摘要
目的 观察人眼放射状视神经鞘切开手术 (RON)后的病理学改变 ,为有效的 RON提供理论基础。 方法 选取 10例因眼部肿瘤行眼球摘除术 (7例 )和眶内容物剜出术 (3例 )而眼球或视盘未受侵犯的眼球 ,作睫状体平坦部双切口 ,一个切口插入导光纤维 ,另一个切口插入标准显微玻璃体视网膜手术刀(MVR刀 ) ,其中选用未弯曲的 MVR刀 4例 ,弯曲的 MVR刀 6例 ,放射状切开视盘鼻侧边缘者 4例 ,鼻侧及颞侧边缘同时切开者 6例 ,并行组织病理切片检查 ,观察手术切口的部位、深度。 结果 8例切开视神经鞘 ,见明显手术间隙 ,观察到 11个切口 ,其中 3个切口略微倾斜地进入视神经束 ;5个于筛板区偏外侧切开 ,手术间隙与蛛网膜下间隙相通 ;3个切口过于中央 ,视神经节细胞轴索损伤相对较多。共有 9个切口深达筛板后 ,切口深度在筛板区及筛板前区各 1个。 1个切口见视盘旁视网膜损伤。均未伤及视网膜中央血管。 结论 于视盘鼻侧边缘切开的 RON是安全可行的 ,切口应该深达筛板及筛板后且于筛板区偏外侧切开 ,手术间隙与蛛网膜下间隙相通。
Objective To explore the histopathological changes of the radial optic neurotomy (RON) in human eyes, and to establish the theoretical foundation for the effective RON. Methods Ten patients with unaffected eyeball or optic disc who had undergone ophthalmectomy (7 patients) or orbital exenteration (3 patients) because of intraocular or orbital tumor were gathered. A double-incision in pars plana was performed. One was inserted into illuminating fiber, and another was inserted into a standard microvitreoretinal (MVR) blade (unbent MVR blade in 4 patients and bent ones in 6; radial incision on nasal side of the optic disc in 4 patients and on both nasal and temporal side in 6). The histopathological examination was performed to observe the location and depth of the incision. Results Eleven incisions were found in 8 out of 10 patients, of which surgical spaces can be observed clearly. Three incisions were obliquely inserted into the optic nerves, 5 sieve plate lateral incisions had the surgical intervals connected with the subarachnoid spaces, and 3 incisions caused obvious damage of retinal ganglion cell axons due to the position close to the center. Nine incisions approached to the retrolaminal level, and the other 2 reached the laminal and prelaminal level respectively. Injured retina beside the optic disc in 1 incision was found. Central retinal vessels were not damaged. Conclusions An optimal incision may be in the edge of the lamina cribrosa, whose depth should be in the level of lamina cribrosa and retrolamina, with surgical intervals connected with the subarachnoid spaces.
出处
《中华眼底病杂志》
CAS
CSCD
2004年第2期67-70,共4页
Chinese Journal of Ocular Fundus Diseases
