大部分虹膜离断严重眼外伤手术虹膜处理方式的探讨.DOC

采用闭合式单针法修复21例大范围虹膜根部离断的手术探讨 李灿 陈康 王一 陈少军 摘要 目的：探讨严重钝性眼外伤行前后节联合手术时对大范围虹膜根部离断修复简便有效方法。 方法：对≥90°虹膜根部离断严重钝性眼外伤21例21眼，在联合行玻璃体切割术前行闭合式单针虹膜根部离断修复术，先切除脱入前房内的玻璃体，用粘弹剂将卷曲虹膜回复至原位，将预先穿入10-0尼龙线1ml注射器针头自角膜缘1mm切口进针，将离断虹膜缝合至相应部位板层巩膜瓣下。如伴有睫状体离断者同时缝合离断的睫状体（6例）；再行晶体切除及玻璃体切除术。 结果：21例虹膜均复位，瞳孔圆形或近圆形，直径4-8mm。联合手术后眼压、视力均不同程度改善。 结论：对伴大范围虹膜根部离断严重眼外伤前后节联合手术中，应用闭合式虹膜根部离断修复术，损伤小，操作简便，效果良好。 关键词：虹膜根部离断、修复、玻璃体切除 Abstract Explore the combining operation to most part of iridodialysis in serious ocular trauma Li Can, Chen Kang, Wang Yi, Chen Shao-jun Objective To explore the simple and effective way for most part of iridodialysis in serious ocular trauma during combining anterior and posterior segment operation. Methods 21 patients (21 eyes) with ≥90°iridodialysis in serious ocular contusion was enforced single needle repairment in close anterior chamber before vitrectomy. Firstly vitreous body in anterior chamber was removed, then iris recoverd to the original position by viscoelastic, 1ml needle within 0/10 nylon suture came into anterior chamber from 1mm to limbus corneae and out from opposite scleral flap corresponding to injured iris. In the condition of 6 patents with ciliary body detachment , the ciliary body were sutured in the same time ,after it with lensectomy and vitrectomy. Results 21 iris were reposition, the pupil diameter 4-8mm, with round or like-round shape.After operation, ocular tension and vision had some degree improvement. Conclusion Close iris repiarment was little injure, simple and effective operation for most part of iridodialysis in serious ocular trauma during combining anterior and posterior segment operation. Key Words: iridodialysis, repairment, vitrectomy 虹膜根部离断是眼顿挫伤较常见的并发症 ，但复杂的眼外伤多数可能因晶体脱位、玻璃体积血、视网膜脱离等需同时行晶体切除、玻璃体切除及网膜复位手术。大范围离断的虹膜会干扰玻璃体手术，从远期患者视功能考虑虹膜修复对其有很重要的价值，但是常规多点角膜切口虹膜修复对玻璃体手术的水密性造成影响。我们据此采用巩膜瓣下闭合式虹膜修复方法对我院21例伴有大范围虹膜根部离断的严重眼外伤患者进行前后节联合手术，既修复虹膜又保证玻璃体手术的水密性，现报道如下： 1临床资料 1.1一般资料 我院2007年1月至2010年6月因伴有大范围虹膜根部离断严重眼外伤者行闭合式虹膜根部离断修复术联合玻璃体手术21例21眼。男19例，女2例。年