角膜穿通伤合并外伤性白内障最佳手术时机及手术方式的探讨余晓锐[1]*王学珍[2][1]*山西省大同市第三人民医院眼科山西大同037006[2]山西省大同大学医学院眼科山西大同037009【摘要】目的：探讨角膜穿通伤合并外伤性白内障手术时机及超声乳化合并人工晶体植入手术的优点。方法：将45例(45眼)角膜穿通伤合并外伤性白内障患者随机分为A、B两组，A组20例，Ⅰ期行角巩膜伤清创缝合术的同时行外伤性白内障囊外摘除联合人工晶状体植入术；B组25例，行角巩膜伤清创缝合术后15-60天Ⅱ期再行外伤性白内障超声乳化联合人工晶状体植入术。观察两组病人术后视力及并发症。结果：术后随访1～5年，术后1年时矫正视力≥0.5者，Ⅰ期植入者7眼，Ⅱ期植入者12眼;矫正视力≥0.8者，Ⅰ期植入者6眼，Ⅱ期植入者8眼;其余12例视力0.05～0.5，Ⅰ期植入者7例，Ⅱ期植入者5例;差异均无显著性(P＞0.05)。A组术后继发青光眼4例、脉络膜脱离3例，睫状体脱离2例，治疗病程较长；B组术前发生青光眼3例、脉络膜脱离2例，睫状体脱离3例，但较A组为轻，经保守治疗后Ⅱ期行外伤性白内障超声乳化联合人工晶状体植入术时一并行小梁切除术，术后眼压仍轻微高者1例，经药物控制治愈，病程较A组为短。A组术后角膜水肿、虹膜炎症反应、后囊膜混浊等的发生率均高于B组。结论：角膜穿孔伤伴外伤性白内障手术治疗效果满意，但以伤后15～60天内行白内障超声乳化联合人工晶状体植入术，效果更好，安全可靠，术后并发症少，远期效果好；同时在此期间也可以观察外伤性青光眼、脉络膜脱离、睫状体脱离、视网膜脱离等并发伤、并发症的发生并在Ⅱ期手术前或手术时对症治疗。【关键词】角膜穿通伤外伤性白内障手术时机超声乳化前部玻璃体切割术人工晶体植入并发症InvestigatetheBestTimingandWayofPenetratingCornealLacerationandTraumaticCataractSurgeryYUXiao-rui*,WANGXue-zhen*OphthalmologyDepartmentofDatongNo.3People’sHospitalinShanXiProvince,Datong,037006,China.[Abstract]Objective:Penetratingcorneallacerationandtraumaticcataractphacoemulsificationtimeandintraocularlensimplantationcombinedadvantages.Methods:45cases(45eyes)ofcornealpenetratinginjurywithtraumaticcataractwererandomlydividedintoA,Bgroups,Agroupof20patients,PhaseⅠcorneoscleralwounddebridementsurgerysimultaneouslytraumaticcataractextractionandintraocularlensimplantation;Bgroupof20patients,Aftercorneoscleralwounddebridement15-60daysOperatephaseⅡSurgeryoftraumaticcataractphacoemulsificationandintraocularlensimplantation;Observedpostoperativecomplicationsand1visualacuity.Results:Patientswerefollowedup1to5years;Afteroneyear,Correctedvisualacuitywas≥0.5,PhaseⅠwas7eyes,PhaseⅡwas12eyes;Correctedvisualacuitywas≥0.8,PhaseⅠwas6eyes,PhaseⅡwas8eyes;TheOthers12casevisualacuitywas0.05~0.5,PhaseⅠwas7eyes,PhaseⅡwas5eyes;Therewasnosignificantdifference(P＞0.05).ComplicationsofAgroupincloudedfourcasesofsecondaryglaucoma,3casesofchoroidaldetachment,2casesofciliarybodydetachment,andlongertreatmentduration.ThepatientsingroupBoccurredpreoperative3casesofglaucoma,2casesofchoroidaldetachment,3casesofciliarybodydetachment，However,lighterthantheAgroup，andafterconservativetreatmentinphaseⅡOperatetraumaticcataractphacoemulsificationandintraocularlensimplantationsimultaneouslytrabeculectomy,IOPwasstillslightlyhigherin1case,Curedbythedrugcontrol,thecoursewasshorterthangroupA.Agroupofcornealedema,irisinflammation,suchasposteriorcapsuleopacificationincidenceratewashigherthantheBgroup.Conclusion：Traumaticcornealcataractsurgeryhavesatisfactoryresults,But15to60daysafterinjury,cataractphacoemulsificationandintraocularlensimplantationisbetter,safeandreliable,haslesspostoperativecomplicationsandlong-termgoodeffect;Alsocan...
