显微枪形麦粒钳在巨大非磁性眼内异物取出术中的应用

Extraction of giant nonmagnetic intraocular foreign body with microscopy gun-shaped kernels clamp

目的探讨玻璃体切除术中应用显微枪形麦粒钳取出巨大非磁性眼内异物临床疗效。方法对22例（22只眼）巨大非磁性眼内异物患者进行回顾性研究，排除无晶状体损伤眼，完成晶状体、玻璃体切除，暴露异物后玻璃体腔注入重水，麦粒钳经扩大的巩膜穿刺口进入玻璃体腔，钳夹异物递送至前房，前房内注入黏弹剂，有齿镊接力将异物自角巩膜缘隧道切口取出。行眼内激光，选择惰性气体或硅油填充。术后随访3-12个月（平均6个月），根据眼内情况行二期手术。结果22例22只眼巨大非磁性眼内异物（玻璃异物14只眼，塑料4只眼，石块3只眼，木块1只眼）均一次性取出，未发生因取异物造成眼部二次损伤。19只眼行硅油填充，3只眼行气体填充。3个月后12只眼行人工晶状体植入术，5只眼因矫正视力不佳仅行硅油取出术，5只眼发生复发性视网膜脱离（其中3只眼行再次手术后视网膜复位，2眼硅油依赖（瘢痕增生重，视网膜脱离不易修复，讲明情况后患者选择暂不取油）。随访期间2只眼（9．1％）矫正视力≥0．3（1只眼视力0．6，1只眼视力0．4），5只眼（22．7％）视力0．12～0．25，7只眼（31．8％）视力0．06—0．1，8只眼（36．4％）视力≤0．05。结论显微枪形麦粒钳在巨大非磁性眼内异物取出术中钳夹异物牢靠，有利于异物的一次性取出，避免异物的二次损伤，术后并发症少，值得在临床推广应用。

Objective To evaluate the effect of extraction of giant nonmagnetic intraocular foreign body （IOFB） with microscopy gun-shaped kernels clamp. Methods Twenty two cases （22 eyes） with giant nonmagnetic intraocular foreign body were studied for retrospective analysis. The eyes without traumatic cataract were excluded. Firstly lentectomy and vitrectomy were done, infused the perfluorocarbon liquid after the IOFB was exposed. The IOFB was transferred into anterior cham- ber by kernels clamp, and then the IOFB was extracted through limbus incision. The photocoagula- tion was performed, and C3F8 gas or silicon oil was used for internal tam-~ponade. The postopera- tive follow up periods ranged from 3 to 12 months （mean=6 months）. Results All giant nonmagnet- ic intraocular foreign bodies were removed successfully in 22 cases （22 eyes）, none of patients oc- curred intraoperative complications. Silicone oil for internal tam-~ponade was used in 19 eyes and C3F8 gas in 3 eyes. Three months after operation, the extraction of silicon oil was performed only in 5 eyes because of the less corrected visual acuity; the intraocular lens implantation was per- formed in 12 eyes. Retinal detachment occurred in 5 eyes （Retinal reattached after second vitreous surgery in 3 eyes, silicone oil dependency in 2 eyes）. The corrected visual acuity was greater than 0.3 ≥0,3） in 2 eyes （9.1%）, greater than 0.12 （0.12-0.25） in 5 eyes （22.7%）, greater than 0.06 （0.06-0.1） in 7 eyes, the rest （8 eyes, 39.4%） had visual acuity of less than 0.05 （≤0.05）. Conclusions The extraction of giant nonmagnetic intraocular foreign body with microscopy gun-shaped ker nels clamp is a safe and effective choice which is helpful to reduce serious complications.