Long-term outcomes following the surgical repair of traumatic cyclodialysis clefts
Long-term outcomes following the surgical repair of traumatic cyclodialysis clefts
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作者：
Agrawal, P.;Shah, P.
目的探讨外伤性睫状体透析裂直接和间接睫状体睫状体睫状体透析术后的长期视力预后及眼压控制情况。方法对17例患者17只眼的连续病例进行回顾性分析。所有出现低眼压症状的眼睛均采用裂眼冷冻疗法和/或直接手术治疗。睫状体睫状体在双板缘巩膜瓣下直接缝合于巩膜突。主要观察指标为IOP、最佳矫正视力（BCVA）、术后并发症发生情况。结果17眼睫状体裂均为创伤后性，延长时间为2.1±1.6小时（范围0.5 ~ 6小时）。平均随访时间为43.7+/-24.6个月（12-110个月）。术前，平均IOP为6.9±4.0 mm Hg（范围2-14 mm Hg）。术后，13只眼出现疼痛的可逆性IOP尖峰，高达70毫米汞柱。术后平均IOP为12.2+/-4.1 mm Hg，无继发性青光眼病例。术前4眼（24%）BCVA为6/12或更好，最终随访时上升至12眼（71%）。在接受直接环丛手术的12例患者中，75%的患者最终BCVA达到6/12或更高。没有严重的并发症，包括脉络膜上出血或眼内炎。结论即使有长期低眼压病史的患者，成功的睫状体透析修复术也能获得良好的长期视力预后和稳定的IOP控制。
Purpose To evaluate the long-term visual prognosis and intraocular pressure (IOP) control following direct and indirect cycloplexy for the surgical treatment of traumatic cyclodialysis clefts.Methods Retrospective consecutive case series of 17 eyes of 17 patients. All eyes showing signs of ocular hypotony were treated with either cleft cyclocryotherapy and/or direct surgical cycloplexy. Cycloplexy was performed by directly suturing the ciliary body to the scleral spur under a double-lamellar limbal-based scleral flap. The main outcome measures were IOP, best-corrected visual acuity (BCVA), and the occurrence of postoperative complications.Results The cyclodialysis clefts were post-traumatic in all the 17 eyes and extended for 2.1+/-1.6 clock-hours (range, 0.5-6 clock-hours). The mean follow-up time was 43.7+/-24.6 months (range, 12-110 months). Preoperatively, the mean IOP was 6.9+/-4.0 mm Hg (range, 2-14 mm Hg). Postoperatively, painful reversible IOP spikes of up to 70 mm Hg developed in 13 eyes. The final mean postoperative IOP was 12.2+/-4.1 mm Hg with no cases of secondary glaucoma. Preoperatively, BCVA was 6/12 or better in 4 eyes (24%), which rose to 12 eyes (71%) at final follow-up. Of the 12 patients who underwent direct cycloplexy, 75% achieved a final BCVA of 6/12 or better. There were no serious complications related to direct cycloplexy, including suprachoroidal haemorrhage or endophthalmitis.Conclusions Successful cyclodialysis cleft repair can lead to a good long-term visual prognosis and stable IOP control, even in cases with a protracted history of ocular hypotony.