曲安奈德辅助玻璃体切割术治疗儿童眼内异物伤的临床研究

Vitrectomy Assisted by Triamcinolone Acetonide for Intraocular Foreign Body Injury in Childhood

目的:观察和评价曲安奈德辅助玻璃体切割术治疗儿童眼内异物伤的临床效果,以指导临床治疗。方法:将2012年1月-2016年10月在本院行玻璃体切割术的80例(83眼)儿童眼内异物伤患者,根据术中是否应用曲安奈德分为两组:A组40例(42眼)行眼内异物取出联合玻璃体切割、曲安奈德注射、眼内光凝、硅油填充术;B组40例(41眼)行眼内异物取出联合玻璃体切割、眼内光凝、硅油填充术,术后随访均≥3个月。结果:80例眼内异物伤患儿均一次手术摘除异物,出院时视网膜均恢复。除2例(3眼)患者视力检查不合作外,术后视力提高53例(56眼),其中A组31例(33眼),占78.57%,B组22例(23眼),占56.10%,两组比较差异有统计学意义(字2=4.774,P=0.029)。41例(42眼)术后矫正视力>0.05,其中A组25例(26眼),占61.90%,B组16例(16眼),占39.02%,两组比较差异有统计学意义(字2=4.345,P=0.037)。13例(13眼)患者术后出现视网膜脱离,其中A组2例(2眼),发生率为4.76%,B组11例(11眼),发生率为26.83%,两组比较差异有统计学意义(字2=7.648,P=0.006)。结论:玻璃体切割手术中辅助应用曲安奈德可明显改善儿童眼内异物伤患者的视力预后,并可有效预防视网膜脱离等术后严重并发症的发生,值得临床推广。

Objective： To observe and valuate the clinical application efficacy of pars plana vitrectomy （ PPV ） assisted by Triamcinolone Acetonide （ TA ） for intraoeuiar foreign body injury in childhood, in order to guide clinical treatment.Method： 80 cases （ 83 eyes ） intraocular foreign body injury in child who received PPV in our hospital from Jan 2012 to Oct 2016 were divided into two groups according to whether TA was used during PPV.40 cases （ 42 eyes ） of group A were treated by intraocular foreign bodies extraction combined with vitrectomy, injecting TA into the vitreous cavity, intraocular photocoagulation and filling with silicone oil.40 cases （ 41 eyes ） of group B were treated by intraocular foreign bodies extraction combined with vitrectomy, intraocular photocoagulation and filling with silicone oil.All the patients were followed-up more than three months after the surgery of intraocular foreign bodies extraction.Result： All intraocular foreign bodies were extracted successfully once.The retina were reset in all cases when they were out of hospital.Except of 2 cases （ 3 eyes ） who did not cooperate in examination of visual acuity, the visual acuities increased in 53 cases （ 56 eyes ）, 31 cases （ 33 eyes ） （ 78.57% ） in group A, and 22 cases （ 23 eyes ）（ 56.10% ） in group B.The differences were statistically significant between the two groups （ x^2=4.774, P=0.029 ） .There were 41 cases （ 42 eyes ） out of blindness （ corrected visual acuity〉0.05 ）, 25 cases （ 26 eyes, 61.90% ） in group A and 16 cases （ 16 eyes, 39.02% ） in group B .The differences were statistically significant between the two groups （x^2=4.345, P=0.037 ） .There were 13 cases （ 13 eyes ）who encounter retinal detachment after PPV, the group A had 2 caces （ 2 eyes ）, the rate was 4.76%; the group B had 11 cases （ 1 l eyes ）, the rate was 26.83%.The differences were statistically significant between the two groups （ x^2=7.648, P=0.006 ） .Conclusion： The assistant application of TA in PPV for intraocular foreign body injury in childhood can significantly improve the visual prognosis of the patients, and it can also prevent the serious complication after PPV for intraocular foreign body injury, such as secondary retinal detachment.The application of TA in PPV for intraocular foreign body injury in childhood is vaulable to promote its application in clinic.