两种手术方式取出眼后段磁性异物的对比研究

Effects comparison of two different procedures in extraction of magnetic intraocular foreign bodies located in posterior segment

目的评价经玻璃体切割手术和经巩膜切口磁取术取出眼后段磁性异物的临床疗效。方法回顾性分析2006年6月至2011年6月因眼后段磁性异物伤住院治疗的患者126例126眼,其中经玻璃体切割手术取出异物者72眼(A组),经巩膜切口磁吸取出异物者54眼(B组)。分别对两种手术方式异物取出率、术后并发症等进行比较。结果 A组72眼(100%)均一次性经玻璃体切割手术取出眼内异物,B组54眼中47眼(87.03%)经巩膜切口磁吸取出异物。两组病例手术前视力分布及外伤程度差异均无统计学意义。A组患者术后视力≥0.10者54眼(75.00%),≥0.50者20眼(27.78%),A组手术前后视力差异有统计学意义(P=0.000)。B组术后视力≥0.10者5眼(9.26%),≥0.50者2眼(3.70%),B组手术前后视力差异无统计学意义(P=0.552)。两组患者手术后视力差异有统计学意义(Z=-6.453,P=0.000)。A组术后并发症发生率小于B组,但差异无统计学意义(P=0.189)。结论眼后段磁性异物伤,经玻璃体切割手术治疗较经巩膜路径磁吸取出异物的取出率高、术后视力恢复好、并发症少。对伴有眼内炎和视网膜脱离的眼后段磁性异物伤患者,应首选玻璃体切割手术治疗。

Objective To evaluate the clinical effects of vitrectomy and non-vit- rectomy procedures in extraction of posterior segment located magnetic intraocuiar for- eign bodies. Methods A total of 125 eyes of 125 inpatients with penetrating ocular in- jury complicated by posterior segment remaining of magnetic intraocular foreign body from July 2005 to July 2011 were retrospectively analyzed, in which 72 eyes underwent vitrectomy and extraction of the intraocular foreign body（group A） ,54 eyes underwent extraction of intraocular foreign body by trans-scleral way（group B）. The foreign body extraction rate and postoperative complication were compared between two operation models. Results The foreign body extraction rate in group A and B were 100% （72 eyes） and 87.0396 （47 eyes） ,respectively. There was no statistical difference in preop- erative visual acuity and injury degree between two groups. The postoperative visual a- cuity in group A was equal to or more than 0.10 in 54 eyes（75.00% ） ,equal to or more than 0.50 in 20 eyes（ 27.78% ） ,there was significant difference compared with pre-op- eration（P =0.000）. In group B, postoperative visual acuity was equal to or more than 0. l0 in 5 eyes（9.26% ） ,equal to or more than 0.50 in 2 eyes（3.70% ） ,there was no statistical difference compared with pre-operation（P = 0. 552 ）. Further more ,there was significant difference in postoperative visual acuity between two groups （ Z = - 6.453, P =0.000）. The incidence of complications in group A was less than that in group B,but there was no statistical difference（P = 0.189）. Conclusion Vitrectomy is more favor- able than non-vitrectomy in the extraction rate of posterior segment located intraocular foreign bodies with better visual acuity recovery and few complications. The patients with endophthalmitis and retinal detachment should be preferred surgical treatment.