眼球穿孔伤并眼内小异物眼前后段联合手术

Combined anterior and posterior segment surgery in the treatment of penetrating eye injuries with small intraocular foreign body

目的探讨眼球穿孔伤并眼内小异物早期行眼前后段联合手术治疗的临床效果。方法22例（22眼）眼球穿孔伤并眼内小异物，清创缝合术后2—4d行前后段联合手术，根据病情，选择不同术式。前段手术：前房成形、虹膜裂伤缝合、白内障摘出、人工晶状体植入；后段手术：玻璃体切除术、异物摘出、视网膜损伤部位周围激光光凝、玻璃体腔C3F8气体或硅油填充。术后随访3—12个月。其中硅油填充眼于术后4～5个月取出硅油，观察手术效果及并发症。结果所有患者均一次手术摘出了眼内异物，一期植入人工晶状体，未发生感染性眼内炎、人工晶状体移位、葡萄膜炎、视网膜脱离、脉络膜脱离或继发性青光眼等并发症。手术前最佳矫正视力为光感～0．1，术后随访最佳矫正视力为0．05～0．8，全组22眼视力均有不同程度提高。结论眼球穿孔伤并眼内小异物早期行眼前后段联合手术治疗可取得良好的临床效果。

Objective To investigate the clinical efficacy of combined anterior and posterior segment surgery in early treatment of penetrating eye injuries with small intraocular foreign body. Methods Twenty-two eyes of 22 patients suffered penetrating eye injuries with small intraocular foreign bodies underwent the combined operations of anterior and posterior eye segment 2-4 days after emergent debridement and suturing and according to their conditions different surgical procedures were preformed. Anterior segment surgery included anterior chamber forming, iris suture laceration, cataract extraction and intraocular lens implantation and posterior segment surgery included vitrectomy, foreign body removal, retinal laser photocoagulation around the injury site and C3 Fs gas or silicone oil tamponade. The surgery efficacy and the complications were analyzed from 3months to 12 months. Silicone oil was removed 4-Smonth after operation. Results Intraocular foreign bodies were removed in once operation in all cases. All the patients got the intraocular lens implantation at the same time during the surgery. No serious complication happened, such as endophthalmitis, intraocular lens shift, uveitis, retinal detachment, choroidal detachment or secondary glaucoma. All the cases got the best corrected visual acuity improved from light perception -0.1 before operation to 0.05-0.8. Conclusion Combined anterior and posterior segment surgery in early treatment of penetrating eye injury with small intraocular foreign body can achieve good clinical efficacy.