眼内异物及其并发症的手术治疗

Surgical treatment of intraocular foreign body and its complications.

目的 探讨玻璃体切除眼内异物摘出联合手术的优缺点及手术时机。方法 对联合手术 495例 ( 5 0 9眼 )进行回顾性研究。术式包括晶状体切除、玻璃体切除、视网膜脱离复位、眼内异物摘出、人工晶状体植入及 /或角膜移植等三联、四联或五联手术。统计手术前后视力以及预后与手术时间的关系。结果 摘出手术成功率为 98 0 4%。术后视力增进者 2 33眼占48 1% ,视力不变者 161眼占 33 3% ,下降者 90眼占 18 6%。受伤后 3天内手术者 3眼术后视力增进 2眼占 66 7% ,受伤后 15～60天手术者 381眼视力增进 184眼占 48 3% ,6月后手术者 35眼视力增进 11眼占 31 4%。结论 联合手术可免除多次手术的痛苦 ,早日恢复视力和双眼单视功能 ,并可同时治疗眼内异物的并发病。使约 1/3伤眼脱盲 ,约 1/4伤眼恢复 0 3以上视力。早日手术预后较好。机化物严密包裹和嵌顿于眼球壁的异物应采取后径摘出术。

Objective To investigate the advantage,shortage,optional time of the combined surgery of vitrectomy and intraocular forein body (IOFB) extraction.Methods 495 cases (509 eyes) who received combined surgery because of IOFB were retrospectively studied.The types of surgery include lensectomy,vitrectomy,retinal detachment surgery,IOFB extraction,intraocular lens implantation,corneal transplantation and so on.Two to five types of the surgery were combined according to different conditions,the relationship between the preoperative vision,postoperative vision and the optional time of operation were analysed.Results The extractive rate of the IOFBs was 98.04%.After operation,vision 233 eyes (48.1%) was increases,161 (33.3%) remained unchanged and 90(18.6%) decreases.In the 381 eyes that received surgery between 15～60 days after injury,184(48.3%) of it got vision increased,in the 35 eyes that received surgery delayed to 6 months,only 11 eyes (31.4%) got vision increased. Conclusions Combined surgery can reduce the pains induced by many times of surgery,get visual rehabilitation and binocular vision in the early time,and treat the complications of IOFBs at the same time.After surgery,about 1/3 of the patients get out of blindness,and 1/4 patients get 0.3 or better vision.Early surgery has a better result.For the IOFBs enclosed or incarcerated in the ocular wall,it should be extracted through the posterior way.