| Ocular trauma is one of the leading causes of vision loss. Ocular trauma oftenserious, often involving each structure of the anterior and the posterior, blindness rateis high and the surgery is complex. But if treatment is timely and the surgery isproperly, most of the injured eye can keep certain vision. Conventional vitreoretinalsurgery is done under a set of contact lenses. During the operation, rotating contactlens constantly is needed in order to obtain fundus images, but rather limited view.For the Ocular trauma often combined corneal turbidity, stitches and so on, theoperation under corneal contact lens is a big difficulty. Since the1990s, theintroduction of wide-angle viewing system make a big change of vitreoretinal surgery.Wide-angle viewing system can provide a wide-angle observation for the doctor invitreoretinal surgery. Wide-angle system has gradually been applied in vitreoretinalsurgery, which makes a lot of complicated retinal surgery has been done successfullybecause of its unique advantages.This study will discuss the clinical effects ofvitreoretinal surgery for the treatment of complicated ocular trauma． ObjectiveSelecting ocular trauma patients with corneal stitches or scar, and also havevitreous hemorrhage, retinal detachment, all subjects were excluded from intraocularforeign body, endophthalmitis and no light perception. Divided all patients into twogroups randomly, use Resight non-contact wide-angle viewing system and contactlens separately in the surgery. By comparing the operation time, the vision before andafter operation and the incidence of complications, etc., to explore the clinical effectof using wide-angle viewing system in vitreoretinal surgery for complicated oculartrauma.Materials and methodsSelecting60cases (60eyes) patients who treatment in hospitalization in theFirst Affiliated Hospital of Zhengzhou University during January2013to December2013. Standard enrolled in the study is all patients had cornea suture or corneal andalso with retinal detachment and vitreous hemorrhage, all subjects were excludedfrom intraocular foreign body, endophthalmitis and no light perception. All patientshad accomplished the first stage suture surgery. The time from trauma to the secondstage surgery is7days to3months (average10.7±3.2days). Patients were dividedinto two groups randomly, the wide-angle viewing system group had30cases (30eyes),24cases (24eyes) were male,6cases (6eyes) were female, from5to57years old (average20.2±3.7years old), corrected vision: light perception-fingercount:9eyes;0.01-0.04:19eyes;0.05-0.1:2eyes, intraocular pressure:0.71-2.97Kpa. The traditional group had30cases (30eyes),22cases (24eyes) weremale,8cases (8eyes) were famale, from7to62years old (average22.5±1.9yearsold), corrected vision: light perception-finger count:11eyes;0.01-0.04:18eyes;0.05-0.1:1eye, intraocular pressure:0.73-2.86Kpa. Above were no significantdifferences after statistical analysis. Before the start of this research had obtained theethics committee’s approval of the First Affiliated Hospital of Zhengzhou University. Each patients had completed visual acuity test, tonometry, slit-lampbiomicroscope exam, anterior photography, and fundus examination.The wide-angle viewing system group used Resight non-contact wide-angleobservation system in surgery, the traditional group used contact lens. Recording thesurgery. The first3days after surgery, visual acuity, intraocular pressure, funduscondition exam were needed. Follow-up time is1-6months (average2.5±1.9months).The results were analyzed with SPSS17.0software.Results1. Intraoperative situation:60eyes were completed surgery successfully.Wide-angle viewing group had a wide-angle view in the process of operation, stereosense is strong, simplified operation processing, didn’t need assistant cooperate tocomplete the vitreous cut, just mild jacking could accomplished the equator vitreouscut. The traditional group’s vision during the operation is stenosis relatively,intraoperative need to suture the cornea ring to fix contact lens. During the operation,rotating contact lens constantly is needed in order to obtain fundus images, but ratherlimited view. For the Ocular trauma often combined corneal turbidity, stitches and soon, the operation under corneal contact lens is a big difficulty. Operation is relativelycomplicated, and the equator vitreous cut need skilled assistant to cooperate.2. Operation time: The operations were done by the same operator. Operationtime of wide-angle viewing system group is41-85min,(average61.2±10.7min),operation time of traditional group is60-115min,(average79.7±9.5min). Therewere significant differences after statistical analysis (P＜0.05).3. Surgical effect: All patients vision after the operation had different degrees ofimprovement. Wide-angle viewing system group: light perception-finger count:3eyes,0.01-0.04:7eyes,0.05-0.1:15eyes,0.12-0.25:3eyes, above0.3:2eyes;Traditional group: light perception-finger count: four eyes,0.01-0.04:9eyes,0.05-0.1:13eyes,0.12-0.25:3eyes, above0.3:1eye. Visual acuity were raised, two groups of postoperative contrast the before vision, there were significant differencesafter statistical analysis (P＜0.05). Two groups of postoperative vision contrast,there was no statistically significant difference (P＞0.05).The surgery success rate included functions cure and anatomy cure. The amountof function cure of wide-angle viewing system group were23eyes (76.7%),6eye(3.3%) were anatomy cure. The amount of function cure of traditional function were24eyes (80.0%),6eyes (20.0%) were anatomy cure. Compared with two groups ofsurgical effect, there was no statistically significant difference(P＞0.05).4. Complications: Latrogenic retinal breaks in the operation:0eye inwide-angle lens group,1eye (3.3%) traditional group. Postoperative silicone oil intothe anterior chamber: wide-angle viewing system group:4eyes (13.3%), thetraditional group:6eyes (20.0%); High intraocular pressure: wide-angle viewingsystem group:5eyes (16.7%), the traditional group:8eyes (26.7%), giving drugscan control. The incidence of latrogenic retinal breaks, postoperative silicone oil intothe anterior chamber and high intraocular pressure between the two groups compared,there was no statistically significant difference(P＞0.05).Conclusions1. The wide-angle viewing system applied to complicated ocular trauma can get aclear fundus images, simplify the operation and shorten operation time.2. Using wide-angle viewing system for ocular trauma in vitreoretinal surgery issafe and effective. |
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