视网膜疾病是有效的 ,但其术前疗效预测性较差 ,术中选择重新处理角膜创口 ,配合不同角度接触镜的运用和巩膜外顶压 。Objective To study the characteristics of vitrectomy in patient with histroy of anterior segment abnormity and assess clinical treatment value.Methods Review analyses 96 cases(96 eyes)with complexity vitreoretinopathy accompanied with cornea or/and lens abnormity.Of the chiefly preoperational diagnosis,60 cases(60 eyes)had retinal detachment,22 cases(22 eyes)had vitreous hemorrhage,2 cases(2 eyes)had the Ⅵ diabetic retinopathy,6 cases(6 eyes)had intraocular foreign body,2 cases(2 eyes)had dislocation of artificial lens and 4 cases(4 eyes)had purulent endophthalmia.All eyes followed pars plana vitrectomy.The anterior segment abnormity included:63 cases(63 eyes)of corneal opacity,47 cases(47 eyes)of lens problem,14 cases(14 eyes)of them had both abnormity.Follow-up period was 2～39 months,mean 5 29±6 99 months.Results Of the 60 eyes with retinal detachment,41 eyes showed success(68 33%).Of the 36 eyes with non-retinal detachment,9 eyes had secondary retinal detachment,the final success rate was 28 eyes(77 78%).Comparing preoperational visual acuity,the improvement of 1 Snellen line or better were 56 14% of retinal detachment group and 65 63% of non-retinal detachment group;respectively.Conclusions Pars plana vitrectomy is effective for majority of severe vitreoretinopathy accompanied with anterior segment abnormity,but prediction of theraptic effect is poor.The difficulty of intraoperational observation can be overcome by re-repairing cornea wound,using contact lenses of different angle and pressing on sclera.

关 键 词：眼前节 玻璃体手术 视网膜脱离 角膜 晶状体 术前 异常 特点 结论 克服 

分 类 号：R779[医药卫生—眼科] R774[医药卫生—临床医学]