The Clinical Analysis On Posterior Structure Reconstruction Of Severe Scleral Rupture

Background and ObjectiveEyes with sclera rupture occupyed a large part and this was the main reason for eyeball enucleation in management of ocular injuries and emergencies. This kind of injury was difficult to treat. The situation had improved with development of surgery machinery and surgical skills, especially after the emergence of vitrectomy technology. It was effective for the treatment of severe ocular injury, The technology cound reconstruct shape of eyeball and avoid eyeball enucleation. Also vision cound be improved to a certein extent. Ocular trauma treatment concept had been development and progress. We cound see that a lot of problems about ocular trauma remain unsolved, such as, the classification of ocular trauma, classification, partition, surgical treatment for traumatized eyes with no light perception (NLP). the treatment for early atrophy eyeball after ocular trauma, the indications of eyeball enucleation, operation opportunity, treatment reason many times, treatment and so on. These problems became a focus in the discussion and disputation of ophthalmologist.The purpose of this study was to explore the treatment of serious scleral rupture and the effect of posterior segment shape reconstruction on different parts of injury, seeking more facilitate and significant treatment measure, evidence based medical science and idea. In this way, the damage of serious scleral rupture cound be reduced to a minimum level.Methods46patients(46eyes) ware collected in our hospital from January2009to January2012.These patients ware severe sclera rupture. Every one were successfully performed with pars plana vitrectomy. We collected a lot of reference information of patients, such as sex, age, occupation, traumatic causes and so on. These patients under local anesthesia or general anesthesia in operation according to the degree of tolerance, during the surgery removed the crystal, iron out retina withpernuorocarbon liquid; cut the proliferation, peel membrance, intraocular laser photocoagulation and electrocautery, retinotomy or retinectomy, silicone oil or C3F8tamponade. Followed up months1,2,3, the information is best corrected visual acuity, intraocular pressure,retinal reattachment, complication and so on. SPSS15.0software was used for all statistical analysis.Results1. The adoption of PPV and choroids membrane and retina reduction techniques was able to treat the serious sclera rupture. The operation effects was obvious. After the operation, a firm ocular surface was formed and the vision improved. Three months after the operation, the best visual acuity of21eyes was NLP-HM,7eyes was CF-0.04,18eyes was0.05～1.0. One can be corrected to1.0, One can be corrected to0.9.2.The effects of vitrectomy on scleral rupture varied depending on the type of scleral rupture. Vision of the case whose wound is located in the cornea after margin10mm is hard to improve. The percentage of visual acuity improvement is15.38%, The percentage of atrophy of eyeball was30.77%after a long follow-up.3. Vitrectomy and silicone oil tamponade improved intraocular pressure. Before operation, the number of patient with low intraocular pressure (<10mmHg) was44, the number of patient with normal Intraocular Pressure(10-21mmHg) was2. Three months after operation, the number of patient with low intraocular pressure (<10mmHg) was6, the number of patient with normal intraocular pressure (10～21mmHg) was40.1eye with high intraocular pressure (>21mmHg) by photocoagulation surgery had normal intraocular pressure.4. After a long follow-up, we cound see that PPV and choroids membrane and retina reduction techniques avoided eyeballs excision and reduced the chance of enucleation. The percentage of atrophy of eyeball was13.04%.ConclusionPPV improves the reattaching rate of the retinas and the vision. The effects of vitrectomy on scleral rupture varies depending on the type of scleral rupture. Vitrectomy improves intraocular pressure. Vitrectomy avoid eyeballs excision and reduces the chance of enucleation. We should try to suture eyeball and achieve anatomical reattachment to prepare for the second phase of the operation and avoid easily remove eye.