Objective To investigate the effect of retinectomy 360° for severe ocular rupture and evaluate the related factors associated w ith prognosis. Methods We retrospectively analyzed 28 consecutive patients (28 eyes), 18 men and 10 women, with severe ocular rupture admitted to the Chinese PLA General Hospital between January 1999 and October 2002. The patient′s ages ragned from 16 to 58 years, mean 29 years. According to the internation standardized classification of ocular trauma, the injuries located in zone I in 5 eyes, zone I-II in 8 eyes，zone II in 3 eyes, zone II-IIIⅢ in 5 eyes, zone III in 7 eyes, zone II in 3 eyes, zone II-III in 5 eyes and zone III in 7 eyes. The presenting visual acuity was in grade 4 (0.02 to light perception) in 19 eyes, and grade 5 in 9 eyes. In 28 patients, 13 had the total absence of iris and lens, 10 had iris deletion more than 1/2, and 15 had lens opacity or rupture. Ultrasound biomicroscopy and B-scan revealed ciliochoroidal detachment in 17 eyes. The B-scan revealed vitreous hemorrhage and retinal detachment in all paitents. The intraocular pressure was from 5 to 11 mm Hg in all patients. The therappeutic operative procedures which were performed by one surgeon in all of the affected eyes included standard 3-port pars plana vitrectomy with scleral encircling buckle, endophotocoagulation and tamponading with silicone oil in all patients; lensectomy in 15 eyes; 360° retinotomy and retinectomy at anterior equator in 16 patients, and posterior equator in 12 eyes.Results During the operation, all patients were confirmed with vitreous hemorrhage and retinal detachment, including hemorrhagic ciliary body detachment in 9 eyes, suprachoroidal hemorrha ge in 12 eyes, retinal twisting like morning glory in 11 eyes, and retinal incarceration in 17 eyes. Postoperative follow-up In 26 eyes who were followed up postoperatively from 6 months to 46 months, retinal reattachment was found in 20 patients (76.9%) in whom the retina of 3 was reattached after revitrectomy and the silicone oil of 8 was removed at the fourth month after operation. In 20 eyes with reattached retina, 14 (70.0%) had corrected visual acuity of 0.02 or more, including 7 (35.0%) had 0.05 or more, 3 had 0.1 or mor e, and 1 had the best visual acuity of 0.3.Conclusion Retine ctomy may improve the prognosis of severe ocular rupture and save the visual fun ction of some patients.(Chin J Ocul Fundus Dis，2003，19：333-404)
The opportunity of vitrectomy for opening eyeball injury is one of the important factors affecting the prognosis. Anterior segment wound repaired by routine suturing needs following and continuous treatment with vitrectomy. The key technique of the following treatment should be the debridement of the inside of wound and expurgation of the surrounding tissues adjacent to the wound, and the emphasis should be put on retinal reattchment and stable repairment.
