Clinical Analysis On Suturing Reattachment Operation Of Traumatic Ciliary Body Detachment

Ciliary body detachment is a rare complication of blunt traumatic injuries or surgical interventions. The operation of ciliary body is always difficult because of this tissue can't be examined directly.In recent years, in view of the application of the ultrasound biomicroscope(UBM), which is a safe and noninvasive diagnostic tool,the structure of the anterior eye can be shown immedia- tely.intuitively.exactly. Therefore,more and more ciliary body diseases can be diagnosed and treated.After blunt traumatic injuries, aqueous humor impacts the anterior chamber angle,which causes ciliary body detachment. In some patients,the injuries may result in cyclodialysis, which means a formation between anterior chamber and superciliary cavity. Hypotony induced by ciliary body detachment will lead to serious destroy of eye,such as visual deterioration.shallow anterior chamber. cataract.anterior uveitis.choriod and retinal detachment. macula lutea radiation-fold etc,which indicates that an positive treatment is necessary.Conservative treatment concludes steroids.vasodilators.tradi- tional Chinese medicine and cycloplegics,they work to eliminate the inflammation of ciliary body and adhesion the ciliary body and the sclera.The effect of conservative treatment is minimal,while surgical therapy is effective,which includes laser.cryotherapy .suturing reattachment operation,et al.The suturing reattachment operation is viewed as the most effective method for its easy to operate .little injury and the reliable effect.In this study,a total of 12 patients diagnosed of ciliary body detachment by Ultrasound Biomicroscope were retrospectively analyzed in our hospital from January 2006 to August 2007 . Before the operation, we used slitlamp.ophthalmoscope.gonioscope.ultras- onic biology microscope to determine the place and scope of serious detachment of ciliary body.All the patients were divided into two groups according to the operation scope in the first time. They are group A(the operation scope is not more than 180 degree)and group B (the total operation scope of two discontinuous parts is not more than 270 degree). Analysis of its etiology, pathogenesis, disease duration, conservative treatment, surgical methods and prognosis, will help us to sum up the treatment of traumatic ciliary body detachment especially the suturing reatta- chment operation.After diagnosis, a conservative treatment given to four patients was inefficient.All patients were observed for six months after operation. In the 9 patients of group A,5 people were successful after the first operation,1 people successed after the second operation,while the other 3 cases failed after the first operation and gave up.All 3 patients in group B were successful after the first operation.Therefore,the success rate in group A(55%) is lower than in group B(100%).The symptoms of all the successful cases in group A and B were improved or unchanged,only a patient remained optic atrophy after operation,which may be related to his optic nerve edema after ten years-disease duration.So the posto- perative resumption of visual acuity, intraocular pressure and ocular symptoms in the two groups dosen't have obviously difference. Whether success or not after the operation dosen't relate to the length of disease duration,but long-term course will seriously affect the recovery of retina and optic nerve which will reduce the postoperative visual acuity ,therefore, a timely and positive treatment is necessary. The ultrasound biomicroscope(UBM) is a key factor in the diagnosis of ciliary body detachment , the characteristic manifestations found by UBM are as follows: shallow anterior chamber.no echoes between sclera and ciliary body.the scope of detachment.superciliary effusion .In cyclodialysis patients, the ciliary body may be completely disintegrated from the scleral spur, resulting in a fistula between anterior chamber and superciliary cavity.According these factors above,UBM can be used to make a correct diagnosis of ciliary body detachment irrespective of optic media condition, provide evidences for treatment,and can evaluate the postoperative effect.In all,the ultrasound biomicrosc-ope(UBM) plays an important role in diagnose and postoperative assessment.We can learn from the above result that the effect of conservative treatment for 360-degree ciliary body detachment is minimal and the surgical treatment is necessary. Suturing reatta- chment operation is an effective surgical methods. The success rate of suturing reattachment operation in a scope of 270- degree is higher than in a scope of 180- degree. The postoperative resumption of visual acuity, intraocular pressure and ocular symptoms in the two groups dosen't have obviously difference. Whether success or not after the operation dosen't relate to the length of disease duration,but long-term course will seriously affect the recovery of postoperative visual acuity. The ultrasound biomicroscope(UBM) is an effective instrument in diagnose and postoperative assessment of ciliary body detachment. However, because of the samples number of this study is small, these conclusions only can be seen as a reference and a large sample of cases is required for the further study.In a word ,the ciliary body detachment should be diagnosed timely and treated promptly, which can assist to improve final visual acutity.