视网膜内界膜剥除在眼内异物伴黄斑部铁锈症的应用

Application of divesting retinal inner limiting membrane in intraocular foreign body associated with siderosis bulbi in macular

目的:探讨视网膜内界膜剥离在眼内异物伴黄斑部铁锈症眼中的应用,及其临床特点和效果。方法:回顾2000/2004因眼内异物需行玻璃体视网膜手术患者112例(123眼),在经平坦部后部玻璃体视网膜手术中发现黄斑部有铁锈和异常物质附着共5例(5眼),男4例,女1例。年龄13～46岁。病程6d～2a,3眼在3mo内,2眼在1a以上。在玻璃体视网膜手术中仔细寻找视网膜内界膜,直接用自做的钩针(常规10mL针头弯曲针尖的前1/3呈85°)在距黄斑中心凹1～1.2PD处的视网膜表面挑起其内界膜,用眼内镊环形撕除。术前视力LP～0.04。追踪观察6～38mo。结果:眼内异物伴黄斑部铁锈症眼,在黄斑前形成铁锈抑或炎性沉着物,不能用笛针清除,采用内界膜剥离很易彻底去除。病程短的视网膜内界膜能很容易剥除,病程长的视网膜内界膜不容易剥除。术后病程短的3眼均获得解剖和功能上的成功,病程较长的2眼在术后2mo均发生PVR,硅油不能取出,但视功能明显改善。术后视力0.05～0.7,尚未发现由视网膜内界膜剥离所致的严重并发症。结论:视网膜内界膜剥离在玻璃体视网膜手术中的应用越来越广泛,其不但可以解除内界膜对黄斑中心凹处视网膜的牵引,还可以清除紧密附着在黄斑前视网膜表面的毒性物质,改善黄斑区局部的代谢,有利于黄斑功能的恢复。

AIM： To describe the applications, clinical features and effects of the divesting of retinal inner limiting membrane in intraocular foreign body associated with siderosis bulbi in macular. METHODS： Retrospective, noncomparative, consecutive case series. The records of 5 cases （5 eyes）diagnosed as intraocular foreign body associated with siderosis bulbi in macular were collected from 112 patients （123 eyes） undergone vitreoretinal surgery （PPV pars plana vitrctyomy） for intraocular foreign body. During the operation, retinal inner limiting membrane was found and carried apart from clivus of fovea 1-1.2DD by the needle made by self ,then was circlewise teared by the intraocular tweezers. Postoperative visual acuity of suffering eyes range LP to 0.04.The follow-up was 6-38 months. RESULTS： Siderosis bulbi and deposition in macular of the eye with intraocular foreign body couldn＇t be removed by flute needle, but by tearing the retinal inner limiting mem- brane easily and drastically. Three eyes obtained the anatomical and functional replacement. Two eyes was temponaded by silicone oil forever. But their visual function was improved obviously. Postoperative visual acuity of suffering eye ranged from 0.05 to 0.7. Serious complication of tearing retinal inner limiting membrane was still not found.CONCLUSION： The application of tearing retinal inner limiting membrane is used in vitreoretinal surgery more and more. It not only can relieve the traction of retinal inner limiting membrane to retina and clivus of fovea but also can get rid of the virose substance adhered firmly to the surface of macular, improve the macular＇s metabolize, accelerate the furbish of the function of macular.