眼球内异物手术治疗的结果分析

Effect of operative treatment on eyeball foreign bodies

目的:分析不同的手术方法治疗眼球穿通伤合并球内异物的手术效果。方法:对57例(57眼)眼球穿通伤合并球内异物的临床资料进行回顾性分析,21例行巩膜外路电磁铁吸出异物,36例采用玻璃体切出术取出异物,其中3例填充硅油,19例行白内障摘除,13例植入人工晶状体,观察视力恢复的情况,玻璃体浑浊程度及并发症,并分析影响视力的因素。结果:21例巩膜外路磁吸术异物摘除率为91%,36例玻璃体切除术异物摘除率为100%,随访3～24mo,巩膜外路组最终视力≤0.2者3例,0.2～0.5者6例,0.5～1.0者9例,>1.0者3例,玻璃体切除组最终视力手动～指数3例,≤0.05者10例,0.05～0.2者15例,0.2～0.5者4例,>0.5者4例,最好视力为0.8。玻璃体浑浊:巩膜外路组0级4例,1级6例,2级9例,3级2例;玻璃体切除组0级6例,1级12例,2级9例,3级4例,4级5例,2例发生眼内炎。结论:两种手术方法异物取出的成功率分别为91%、100%,对于合并有晶状体、玻璃体浑浊的眼内异物、后极部异物须行玻璃体切除术,赤道前、定位准确的磁性异物,以巩膜外路磁吸术为宜,视力的恢复与术前视力、异物的部位、视网膜损伤、眼内感染等因素相关。

AIM： To analyze the therapeutics effect of vitrectomy on eyeball foreign bodies. METHODS： Clinical data of 57 cases （57 eyes） with foreign bodies were retrospective analyzed, 21 cases underwent with eletrolyzer magnetic extraction, and the other 36 cases underwent vetrectomy extraction. Visual acuity, vitreous clouding and complications were observed, and the causes were analyzed. RESULTS： The successful rate of magnetic extraction （21cases） was 91%, and the suooessful rate was 100% for those underwent vitrectomy. During the follow-up of 3-24 months, the final visual acuity was： magnetic extraction groups： 〈0.2 in 3 cases, 0.2-0.5 in 6 cases, 0.5-1.0 in 9 cases and 〉1.0 in 3 cases; vitrectomy groups： no LP in 3 cases, 〈0. 05 in 10 cases, 0.05-0.2 in 15 cases, 0.2-0.5 in 4 cases, 〉0.5 in 4 cases, with 0.8as the best. The degrees of vitreous clouding were： magnetic extraction groups： grade 0 in 4 cases, grade 1 in 6 cases, grade 2 in 9 cases and grade 3 in 2 cases; the vitrectomy groups： grade 0 in 6 cases, grade 1 in 12 cases, grade 2 in 9 cases, grade 3 in 5 cases and grade 4 in 4 cases. CONCLUSION： The successful rate of the two methods were 90.9% and 100% respectively. Vitrectomy is more favorable for the extraction of foreign bodies embedded in posterior vitreous cavity, non magnetic foreign bodies, complicated cataract and vitreous clouding. The recovery of visual acuity is correlated to preopertive visual acuity, locus of foreign bodies, impairment of retina and endoDhthalmitis.