眼内镜下的玻璃体切除术中取出睫状体异物

Extraction of intraocular foreign body at or near the ciliary body under endoscopic vitrectomy

目的总结眼内镜下的玻璃体切除手术取出睫状体及其附近异物的可行性和效果。方法回顾性系列病例研究。收集自2002年7月至2010年12月的15例（16只眼）睫状体异物患者的临床资料，所有病例均行内镜下的玻璃体切除术和异物取出术。结果15例（16只眼）睫状体异物患者的异物均顺利取出（共36个异物），其中磁性异物18个，非磁性异物18个。异物大小从不足1．0mm×1．0mm×1．0mm到9．0mm×6．0mm×4．0mm不等。31个异物在睫状体上或其附近，5个异物在其他部位。术前11只眼角膜混浊，术后12只眼的视力较术前提高，其中4只眼从数指及以下提高到0．1～0．3，14只眼的眼压正常，2只眼眼压稍低，12只眼视网膜复位，8只眼角膜较术前清亮。至随访结束时，仅有7只眼视力为数指及以下。结论眼内镜下玻璃体手术中观察睫状体、周边视网膜裂孑L或病变、睫状体异物和其他周边异物以及整个视网膜几乎无盲区，使得睫状体异物取出和睫状突光凝更准确而简便。

Objective To study the feasibility and effectiveness of the extraction of intraocular foreign body （IOFB） at or near the ciliary body by using endoscopic vitrectomy. Methods It was a retrospective case series study. Clinical materials and data of 15 patients （ 16 eyes） with IOFB at or near the ciliary body from July 2002 to December 2010 were analyzed retrospectively. Vitrectomy and IOFB extraction under endoscope were conducted in all cases. Results Thirty six IOFB （ 18 magnetic and 18 nonmagnetic IOFBs） were extracted successfully. The size of IOFB ranged from smaller than 1 mmx 1 mm x 1 mm to 9 mm x6 mm x4 mm. Among them, 31 IOFB were extracted from ciliary body or nearby and 5 IOFB were located at other places. The cornea was opaque before the operation in 11 eyes. Postoperative visual acuity was improved in 12 eyes. Vision was improved from finger-counting and below to 0. 1 - 0. 3 in 4 eyes. Intraocular pressure was normal in 14 eyes. The retina was reattached in 12 eyes. The cornea was clearer than before in 8 eyes. After the end of the fellow-up, vision was remained in finger-counting and below in only 7 eyes. Conclusions There was almost no blind spot by using endoscope to observe the ciliary body, periphery retina tear or other pathological changes, the IOFB at or near ciliary body and the whole retina in the vitrectomy. This makes the extraction of IOFB at or near the ciliary body and the conduct ofcyclophotocoagulation more accurate and simple.