Shiraki Nobuhiko, Wakabayashi Taku, Sato Tatsuhiko, Sakaguchi Hirokazu, Nishida Kohji
Department of Ophthalmology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, E-7 Suita, Osaka, 565-0871, Japan.
Graefes Arch Clin Exp Ophthalmol. 2017 Nov;255(11):2287-2291. doi: 10.1007/s00417-017-3771-1. Epub 2017 Aug 30.
Our purpose was to report the initial clinical experience of intraoperative B-scan ultrasonography in combination with 25-gauge pars plana vitrectomy for severe open globe injury with hemorrhagic retinal and choroidal detachment.
Six eyes of six consecutive patients with severe open globe injury underwent intraoperative B-scan ultrasonography and 25-gauge pars plana vitrectomy at Osaka University Hospital in Japan. The feasibility of intraoperative B-scan ultrasonography, best-corrected visual acuity (BCVA), retinal reattachment, and intraoperative and postoperative complications were evaluated.
Five patients presented with a ruptured globe and one patient with double penetration. Preoperative best-corrected visual acuity was no light perception in four eyes and light perception in two eyes. All patients underwent intraoperative B-scan ultrasonography and 25-gauge pars plana vitrectomy within 12 h after open globe injury. Intraoperative B-scan ultrasonography was feasible in all cases and was useful for diagnosing choroidal hemorrhage (four eyes), massive subretinal hemorrhage (two eyes), and retinal detachment (five eyes). In addition, serial real-time B-scan imaging facilitated successful evacuation of the choroidal hemorrhage and massive subretinal hemorrhage by external drainage, resulting in opening of the vitreous space to allow subsequent pars plana vitrectomy without entry site-related complications. After surgery, all patients had successful retinal attachment, and there was no loss of light perception.
Intraoperative B-scan ultrasonography is technically feasible and may potentially improve the safety and efficacy of severe open globe injury repair.
我们旨在报告术中B超联合25G玻璃体切割术治疗伴有视网膜和脉络膜出血性脱离的严重开放性眼球损伤的初步临床经验。
在日本大阪大学医院，对6例连续性严重开放性眼球损伤患者的6只眼进行术中B超检查及25G玻璃体切割术。评估术中B超检查的可行性、最佳矫正视力（BCVA）、视网膜复位情况以及术中及术后并发症。
5例患者为眼球破裂，1例为眼球双穿通伤。术前最佳矫正视力，4只眼无光感，2只眼有光感。所有患者在开放性眼球损伤后12小时内均接受了术中B超检查及25G玻璃体切割术。术中B超检查在所有病例中均可行，有助于诊断脉络膜出血（4只眼）、大量视网膜下出血（2只眼）和视网膜脱离（5只眼）。此外，连续实时B超成像有助于通过外引流成功排出脉络膜出血和大量视网膜下出血，从而打开玻璃体腔，以便后续进行玻璃体切割术，且无穿刺部位相关并发症。术后，所有患者视网膜均成功复位，且无光感丧失。
术中B超检查在技术上是可行的，可能会提高严重开放性眼球损伤修复的安全性和有效性。
