眼铁质沉着症诊治分析

The treatment and analysis of 51 cases of ocular siderosis.

目的 探讨眼铁质沉着症发生的相关因素 ,找出铁沉着症可靠体征。方法 对我院 12年铁沉着症 5 1例进行回顾性分析。结果 ①异物最大长径≤ 2 0mm ,铁沉着症发生率 84 31% ;82 5 0 %位于睫状体锯齿缘附近 ;② 95 2 4%位于眼内下半部 ;③≤ 1 0mm异物 ,96 %是医、患漏诊和疏忽 ;④ 2 1～ 3 0mm异物共 6例 ,5例是医、患疏忽 ,均为巩膜穿孔伤 ;⑤手术前后视力比较差异无显著性 (P >0 0 5 ) ;⑥手术成功率 93 18% ,失败 6 82 % ;⑦ 5 1眼均见晶状体铁质沉着。结论 眼内较小异物动能小 ,穿透力弱 ,易停留在眼内前部 ,因重力下沉于睫状体平坦部 4～ 8点范围 ,该区域隐蔽 ,不充分扩瞳 ,医师易漏诊 ,需作X线摄片 ;小异物入眼损伤小 ,初期视力无影响 ,易被患者疏忽 ;较大异物巩膜穿孔 ,易引起医、患疏忽。

Objective To study the relative factors in the occurrence of ocular siderosis(SID) and find out the reliable sign for earlier clinical diagnosis and treatment. Methods 51 SID eyes are retrospectively analyzed. Results The occurrence rate of SID was 84.31% for foreign body (FB) with maximum length ≤2 mm; 82.50%(33/40) were located in ciliary body and serratus area; 95.24%(40/42) of FB were located in the lower half of the eye; for FB≤1.0 mm, 96%(24/25) were misdiagnosed and neglected by doctors and patients; in 6 eyes with FB 2.1～3.0 mm,83.34%(5/6) had penetrating wound in sclera but were missed by doctors and patients;No statistical difference was found in vision before and after surgery( P >0 05);rate of successful surgery was 93.18%(41/44), for failed sugery was 6.82%(3/44);lens SID were observed in all 51 eyes. Conclusions Smaller FB, owing to its lower kinetic energy, weak penetration power, is liable to lodge in the inner front half of the eye ball, and sink down to the pars plana of ciliary body or 4～8 o'clock position of serratus area by gravitational force. These area are quite concealed and easily missed without full dilatation of the pupil, so a routine x ray examination is mandatory; smaller FB into the eye which causes less injury to the ocular tissue and no obvious damage to visual acuity in the early stage, is not easily noticed by the patient; scleral penetration with larger FB is liable to be missed by medical staff and patient too. Wreathlike SID patches in the subcapsular epithelium is a diagnostic sign for SID.