目的:评价皮质激素联合环孢素对比皮质激素单用防治穿透性角膜移植(PKP)术后排斥反应的疗效。方法:计算机检索PubMed,EMBASE.com,SCI,Cochrane图书馆,CBM,CNKI数据库,纳入皮质激素联用环孢素对比皮质激素单用防治PKP术后排斥反应的随机对照试验,进行方法学质量评价并应用RevMan软件进行meta分析。结果:共纳入5篇报道,1篇A级文献,B、C级各2篇。Meta结果:术后排斥反应发生情况组间差异有统计学意义(RR=0.3,95%CI 0.140.65);对既发排斥反应的逆转,组间差异无统计学意义(RR=1.15,95%CI 0.93-1.42)。结论:基于当前证据,皮质激素联合环孢素防治PKP术后排斥反应疗效并不优于皮质激素单用。
Objective To observe the clinical characteristics of severe ocular detonator explosive injuries and to evaluate the therapeutic effects of vitrectomy on it. Methods Clinical data of 37 consecutive patients (65 eyes) with severe ocular detonator explosive injuries were retrospectively analyzed. The patients included 36 males and 1 female with the average age of 28.6 years. The biocular injuriy was in 31 cases (83.8 %), and one-eyed injury was in 6 cases (16.2%). A total of 48 eyes had severe explosive injury. The visual acuity was no light perception in 9 eyes in which 3 eyeballs were obviously atrophic, light perception in 28 eyes, hand moving in 4 eyes, and counting finger/33 cm in 7 eyes. Vitrectomy was performed on 46 eyes, in which 41 had severe ocular explosive injury. There were no vitreous surgery indications in 13 eyes of 19 eyes didnprime;t undergo surgery; the other 6 eyes didnprime;t undergo surgery due to the atrophic eyeballs or economic reasons. The treating time after trauma was within 1 week in 7 patients (18.9%), 1 week to 1 month in 13 (35.2%), and more than 1 month in 17 (45.9%). The follow-up duration lasted 6 months to 2 years after operation with the average of 8.6 months. Results In 65 eyes, the occupation ratio of conjunctival foreign bodies was 66.2%; corneal foreign bodies was 46.2%; vitreous hemorrhage was 70.8%; intraocular foreign bodies (IOFB) was 69.2%; retinal shocking injury or optic nerve blasting injury was 56.9%. The visual acuity improved in 33 eyes, remained unchanged in 25 eyes, and decreased in 7 eyes. In 46 eyes which had undergone vitrectomy, IOFB injuries was in 35 eyes (76.1%); the visual acuity increased in 26 eyes (59.5%), remained unchanged in 13 eyes (28.3%), and didnprime;t cure in 7 eyes (15.2%) in which 2 eyes underwent ocular enucleation and 5 eyes were atrophic. The increasing rate of visual acuity in the patients who accepted the treatment more than 1 month after injury was low. The occupation ratio of monocular blindness was 51.4% and biocular blind was 8.1%. Conclusions Most of severe ocular explosive injuries by detonator are with IOFB. causes of the high blinding rate are late treatment and serious injury. Strengthening the diagnosis and treatment of retinal shock and optic nerve blast, and performing vitrectomy as soon as possible can improve prognositc visual function of injured eyes.
Objective To evaluate the effect of vitrectomy on traumatic retinal detachment combined with choroidal damage. Methods The data of 1075 traumatic eyes which underwent vitrectomy from 1995 to 2005 were retrospectively analyzed. Forty-one patients (41eyes, 3.8%) with different kinds of choroidal injuries, including traumatic retinal detachment combined with serous choroidal detachment, hemorrhagic choroidal detachment (including traum atic separation of choroid and sclera) or subretinal hemorrhage, underwent closed vitrectomy. The operative prognosis in different groups were analyzed statisti cally. Results The retina reattached in 38 eyes （92.7％）, in cluding 10 with the final visual acuity gt; 0.1（24.4％）；the visual acuity improved postoperatively in 29 (70.7％)，including 14 in subretinal hemorrhage group （87.5％, 14/16），12 in serous choroidal detachment group（75.0%, 12/16）and 3 in hemorrhagic choroidal detachment（33.3%, 3/9） (chi;2＝8.394, P＝0.015); amaurosis was found in 6 eyes, all of which were with hemorrhagic choroidal deta chment preoperatively. In 17 eyes with ocular hypotension, a persistent silicone oil tamponade was needed in 8（47.1％）, in which 5 were in the hemorrhagic choroidal detachement group (55.6％, 5/9). Conclusions Appropriate vitrectomy is helpful for traumatic retinal detachment combined with choroidal damage, and the operative prognosis of the patients combined with subretinal hemorrhage is good. The operative prognosis of hemorrhagic choroidal detachment is worse than that of the serous choroidal detachment. However, it doesnprime;t mean that all the hemorrhagic choroidal detachment eyes need ocular enucleation. The prognosis of eyes with severe traumatic choroidal detachment was poor, and the eyes are with ocular hypotension which needs a long-term silicone oil tamponade. (Chin J Ocul Fundus Dis, 2006, 22:295-298)