应用临时人工角膜行前后节联合手术治疗严重眼外伤  

Combined anterior and posterior segments surgery using temporary keratoprosthesis for severe ocular injuries

作　　者：王兴荣[1] 温莹[1] 毕宏生[1] 

机构地区：[1]山东中医药大学眼科中心,山东施尔明眼科医院,山东250002

出　　处：《中国实用眼科杂志》2008年第5期501-503,共3页Chinese Journal of Practical Ophthalmology

摘　　要：目的比较应用临时人工角膜行玻璃体切割联合穿透性角膜移植术治疗不同类型严重眼外伤的临床效果。方法对伴有严重角膜混浊的眼外伤患者20例（21只眼），包括爆炸伤11例（12只眼）、眼球穿通伤9例（9只眼）。术前视力为光感～眼前手动，采用临时人工角膜代替病变角膜完成闭合式玻璃体切割、白内障切除、球内异物取出、视网膜复位等眼内操作后，再用新鲜供体角膜置换人工角膜。术后随访3～36个月，平均17月，随访视力、眼压、眼球解剖完整性及并发症。结果全部眼爆炸伤和78％的眼球穿通伤，共19只眼（90％）保存眼球解剖结构完整性。11只眼（52％）保持最佳矫正视力≥0．05，其中眼爆炸伤9只眼（9／12），穿通伤2只眼（2／9）。严重影响预后的并发症有持续性低眼压、复发性视网膜脱离，均发生在眼穿通伤。结论临时人工角膜下行前后节联合手术是治疗伴有严重角膜混浊的外伤眼的惟一有效的方法，眼爆炸伤预后好于眼球穿通伤。Objective To compare the effectiveness of combined vitrectomy with penetrating keratoplasty using temporary keratoprosthesis for different types of severe ocular injuries. Method 20cases （21eyes） including 11 ocular explosive injuries and 9 ocular penetrating injuries were underwent combined surgery .The preoperative visual acuity was from light perception to hand movement, With temporary keratoprosthesis pars plana vitrectomy, cataract excision, foreign body removal ,reattachment of retina and partial penetrating keratoplasty was performed .The follow-up period was from 3-36 months, the mean follow-up time was 17 months. Analysis was focused on visual acuity （VA）, intraocular pressure, anatomic results and complications. Result 19 eyes including 100% ocular explosive injuries and 78% ocular penetrating injuries retained anatomic integrity of eyeball. 11 cases （52%） got the final postoperative VA 0.05 or better, 9 eyes were explosive injuries, the other 2 eyes were penetrating injuries. The severe complications including intraocular hypotension and retinal redetachment were all occurred in the cases with ocular penetrating injuries. Conclusion Temporary keratoprosthesis used in the combined surgeries of anterior and posterior ocular segments is proved to be an unique effective method for treatment of severe ocular injuries. Prognosis of ocular explosive injuries is better than ocular penetrating injuries.

关 键 词：眼外伤 联合手术 临时人工角膜 

分 类 号：R473.77[医药卫生—护理学] R697.32[医药卫生—临床医学]