摘要
目的探讨无晶状体眼硅油进入前房的原因及治疗方法。设计回顾性病例系列。研究对象2007年3月至2009年12月沈阳爱尔眼视光医院收治的玻璃体切除术后无晶状体眼,出现硅油进入前房患者14例(14眼)。方法根据术中及术后情况、术后有无晶状体囊膜及虹膜根部切除孔(根切孔)的状态分析硅油进入前房的原因并采取相应治疗。治疗方法:(1)9例根切口阻塞或无根切口患者,采用Nd:YAG激光在原根切孔造瘘或周边虹膜切开,其中Nd:YAG激光造瘘失败者又行手术虹膜周边切除术者4例,除1例重硅油采取半卧位外,术后均采取低头坐位。(2)1例炎症造成的房水分泌不足者采用局部注射糖皮质激素抗炎治疗。(3)1例体位配合不佳者采用正确体位治疗。(4)1例硅油填充过多者,手术放出少量硅油。(5)1例视网膜未复位者,再次行玻璃体手术平复视网膜。(6)1例视网膜无法复位者,行人工晶状体植入,阻隔前后房。主要指标前房硅油回退。结果由以上各种原因造成硅油进入前房的14眼中经各种方法处理,术后第2天观察13眼硅油全部回退,视网膜平复。随诊3个月,发现硅油再次进入前房者1例,且其视网膜脱离,眼压T-1。结论未能建立正常的房水循环途径是无晶状体眼中硅油进入前房的主要原因。只有建立正常足量的房水循环,配合正确体位才能使前房硅油回退成为可能。
Objective To discuss the causes and treatment experiences of silicone oil migration into anterior chamber of aphakic eyes after vitrectomy. Design Retrospective case series. Participants 14 aphakic eyes with silicone oil migration into anterior chamber after vitrectomy. All patients were from Shenyang Aier Eye Hospital, where the patients were treated from Mar. 2007 to Dec. 2009. Methods The reasons of silicone oil migration into anterior chamber were analyzed and corresponding treatments were adopted according to the preoperative and postoperative state, with or without lens capsule membrane or iris root incision （root cut holes） and its situation. Treatments： （ 1 ） We made fistula in the original root or root incision with Nd：YAG laser for 9 cases with blockage or absence of the root holes. Four patients underwent surgical root resection of iris later due to failure in making fistula. All the patients adopted face-down seating posture except 1 patient adopted semireclining position with heavy oil in his eye. （2） 1 patient underwent local injections of glucocorticoid for inadequacy of aqueous humor secretion. （3） 1 patient took correct posture treatment due to bad cooperation in posture. （4） 1 patient with silicone oil over filled underwent an operation to release a few silicone oil. （5） 1 patient underwent vitreetomy again to make retinal reattach for re-detachment of retina. （6）1 case was implanted IOL to block posterior chamber from anterior chamber due to the retina couldn＇t be made reattach. Main Outcome Measures Silicone oil in anterior chamber went back. Results In 13 out of 14 cases silicone oil went back with retina reattachment by using above methods. During the 3 month follow-up , 1 case was found silicone oil migration into anterior chamber again, with its retinal detached and intraocular pressure T-1. Conclusion It is possible to make anterior chamber silicone oil go back by establishing normal aqueous humor circulation with the correct postoperative posture.
出处
《眼科》
CAS
2011年第2期109-112,共4页
Ophthalmology in China
