留置性硅油填充的萎缩眼球作为义眼台的临床应用  

Clinical application of atrophic eyeballs permanently filled with silicone oil as ocular prostheses

作　　者：陈酉[1] 赵通[1] 孙川[1] 王志军[1] Chen You;Zhao Tong;Sun Chuan;Wang Zhijun(Department of Ophthalmology,China-Japan Friendship Hospital,Beijing 100029,China)

机构地区：[1]中日友好医院眼科,北京100029

出　　处：《眼科》2020年第5期380-384,共5页Ophthalmology in China

摘　　要：目的观察利用留置性硅油充填的外伤后保留眼球作为义眼台的临床效果。设计回顾性病例系列。研究对象2010年10月至2017年5月在中日友好医院眼科行开放性眼外伤探查性修复术后留置性硅油充填保留眼球的患者22例(22眼)。方法对留置性硅油填充的萎缩眼球实施角膜前弹力层下浅板层切除联合球结膜覆盖手术,待角膜基质层与球结膜完全愈合拆除缝线后配戴义眼片。术后随访8个月至3年。观察是否结膜切口裂开、结膜瓣后退及上皮植入性囊肿发生。术前术后采用疼痛NRS评分了解角膜刺激症状,对比术前术后睑裂高度及眼球突出度变化,患者对外观改善满意度。主要指标结膜及角膜愈合情况,NRS评分,睑裂高度及眼球突出度,满意度评分。结果术后22例患者20例裂隙灯检查结膜与角膜愈合良好。2例发生上皮植入性囊肿,行囊肿切开及内外层上皮缘对吻缝合治疗后消退。所有患者配戴义眼片后无不适感,疼痛NRS评分均为0分。睑裂高度术前(3.45±1.37)mm,术后提高为(9.73±1.70)mm(t=14.03,P=0.00);眼球突出度术前(6.77±1.41)mm,术后提高为(11.50±1.57)mm(t=23.71,P=0.00)。外观明显改善,满意度评分4~5分,中位数5分。疼痛NRS评分术前0~6分,中位数1.5分;术后0分。3例患者术前有明显角膜刺激症状(疼痛NRS评分4分以上)术后症状全部消失。结论留置性硅油填充所保留的萎缩眼球行浅板层角膜切除联合球结膜覆盖后佩戴义眼片,可良好地改善伤眼的外观及消除角膜刺激症状。Objective To study the clinical efficacy of retained atrophic eyeballs permanently filled with silicone oil after open ocular trauma repair as ocular prostheses.Design Retrospective case series.Participants 22 patients(22 eyes)involved were retained eyeballs after exploratory and reparative surgery combined with long-term silicone oil retention due to open ocular trauma and ocular content loss in China-Japan Friendship Hospital from October 2010 to May 2017.Methods The patients were performed with shallow lamellar keratectomy(underneath Bowman’s membrane layer)combined with total conjunctival flap coverage and wore prosthetic eye pieces directly after conjunctival flap healed with corneal stromal layer.All patients were followed up from 8 months to 3 years to exam if there were any complications such as conjunctival wound disruption,conjunctival flap retraction or epithelial implantation cysts.Numeric rating scales(NRS)of pain was used to evaluate the relief of corneal irritation before and after operation.Exophthalmos and palpebral fissure height before and after operation were compared.Rating scales of satisfaction was used to evaluate the patients’satisfaction with appearance improvement.Main Outcome Measures Situation of wound healing under slit lamp examination,NRS of pain,palpebral fissure height and exophthalmos measurement,rating scales of satisfaction.Results Conjunctival flap healed firmly with corneal stromal layer was 20/22 eyes.Epithelium implantation cysts at the limbus appeared in 2 eyes,and the cysts were incised and sutured at the inner and outer epithelial margins of the cysts.All patients had no pain and foreign body sensation after wearing prosthetic eye pieces.NRS of pain were all zero.Palpebral fissure height on preoperation and postoperation was(3.45±1.37)mm,(9.73±1.70)mm,respectively.Exophthalmos on preoperation and postoperation was(6.77±1.41)mm,(11.50±1.57)mm,respectively.The postoperative appearance was improved significantly.Rating scales of satisfaction were 4 to 5(median 5).P

关 键 词：开放性眼外伤 留置性硅油填充 角膜浅板层切除 全结膜覆盖 义眼台 

分 类 号：R779.6[医药卫生—眼科]