Department of Ophthalmology, Geneva University Hospitals and School of Medicine, Geneva, Switzerland; Department of Ophthalmology, Addenbrooke's Hospital, Cambridge University Hospital NHS Foundation Trust, Cambridge, UK.
Department of Ophthalmology, Addenbrooke's Hospital, Cambridge University Hospital NHS Foundation Trust, Cambridge, UK.
Surv Ophthalmol. 2018 Sep-Oct;63(5):694-699. doi: 10.1016/j.survophthal.2018.04.001. Epub 2018 Apr 9.
Occult globe rupture is a traumatic dehiscence of the sclera at or posterior to the rectus muscle insertions without a visible eye wall defect on slit lamp examination. Occult scleral ruptures are important because they can be difficult to diagnose, but normally require preoperative protection against external pressure to reduce risk of herniation of ocular contents through the rupture and then urgent surgical repair to restore eye wall structural integrity and achieve optimum prognosis. A deeper-than-normal anterior chamber with posteriorly retracted plateau iris seen immediately after acute ocular trauma is virtually pathognomonic of posterior globe dehiscence. Three additional less specific signs are helpful: extensive chemosis that is often hemorrhagic, relative hypotony, and vitreous hemorrhage. Although the diagnosis is normally clinical, made by history of direct severe ocular trauma and careful anterior-segment slit lamp examination, computed tomography and ultrasonography can be helpful when thorough slit lamp examination is not possible. Strong suspicion of occult rupture should engender surgical exploration. Vitreous hemorrhage, vitreous or retinal incarceration, and retinal tears or detachment may necessitate subsequent pars plana vitrectomy or other vitreoretinal surgery. When pars plana vitrectomy is indicated, special precautions are suggested if watertight closure of the globe rupture has not been possible.
隐匿性眼球破裂是指直肌附着处或其后的巩膜在创伤性破裂，而在裂隙灯检查时没有可见的眼球壁缺损。隐匿性巩膜破裂很重要，因为它们可能难以诊断，但通常需要术前保护免受外部压力，以降低眼内容物通过破裂疝出的风险，然后紧急手术修复以恢复眼球壁结构完整性并获得最佳预后。急性眼球创伤后立即出现的前房较深和虹膜后移平台几乎是后眼球破裂的特征性表现。另外三个不太特异的体征有帮助：广泛的水肿，通常是出血性的，相对低眼压和玻璃体积血。虽然诊断通常是临床诊断，通过直接严重的眼外伤病史和仔细的前节裂隙灯检查做出，但当无法进行全面的裂隙灯检查时，计算机断层扫描和超声检查可能会有所帮助。对隐匿性破裂的强烈怀疑应进行手术探查。玻璃体积血、玻璃体积血或视网膜嵌顿以及视网膜裂孔或脱离可能需要随后进行玻璃体切割术或其他玻璃体视网膜手术。如果无法实现眼球破裂的防水密封，当需要进行玻璃体切割术时，建议采取特殊预防措施。
