ABSTRACT
Open-globe injuries (OGI) result in complicated and diverse conditions with different mechanisms and anatomical locations,which lead to completely different outcomes based on when to perform pars plana vitrectomy (PPV) after trauma.The PPV operation time points are generally divided into early (0-3 days),delayed (4-14 days),and late (＞ 2 weeks).There are still some controversies about the PPV time points after OGI.Injuries with intraocular foreign bodies or high risk of infection usually need early surgery to reduce the occurrence of endophthalmitis.However comeal edema and vitreous hemorrhage can increase the difficulties for early diagnosis and surgery.If there is choroidal hemorrhage or severe trauma in the back part of the eye,delayed intervention can allow the blood clots to be liquefied and removed easily.But there is higher incidence of postoperative complications.Late surgery can reduce the difficulty of PPV,but the increased incidence of proliferative vitreoretinopathy may lead to severe retinal traction,tears and postoperative scar formation.
ABSTRACT
Background Orbital fracture in children has its own characteristics.Choosing the suitable plastic materials is the effective measurement to improve the successful rate of surgery.Absorbable plate filling provides a new material for children with orbital fracture.However,few studies compare the effectivity and safety between absorbable plate filling and conventional filling.Objective The aim of this study was to compare the longterm efficacy and safety between absorbable plate and Medpor implants in the repair of pediatric orbital fracture.Methods Clinical data of 72 eyes of 72 pediatric patients with orbital fracture who received surgicals reconstruction in Beijing Tongren Eye Center from 2008 April to 2014 August were respectively analyzed,including 28 patients with absorbable plates filling and 44 patients with Medpor implants.Demography and preoperative clinical signs were matched between the two groups.Operative procedure was same except the implanted materials.The functional training of extraocular muscle was performed since the second day after surgery in both groups.The imaging findings of the orbit were evaluated by computed tomography (CT) before and after surgery.The patients were followed-up for avarage 12.7 months after operation.The therapeutic effectiveness and safety were compared between the different implants,such as incidence of enophthalmos,extraocular movement impairment and diplopia,and the sensory deficit of skin and complications were documented.Results Extraocular muscle movement improved and diplopia alleviated or disappeared in 92.9％ (26/28) in the absorbable plate group and 90.9％ (40/44) in the Medporgroup,without significant difference between the two groups (P=0.57).The sensory deficit of skin was found in 13 eyes (46.4％) and 20 eyes (45.5％ in the absorbable plate group and Medpor group,respectively,and there was no significant difference between the two groups (P =0.56).CT revealed that the anatomical reconstruction of orbits could be achieved in all patients in both groups without the shifting of implants and extrusion.No enophthalmos and postoperative infection were found in absorbable plate group,however,the residual enophthalmos or late infection was found in I eye for each in the Medpor group.Conclusions Both the absorbable plate and Medpor implants show good results for reconstruction of pediatric orbital fracture.Absorbable plate is an ideal material for pediatric orbital blowout fracture because of fewer postoperative complications.
ABSTRACT
The opportunity of vitrectomy for opening eyeball injury is one of the important factors affecting the prognosis.Anterior segment wound repaired by routine suturing needs following and continuous treatment with vitrectomy.The key technique of the following treatment should be the debridement of the inside of wound and expurgation of the surrounding tissues adjacent to the wound,and the emphasis should be put on retinal reattchment and stable repairment.