25G微创玻璃体切割术治疗球内异物的临床观察

Clinical assessment of 25G micro-incision vitrectomy for treatment of intraocular foreign bodies

目的探讨25G微创玻璃体切割术治疗眼后段球内异物的临床疗效。方法回顾性分析眼后段球内异物并接受25G微创玻璃体切割术联合球内异物取出术的21例21眼患者临床资料,其中17例17眼为磁性异物,4例4眼为非磁性异物。20例(20眼)并发白内障,3例3眼伴眼内炎,12例12眼伴视网膜脱离。根据不同的病情分别联合了白内障摘出、视网膜复位、硅油填充等操作,术后随访6个月,对其并发症和手术效果进行分析。结果所有患眼均于完善术前检查后尽快行25G微创玻璃体切割手术联合球内异物取出术,Ⅰ期球内异物取出率为100%,眼内炎3眼炎症均得到控制,术中摘出混浊的晶状体,20例20眼球内异物由角膜切口取出,1例由巩膜切口取出。共19眼术后矫正视力较术前视力有所提高,14眼进行了II期人工晶状体植入,2眼硅油存留。术后未见与微创手术相关的并发症。结论 25G微创玻璃体切割术在眼后段球内异物取出术中显示出良好的临床效果,手术创伤小,视功能恢复快,并发症少,但要注意其适应证的选择。

Objective To investigate the clinical efficacy of 25 G minimally invasive vitrectomy for the removal of foreign bodies in the posterior segment of the ball. Methods The clinical data of 21 patients（ 21 eyes） with intraocular foreign bodies who underw ent 25 G minimally invasive vitrectomy combined with intrabulbar foreign body removal were retrospectively analyzed,including magnetic foreign bodies in 17 patients and non-magnetic foreign bodies in 4 patients. All the patients had cataract and vitreous hemorrhage,with 3 patients（ 3 eyes） suffering secondary endophthalmitis,and 12 patients（ 12 eyes） suffering secondary retinal detachment. Cataract extraction,retinal reattachment and silicone oil tamponade were combined according to different conditions,and the complications and surgical outcomes were analyzed for 6-month follow-up.Results All patients received preoperative examinations,immediately following implementation of 25 G minimally invasive vitrectomy and intrabulbar foreign body removal procedures. The removal rate of foreign bodies in phase Ⅰ was 100%. All the endophthalmitis and retinal detachment were cured before operation. The turbid lens was removed during operation from the corneal incision in 20 patients（ 20 eyes）,and from a scleral incision in 1 patient after cataract extraction. A total of 19 eyes had better postoperative visual acuity than preoperative vision,14 eyes underw ent phase Ⅱ intraocular lens implantation,and silicone oil was retained in 2 eyes. No postoperative complications related to minimally invasive surgery occurred. Conclusion 25 G minimally invasive vitrectomy has good clinical outcomes in the removal of intraocular foreign bodies in the posterior segment of the eye,with minimal surgical trauma,rapid visual function recovery,and few er complications,but great attention should be paid to its indications.