玻璃体切割治疗后段眼内异物伤视力预后及相关因素分析

Treatment and visual outcome of posterior segment located magnetic IOFB by vitrectomy

目的评价经玻璃体切除手术治疗后段眼内异物伤的临床疗效，以及术后视力预后的主要影响因素。方法于2008年9月至2011年6月，经玻璃体切除治疗后段眼内异物伤患者64例64眼，对术前最佳矫正视力（BCVA）、异物大小、异物位置、外伤严重程度、手术时间、视网膜脱离（RD）与术后BCVA的关系进行分析。结果经玻璃体切除术后BCVA≥0．1者50只眼（78．13％），≥0．5者18只眼（28．13％）。玻璃体切除联合眼内异物取出手术后影响BCVA的因素为伤口长度、术前BCVA、手术时机、RD、眼内炎、tPVR、异物损伤区域。结论后段眼内异物伤宜首选玻璃体切割手术。合并RD、眼内炎和tPVR者应尽早行玻璃体切割手术治疗，但术后视力预后差。

Objective To evaluated the clinical effects and influence factors to the prognosis af- ter extraction of posterior segment located magnetic intraocular foreign bodies by vitrectomy proce- dures. Methods Sixty-four eyes of 64 patients with penetrating ocular injury complicated by posteri- or segment remaining of magnetic intraocular foreign body were evaluated, and those patients were hospitalized from September 2008 to July 2011, in which 64 eyes underwent vitrectomy. The correla- tions between the postoperative best corrected visual acuity and the influence factors, included opera- tion models, preoperative best corrected visual acuity, locations and size of the foreign bodies, tim- ing of operation, traumatic conditions, retinal detachment were analyzed. Results Fifty eyes （78.13%） of 64 patients had a postoperative BCVA more than 0.1, 18 eyes （28.13%） had a postoper- ative BCVA more than 0.5, and statistical analysis showed a significant different （P =0.000） between preoperative and postoperative BCVA in this group. The influence factors to the prognosis were as the following： length of the wound, preoperative visual acuity, operative timing, retinal detachment, endophthalmitis, tPVR and zone of retinal injury. Conclusions Vitrectomy surgery is an effective method for patients with posterior segment located IOFB. Early vitrectomy should be emphasized as early as possible, which complicated with endophthalmitis or with retinal detachment. Even if do so, the postoperative visual outcomes is poor.