Roper-Hall M J
Klin Monbl Augenheilkd. 1979 Oct;175(4):447-52.
Improvement in the management of perforating injuries has become possible since the successful control of infection. However, the decisive step ahead was accurate suturing. The use of finer needles and of thinner, standardised suture material enabled accurate adaption of the margins and closer suturing. The anterior chamber could now be filled with air, thus preventing contact between iris and cornea. Development of new instruments enabled simultaneous management of haemorrhages and of injuries of the lens and vitreous body. Prolapse of iris without essential damage to the iris could be reduced either by limbal puncture or by intensive rinsing with fluid, proceeding from the edges of the wound. Parallel to the successful management of lens injuries a more radical form of vitreous surgery developed without significantly increasing surgical trauma. In Birmingham, during 1950--1958 45% of the patients with perforating injury of the anterior segment--including injury of the lens or iris--achieved a visual acuity of 6/12 or better. During 1971--1974 the corresponding percentage was 62% at the same clinic.
自从成功控制感染以来，穿孔伤的治疗取得了进展。然而，向前迈出的决定性一步是精确缝合。使用更细的针和更细的标准化缝合材料能够精确对合边缘并进行更紧密的缝合。现在可以向前房注入空气，从而防止虹膜与角膜接触。新器械的开发使得能够同时处理出血以及晶状体和玻璃体损伤。对于虹膜脱垂且虹膜无严重损伤的情况，可通过角膜缘穿刺或从伤口边缘开始用液体强力冲洗来复位。在成功处理晶状体损伤的同时，一种更激进的玻璃体手术形式得以发展，且手术创伤没有显著增加。在伯明翰，1950年至1958年期间，45%的前段穿孔伤患者（包括晶状体或虹膜损伤）视力达到了6/12或更好。在同一诊所，1971年至1974年期间这一相应比例为62%。
