Viestenz Arne, Huth Andrea, Heichel Jens, Seitz Berthold
Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Halle UKH, Martin-Luther-Universität Halle-Wittenberg, Ernst-Grube-Str. 40, 06120, Halle (Saale), Deutschland.
Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes UKS, Kirrberger Str., Geb. 22, 66424, Homburg/Saar, Deutschland.
Ophthalmologe. 2021 Jan;118(1):81-94. doi: 10.1007/s00347-020-01290-4.
The posttraumatic ocular hypotony (3% after ocular contusion, 50-74% after open globe injury) can lead to severe secondary damage of the eyeball. In addition to corneal folds, ciliary body and choroidal detachment, papilledema e vacuo and macular folds, the shrinking of the eye can lead to substantial visual impairment. Subsequently, the contralateral eye may react with ocular hypertension. The cause of the hypotony must be identified and causally treated. A preservation of the globe is possible if more than 210 ° of the ciliary body are intact. One of the major causes of posttraumatic hypotony is cyclodialysis. Smaller cyclodialysis clefts respond to a cycloplegic treatment, larger clefts require a surgical approach. The direct cyclopexy can be combined with primary wound repair or pole to pole surgery. An alternative consists of silicone oil endotamponade or occlusion of Schlemm's canal. The posttraumatic ocular hypotony is complex and requires exact diagnostics to be able to differentially and specifically treat the causes of hypotony.
创伤后低眼压(眼球挫伤后发生率为3%,开放性眼球损伤后为50 - 74%)可导致眼球严重的继发性损害。除了角膜皱褶、睫状体和脉络膜脱离、视乳头水肿性空虚和黄斑皱褶外,眼球萎缩可导致严重视力损害。随后,对侧眼可能会出现眼压升高。必须查明低眼压的原因并进行针对性治疗。如果睫状体超过210°完整,则有可能保住眼球。创伤后低眼压的主要原因之一是睫状体脱离。较小的睫状体脱离裂隙可通过睫状肌麻痹治疗,较大的裂隙则需要手术治疗。直接睫状体缝合术可与一期伤口修复或极间手术相结合。另一种方法是硅油眼内填充或施累姆管阻塞。创伤后低眼压情况复杂,需要精确诊断才能对低眼压的病因进行鉴别和针对性治疗。