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目的:探讨严重外伤导致虹膜根部大部离断修复术的简便方法。方法:麻醉后在虹膜根部离断处角膜后方1mm作 几个以穹隆部为基底的结膜瓣。制作标准为每象限内作一个瓣。在距虹膜卷缩粘连最近的巩膜切口注入粘弹性物质,并使虹膜 向其所对应最远处角膜缘靠拢。全部缝合完毕后,将虹膜平复,将前房内粘弹性物质处理干净,缝合结膜瓣。术后观察眼压, 并给予抗生素联合激素全身及局部治疗。结果:对该23例患者进行随访6月-25月,平均为18月。随访结果全部离断虹膜复位, 瞳孔正圆者为18例,近圆形5例。由于虹膜括约肌不同程度受到损伤,瞳孔不同程度散大。其中瞳孔直径4 mm以下者6例, 4mm-5mm之间者为11例,5mm-6mm之间者为4例,等于或大于6mm以上者为2例。结论:手术时机选择应在伤势经过常规 治疗后得到控制的情况下应待炎症稳定后再行手术比较稳妥。由于借鉴了超声乳化法吸出白内障手术中的巩膜隧道切口,使切 口容易达到水密状态,且可以有效减少术中产生的医源性散光。粘弹性物质的应用对手术也至关重要,可以减少手术对角膜内 皮及眼内结构的损伤,从而使某些复杂并发症可以在一期得到及时有效的治疗。
Objective: To explore a simple method of severe trauma leading to the repair of most of iris roots. Methods: After anesthesia, several 10-cm-conjunctival flap basal domes were cut off 1mm behind cornea in the root of iris. Make a standard for each quadrant to make a petal. Viscoelastic material is injected into the scleral incision closest to the iris crimp adhesions, and the iris moves closer to the limbus farthest from it. After all the sutures were completed, the iris was recovered and the viscoelastic material in the anterior chamber was treated cleanly. The conjunctival flap was sutured. Postoperative intraocular pressure was observed, and antibiotics combined with systemic and local hormone therapy. Results: The 23 patients were followed up from June to 25 months, with an average of 18 months. Follow-up results were all off the iris reduction, pupil were 18 cases were round, nearly 5 cases of round. As the iris sphincter injury to varying degrees, different degrees of pupil scattered. The pupil diameter of 4 mm or less in 6 cases, 4mm-5mm between 11 cases, 5mm-6mm between 4 cases, equal to or greater than 6mm in 2 cases. Conclusion: The timing of surgery should be controlled after the injury is controlled by conventional treatment should be stable after surgery and surgery more secure. Drawing on the scleral tunnel incision in phacoemulsification cataract surgery, it is easy to achieve watertight incision and can effectively reduce the iatrogenic astigmatism. The application of viscoelastic material is also crucial to the operation, which can reduce the damage to the corneal endothelium and intraocular structure caused by the operation, so that some complicated complications can be treated effectively in a timely manner.