眼后段眼内异物行玻璃体手术摘出的临床观察

Extraction of intraocular foreign bodies in posterior segment by vitrectomy

目的观察眼后段眼内异物行玻璃体手术摘出的临床效果。方法本组156例（156眼）。其中非磁性异物128眼，伴玻璃体积血浑浊96眼，外伤性白内障81眼，视网膜脱离69眼，异物被纤维包裹33眼，伴眼内炎5眼，视网膜下异物2眼。手术均采用经睫状体平坦部标准三通道切口。伴有晶状体浑浊者，先行晶状体摘出，再行玻璃体手术摘出眼内异物；伴有视网膜脱离者，在玻璃体手术摘出眼内异物后再行视网膜复位、眼内光凝术或气体或硅油填充。行I期或Ⅱ期人工晶状体植入或睫状沟缝合固定术。本组3眼因异物较大，而采用角膜缘隧道切口摘出。术后观察3—6个月。结果本组156眼均经玻璃体手术成功摘出眼内异物，伴视网膜脱离的69眼均复位，伴眼内炎的5眼均得以有效控制。术后视力与术前相比均有不同程度提高。结论玻璃体手术可以去除屈光间质浑浊，同时摘出眼内异物、治疗视网膜脱离及其他并发症。

Objective To observe the clinical effects after extraction of intraocular foreign bodies in posterior segment by vitrectomy. Methods 156 eyes from operated on between 2002.3 and 2008.3 in our hospital. 128 eyes with non-ferromagnetie foreign bodies; 96 eyes withvitreous hemorrhage opacity; 81 eyes withtraumatic cataract; 5 eyes with endophthalmitis ;69 eyes with retinal detachment; 2 eyes with sub-retinal foreign bodies; 33 eyes with fiber wrapped foreign bodies. Operations were almost done with standard three-port scleral cut via pars plana. Lensectomy combined with vitrectomy was performed if cataract was found. Retinal reattachment and endolaser surgery was performed after the extraction of the foreign bodies if retinal detachment was found, and gas injection or silicone oil tamponade was used if necessary . Depending on states after operations above , primary , secondary intraocular lens implantation or affixation in ciliary sulcus was done. 3 eyes were with major foreign bodies. It was hard and damaging to extract foreign bodies via pars plana. So sclerokeraloplasty channel cut was replaced. All eyes were followed up for 3 to 6 months. Results The extractions of foreign bodies by Vitrectomy in all 156 eyes were done. successfully for one time merely. 69 eyes with retinal detachment got reattachment; 5 eyes with endophthalmitis were controlled and no sympathetic ophthalmia occured. Postoperative visions （and best visions） were 〉 0.05 . Comparing with the visions before, all patients got higher visions. Foreign bodies in posterior segment of the eye is a severe ocular trauma which can do damage to cornea, sclera, lens, vetrous body and retinea at the same time. Conclusions Vitrectomy can remove the opacity of refractive media and foreign bodies. The treatment of retinal detachment and the elimination of other intraocular complications can also be done at the same time.