应用内窥镜治疗伴有眼内异物的眼内炎

Application of endoscope to treat endophthalmitis complicated with intraocular foreign body

目的探讨应用眼内窥镜治疗屈光间质混浊的伴有眼内异物的眼内炎的效果。设计回顾性病例系列。研究对象8例角膜混浊的伴有眼内异物的眼内炎患者。方法对上述患者应用内窥镜引导行患眼玻璃体切除术,同时行眼内异物取出,7例眼内充填硅油。术后随诊3～12个月,观察患眼的视力及眼内炎的转归。主要指标视力、房水闪光、视网膜情况。结果在内窥镜引导下所有患者均成功取出异物。随诊期内所有患者角膜水肿消失,前房积脓及房水闪光消失,玻璃体腔清亮透明,眼内炎症得到有效控制。6例视力提高(光感～0.2),其中2例矫正视力≥0.1,2例术前术后视力无变化。所有患者均未发现视网膜脱离。结论内窥镜的应用扩大了玻璃体切除术的适应范围,不受角膜混浊的限制,及时对伴有眼内异物的眼内炎患者行玻璃体切除治疗,且有助于发现显微镜不能窥清区域的异物和病变。(眼科,2007,16:354-356)

Objective To demonstrate the efficacy of application of endoscope in vitrectomy to treat endophthalmitis complicated with intraocular foreign body. Design Retrospective case series. Participants 8 patients （8 eyes） of endophthalmitis with opaque corneal and intraocular foreign body were enrolled in this study. Methods Endoscope was used to guide vitrectomy and extration of in- traocular foreign body. Combined silicone oil tamponade was performed in 7 patients. Postoperative followed-up ranged 3-12 months, the status of endophthalmitis and visual acuity were observed. Main Outcome Measures Physical signs of inflammation, retinal status, visual acuity. Results With the use of ophthalmic endoscope, all foreign bodies were extracted successfully. In all patients, the corneal edema, hypopyon and aqueous flare disappeared, vitreous cavity was clear, and the intraocular inflammation was controlled. Visual acuities of 6 eyes were improved（LP-0.2）, corrected visions of 2 eyes were better than 0.1, visual acuities of 2 eyes did not change after operation. No retinal detachment occurred in all patients. Conclusions Vitrectomy led by ocular endoscope increased the indication of vitrectomy, endophthalmitis with intraocular foreign body can be treated in time, and severely opaque cornea did not limit the visual- ization. Endoscope could help to detect foreign body and other abnormalities in the dead zone of microscopy.