颅脑外伤合并开放性眼外伤Ⅱ期玻璃体切除术的疗效观察  

Efficacy of secondary vitrectomy in open globe injury with craniocerebral injury

作　　者：杨淑芳 曾峥[2] 刘晓瑞 赵宇[1] 丁然然 颜华[1] 由彩云[1] Yang Shufang;Zeng Zheng;Liu Xiaorui;Zhao Yu;Ding Ranran;Yan Hua;You Caiyun(Department of Ophthalmology,Tianjin Medical University General Hospital,Tianjin 300052,China;Department of Neurosurgery,Tianjin Medical University General Hospital,Tianjin 300052,China)

机构地区：[1]天津医科大学总医院眼科,天津300052 [2]天津医科大学总医院神经外科,天津300052

出　　处：《中华眼外伤职业眼病杂志》2022年第6期401-405,共5页Chinese Journal of Ocular Trauma and Occupational Eye Disease

基　　金：国家自然科学基金(81800817)。

摘　　要：目的评价伴有颅脑外伤的开放性眼外伤患者Ⅱ期玻璃体切除术的效果。方法回顾性病例系列研究。分析2010年1月至2020年12月天津医科大学总医院神经外科住院的颅脑外伤合并开放性眼外伤行Ⅱ期玻璃体切除手术32例(32只眼)的临床资料。患者年龄20~70(43.2±14.0)岁。术前视力无光感~手动。开放性眼外伤类型包括:眼球穿孔伤6例,眼球破裂伤26例。12例于伤后10~14 d行玻璃体手术,20例于受伤2周后待脑脊液漏好转行玻璃体手术。术后随访12个月,观察患者一段情况、视力、视网膜复位情况及并发症。结果所有患者均在全麻下顺利完成玻璃体切除手术,其中28例(87.50%)行玻璃体硅油填充,术后随访颅脑外伤病情无恶化。术后视力提高20只眼(62.50%),视力不变12只眼(37.50%)。术后12个月,硅油取出视网膜复位24只眼(75.00%)。视网膜脱离复发8只眼(25.00%),均再次行硅油填充成功复位视网膜。结论颅脑外伤合并开放性眼外伤患者,在围手术期积极控制全身病情及脑脊液漏后,可以顺利进行Ⅱ期玻璃体切除手术并挽救一定的视功能。Objective To evaluate the efficacy of secondary vitrectomy in patients with open globe injury with craniocerebral injury.Methods This was a retrospective case series study.The data of 32 eyes of 32 patients with craniocerebral injury accomparied with open globe injury underwent secondary vitrectomy from Jan.2010 to Dec.2020 in the Department of Neurosurgery of Tianjin Medical University General Hospital were analyzed.The average age was(43.2±14.0)years,in a range of 20-70 years.The preoperative visual acuity was from no light perception to hand motions.The types of open globe injury included penetrating injury in 6 cases and rupture in 26 cases.Twelve patients underwent vitrectomy from 10 to 14 days after injury.Twenty patients underwent vitrectomy after 2 weeks since injury when the cerebrospinal fluid leakage improved.The patients were followed up for 12 months.The general condition,visual acuity,retinal reattachment and complication were observed.Results All patients were successfully performed with vitrectomy under general anaesthesia,and 28 patients(87.50%)received silicone oil tamponade,and the condition of craniocerebral injury did not worsen after follow-up.In current study,final visual acuity was improved in 20 eyes(62.50%)and remained unchanged in 12 eyes(37.50%).At 12 months after surgery,silicone oil was removed successfully in 24 eyes(75.00%)with attached retina.In the 8 eyes(25.00%)with retinal redetachment,all eyes achieved anatomical success with silicone oil tamponade.Conclusion Under proper perioperative management of systemic condition and cerebrospinal fluid leakage,secondary vitrectomy can be performed successfully on patients with open globe injury complicated with craniocerebral injury and achieve certain visual function recovery.

关 键 词：眼损伤 穿透性 玻璃体切除术 视力 效果 

分 类 号：R651.15[医药卫生—外科学] R779.6[医药卫生—临床医学]