眼内铁质异物漏诊致眼铁质沉着症特点及治疗

Characteristic and treatment of ocular siderosis due to missed diagnosis of intraocular iron foreign body

目的分析以眼铁质沉着症就诊的眼内铁质异物漏诊患者临床特点及治疗效果。方法2010年1月至2014年12月在我院接受眼内异物摘出手术者32例（32眼）。其中2例为眼内铁质异物漏诊后因眼铁质沉着症而就诊者。此2例均为男性，眼内异物存留时间分别为8个月和10年，均接受玻璃体切除联合眼内异物摘出手术。术后观察均超过6个月。结果2例眼铁质沉着症患者患病后视力均不同程度下降，眼部反复出现慢性葡萄膜炎症反应。眼内异物均位于睫状体平坦部。眼内异物均一次手术成功摘出。术后视力均有提高，例1术前视力0．4，术后视力0．8；例2术前视力光感，末次随访视力0．2。随访期间葡萄膜炎均未复发。结论对于开放性眼外伤患者应详细检查，并排除眼内异物的可能。玻璃体切除联合眼内异物摘出术是治疗伴眼铁质沉着症的眼内异物的有效方法。

Objective To analyse the clinical characteristics and efficacy of treament of ocular siderosis due to missed diagnosis of iron intraocular foreign body. Methods There were 32 eyes of 32 patients who underwent surgery of intraocular foreign body extraction from January 2010 to December 2014 in our department. Two male patients among them presented ocular siderosis. The duration time of intraocular foreign body was 8 months and 10 years separately. The foreign bodies were extracted through vitrectomy. The follow-up period was beyond 6 months. Results Visual impairment and recurrent chronic uveitis occurred in patients with ocular siderosis. The intraocular foreign bodies lying on pars plana were extracted successfully in both two patients. Postoperative visual acuities were improved in both eyes. The best visual acuity was from preoperative 0.4 to postoperative 0.8 in one patient and from preoperative light perception to postoperative 0.2 in the other patient. No serious recurrent uveitis was observed during follow-up period. Conclusion The examinations on open-globe trauma should be performed comprehensively and carefully to avoid missing intraocular foreign body. Extraction of intraocular foreign body with vitrectomy is an effective and safe approach for the treatment of ocular siderosis.