中华眼底病杂志

中华眼底病杂志

玻璃体切割手术时机对开放性眼外伤预后影响的研究现状

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开放性眼外伤(OGI)因损伤机制、部位不同等导致病情复杂、变化多样,以致OGI后不同时机行玻璃体切割手术(PPV)的结局完全不同。OGI PPV时机一般分为早期(≤3 d)、延迟(4~14 d)、晚期(>14 d)。国内外对于OGI后PPV的手术时机仍存在较大争议。眼内异物或高感染风险者通常早期手术,可有效降低眼内炎的发生;但由于OGI导致的角膜水肿、玻璃体积血等为早期诊断及手术增加困难。伴有明显脉络膜出血或较大后部创伤者一般选择延迟手术,此时血凝块已液化使其更容易去除;但手术后并发症风险也相应增加。晚期手术可降低PPV难度,但增生性玻璃体视网膜病变的发生几率增加,可能导致严重的视网膜牵拉、裂孔以及手术后瘢痕的形成。了解OGI后PPV时机、眼内变化和特点、手术结局,可为OGI后PPV时机的选择提供参考。

Open-globe injuries (OGI) result in complicated and diverse conditions with different mechanisms and anatomical locations, which lead to completely different outcomes based on when to perform pars plana vitrectomy (PPV) after trauma. The PPV operation time points are generally divided into early (0 - 3 days), delayed (4 - 14 days), and late (> 2 weeks). There are still some controversies about the PPV time points after OGI. Injuries with intraocular foreign bodies or high risk of infection usually need early surgery to reduce the occurrence of endophthalmitis. However corneal edema and vitreous hemorrhage can increase the difficulties for early diagnosis and surgery. If there is choroidal hemorrhage or severe trauma in the back part of the eye, delayed intervention can allow the blood clots to be liquefied and removed easily. But there is higher incidence of postoperative complications. Late surgery can reduce the difficulty of PPV, but the increased incidence of proliferative vitreoretinopathy may lead to severe retinal traction, tears and postoperative scar formation.

关键词: 眼损伤/外科学; 玻璃体切除术; 综述

Key words: Eye injuries/surgery; Vitrectomy; Review

引用本文: 朱鑫磊, 颜华. 玻璃体切割手术时机对开放性眼外伤预后影响的研究现状. 中华眼底病杂志, 2018, 34(2): 184-186. doi: 10.3760/cma.j.issn.1005-1015.2018.02.022 复制

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