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复杂创伤睫状体分裂的内部睫状体缝合术

Wang C, Peng XY, You QS, Liu Y, Pang XQ, Zheng PF, Jonas JB

期刊名称:Acta Ophthalmologica

卷期:2017年第95卷第6期

关键词:
睫状体 创伤

摘要

摘要:目的:评价复杂创伤睫状体分裂患者给予内部直接睫状体缝合术的手术效果以及功能恢复。方法:单中心介入性病例研究包括创伤性睫状体脱离后持续进行治疗的眼睛。内部睫状体缝合术中双臂缝合线从眼部穿过睫状体分离面的相反部分,置于平行的盘状软骨上。额外的程序包括白内障手术以及玻璃体切除术。采用超声生物显微镜和前房角镜检查记录睫状体脱离手术。结果:这项研究包括44个患者(44只眼睛)。睫状体脱离手术历经4.8±3.2小时刺激巩膜周长(范围e 1-12hr,平均 4hr)16只眼睛(37%)中刺激巩膜周长>180°,3只眼睛为360°。除了睫状体脱离手术,额外的创伤相关并发症包括眼前房出血、虹膜根部断裂、晶状体脱位、白内障、玻璃体出血、视网膜脱落、脉络膜上腔出血以及眼内炎。一般创伤64天后进行手术包括平均4.6±1.9缝合(范围: 2-9),每30°睫状体脱离有1.2个缝合。平均随访期是32±8(范围: 6-51)。在所有44只眼睛中睫状体脱离术闭合,眼内压(IOP)8.0±3.4mmHg (范围: 3 21mmHg)增加到14.4±4.0mmHg(范围:11-21mmHg)。平均视敏度(VA)2.3±1.1 logMAR (范围:0.22-4.0)增加到1.2±0.8 logMAR (范围:0.3-4.0 logMAR)。结论:内部直接睫状体缝合术对于创伤睫状体分裂是一个新颖、微创的手术技术。

PURPOSE:To assess the surgical and functional outcome of internal direct cyclopexy as therapy of complicated traumatic cyclodialysis.METHODS:The single-centre interventional case-series study included eyes with traumatic cyclodialysis who had consecutively been treated. Internal cyclopexy was performed using double-armed sutures introduced into the eye through the pars plana opposite to the cyclodialysis cleft and which were laid parallel to limbus. Additional procedures included cataract surgery, and pars plana vitrectomy. The cyclodialysis was documented upon ultrasound biomicroscopy and gonioscopy.RESULTS:The study included 44 patients (44 eyes). The cyclodialysis extended over 4.8±3.2 clock hours of scleral spur circumference (range 1-12hr, median 4hr), involving >180° of the scleral spur circumference in 16 eyes (37%) and 360° in 3 eyes (7%). Besides cyclodialysis, additional trauma-related complications included hyphema, iridodialysis, lens dislocation, cataract, vitreous haemorrhage, retinal detachment, suprachoroidal haemorrhage and endophthalmitis. The surgery performed on average at 64days after the trauma included a mean number of 4.6±1.9 sutures (range: 2-9), with 1.2 sutures per 30° width of cyclodialysis. Mean follow-up was 32±8weeks (range: 6-51weeks). Closure of the cyclodialysis was achieved in all 44 eyes, and intraocular pressure (IOP) increased from 8.0±3.4mmHg (range: 3 21mmHg) to 14.4±4.0mmHg (range: 11-21mmHg). Mean visual acuity (VA) improved from 2.3±1.1 logMAR (range: 0.22-4.0) to 1.2±0.8 logMAR (range 0.3-4.0 logMAR).CONCLUSION:In conclusion, internal direct cyclopexy is a novel and relatively little invasive surgery technique for the repair of traumatic cyclodialysis.

PMID28631430


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