Strmen P
Klinika oftalmológie LF UK, Bratislava, CSc.
Cesk Slov Oftalmol. 1998 Apr;54(2):71-5.
A deep anterior chamber can be perioperative maintained by irrigation solution or by viscoelastic material. By longlasting reconstructive procedures after penetrating injuries we use an infusion through a pars plana cannula.
Between January 1994 and February 1995 five patients (aged 17-28 years) underwent secondary IOL implantation after penetrating eye injury with traumatic cataract. The reconstructive procedure was performed 6-11 years after the injury and linear cataract extraction. In all eyes corneal scars, iris anterior and posterior synechias, vitreous prolaps, and fibrotic posterior capsule remnants were present. The preoperative visual acuity ranged from 0.05-1.0. A pars plana infusion cannula was positioned 3 mm posterior to the limbus. In one eye with glaucoma a trabeculectomy and in two eyes with a greater defect of the posterior capsule, a lamellar scleral flap for transscleral suturing of one IOL haptic were performed. Then the prolapsed vitreous between cornea and infusion cannula was removed using the vitreous cutter. Iris synechiae were blunt or sharp dissected, the cortical masses were aspirated, the fibrotic or calcificated lens remnants were ectomised and an IOL was implanted into the ciliary sulcus. Two haptics were transsclerally fixated. The follow-up period ranged from 4-18 months.
The surgery duration ranged between 45-90 minutes. No perioperative complications were recorded. On the fourth postoperative day bleeding into the anterior chamber and vitreous in one patient with transsclerally fixated haptic was observed. The blood reabsorbed spontaneously within a week. No complications from the infusion cannula could be observed. The postoperative visual acuity is 0.1-1.0.
The permanent pars plana infusion maintains a stabile anterior chamber depths and intraocular pressure. The deep anterior chamber allows long-lasting surgical manoevers with less risk of corneal endothelium damage.
术中可通过灌注液或粘弹剂维持前房深度。在穿透性眼外伤后的长期重建手术中，我们通过睫状体平坦部插管进行灌注。
1994年1月至1995年2月，5例年龄在17 - 28岁的患者在穿透性眼外伤合并外伤性白内障后接受二期人工晶状体植入术。重建手术在受伤及线状白内障摘除术后6 - 11年进行。所有患眼均存在角膜瘢痕、虹膜前后粘连、玻璃体脱出及纤维化的后囊膜残留。术前视力范围为0.05 - 1.0。在角膜缘后3mm处放置睫状体平坦部灌注插管。1例青光眼患者行小梁切除术，2例后囊膜缺损较大的患者行巩膜板层瓣以便经巩膜缝合一个人工晶状体襻。然后用玻璃体切割器清除角膜与灌注插管之间脱出的玻璃体。钝性或锐性分离虹膜粘连，吸出皮质块，切除纤维化或钙化的晶状体残留，将人工晶状体植入睫状沟。两个襻经巩膜固定。随访期为4 - 18个月。
手术时间为45 - 90分钟。未记录到围手术期并发症。术后第4天，1例经巩膜固定襻的患者前房和玻璃体出现出血，血液在1周内自行吸收。未观察到灌注插管相关并发症。术后视力为0.1 - 1.0。
永久性睫状体平坦部灌注可维持稳定的前房深度和眼压。较深的前房允许进行长时间的手术操作，且角膜内皮损伤风险较低。
