Wang Yu-sheng, Xu Jian-feng, Guo Chang-mei
Department of Ophthalmology, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China.
Zhonghua Yan Ke Za Zhi. 2008 May;44(5):431-5.
To evaluate the clinical characteristics and therapeutic efficacy of occult scleral rupture.
It was a retrospective case series. Clinical data of 28 patients (28 eyes) with occult scleral rupture in recent 10 years was reviewed. All patients were performed with I-stage debridement and suturing surgery when the scleral ruptures were confirmed by operation search, and fourteen eyes of them were performed II-stage vitrectomy in following up periods.
In 28 cases with occult scleral rupture, the major clinical signs included bulbar conjunctival edema and subconjunctival hemorrhage (100%), vitreous hemorrhage (89.3%), hyphema (78.6%), ocular hypotension (75.0%), limitation of ocular movement (75.0%), reduction of visual acuity to light perception or less than light perception (67.9%), impairment or dislocation of the lens (39.3%), pupilla distortion or dilatation (35.7%), choroidal hemorrhage or detachment (35.7%) and retinal detachment (32.1%). In 23 patients their eyes were scanned by A/B-ultrasonography, the image of eyeball wall were found to be interrupted or disorder in 5 eyes and the ocular axis was shorten in 4 eyes. X-ray computed tomography (CT) were performed in 10 patients before operation. It was found interruption or unsharpness of ocular ring in 3 eyes, the unevenness of ocular density in 2 eyes, and both signs were seen in 5 eyes. Total 28 eyes, the visual acuity were improved in 18 eyes after operation, no change 9 eyes and decreased 1 eye. Visual acuity was significantly increased postoperation (X2 = 13.29, P < 0.05). The result showed that the visual acuity increased in 21.4% (6/28) of eyes with I-stage operation and 85.7% (12/14) of eyes with II-stage vitrectomy respectively.
The major sign of diagnosis of occult scleral rupture are visual acuity with light perception or less than light perception, bulbar conjunctival edema and subconjunctival hemorrhage, hyphema, ocular hypotension and limitation of ocular movement, etc after ocular trauma. The intraocular damage such as impairment or dislocation of the lens, vitreous hemorrhage, retinal detachment etc. , is regarded as the important references in the diagnosis, treatment and prognosis. The rates of misdiagnosis can reduce if auxiliary examinations of A or B-ultrasonography and CT are applied. The prompt and appropriate surgery play an important role in the recovery of visual function.
评估隐匿性巩膜破裂的临床特征及治疗效果。
这是一项回顾性病例系列研究。回顾了近10年28例（28只眼）隐匿性巩膜破裂患者的临床资料。所有患者经手术探查确诊巩膜破裂后均行一期清创缝合术，其中14只眼在随访期间行二期玻璃体切除术。
28例隐匿性巩膜破裂患者中，主要临床体征包括球结膜水肿及结膜下出血（100%）、玻璃体积血（89.3%）、前房积血（78.6%）、眼压降低（75.0%）、眼球运动受限（75.0%）、视力下降至光感或无光感（67.9%）、晶状体损伤或脱位（39.3%）、瞳孔变形或散大（35.7%）、脉络膜出血或脱离（35.7%）以及视网膜脱离（32.1%）。23例患者行A/B型超声检查，5只眼发现眼球壁图像中断或紊乱，4只眼眼轴缩短。10例患者术前进行X线计算机断层扫描（CT）检查，3只眼发现眼环中断或模糊，2只眼眼密度不均匀，5只眼同时出现上述两种征象。28只眼中，术后视力提高18只眼，不变9只眼，下降1只眼。术后视力显著提高（χ² = 13.29，P < 0.05）。结果显示，一期手术的患眼中视力提高者占21.4%（6/28），二期玻璃体切除术的患眼中视力提高者占85.7%（12/14）。
隐匿性巩膜破裂的主要诊断体征为眼外伤后视力下降至光感或无光感、球结膜水肿及结膜下出血、前房积血、眼压降低及眼球运动受限等。晶状体损伤或脱位、玻璃体积血、视网膜脱离等眼内损伤情况是诊断、治疗及预后的重要参考依据。应用A或B型超声及CT等辅助检查可降低误诊率。及时、恰当的手术对视功能恢复起重要作用。
