后入路玻璃体切割术治疗眼球贯通伤伴球内异物

Posterior approach vitrectomy treating penetrating ocular trauma with intraocular foreign body

目的:探索早期后入路玻璃体切割术治疗眼球贯通伤伴球内异物的有效性。方法:近2a来我院急诊收治的10例10眼眼球贯通伤伴球内异物患者,急诊行玻璃体切割+眼内异物取出+硅油填充术,术后给予积极预防感染、消炎处理,根据伤道周围视网膜生长情况补充视网膜光凝。结果:患者1眼因化脓性眼内炎、术中视网膜脉络膜损毁严重视网膜未能复位,最终眼球萎缩,患者9眼成功施行玻璃体切割手术,取出异物,随诊时间3~18mo,其中2例患者因复发性视网膜脱离行二次玻切硅油置换手术,其余患者视网膜复位良好,无再出血,眼压维持8~21mmHg;最后一次随访时患者3眼最佳矫正视力>0.1,2眼矫正视力0.01~0.1,患者4眼因后极部脉络膜视网膜损伤严重矫正视力光感~指数/50cm,眼球萎缩患者视力无光感。结论:早期后入路玻璃体切割、异物取出联合硅油填充术为一种有效地治疗眼球贯通伤伴球内异物的手术治疗方法。

AIM： To explore the effect of early posterior approach vitrectomy in the treatment of penetrating ocular trauma with intraocular foreign body. METHODS： Totally 10 cases of penetrating ocular trauma with intraocular foreign bodies（IOFB） in the past two years were included. Emergency vitrectomy, intraocular foreign body removal and silicone oil tamponade were performed by the same surgeon. Antibiotics and steroids were given after surgeries. Retinal photocoagulation was done according to fundus conditions after surgeries. RESULTS： One patient combined with preoperation endophthalmitis and severely damaged retina failed to recover, eventually came to phthisis bulbi. Vitrectomy and IOFB removal were all successfully performed in the other patients. The postoperation follow-up time was 3- 18mo. Two of the patients received secondary vitrectomy and silicone replacement surgeries due to recurrent retinal detachment. The remaining patients had no further bleeding with intraoclar pressure（lOP） 8-21mmHg. At the last follow-up, three of them gained best corrected visual acuity better than 0.1, two patients had visual acuity of 0.01 to 0.1 and four patients had poor visual acuity of light perception to FC/50cm because of macular damage. The patient with phthisis bulbi had no light perception. CONCLUSION： Early vitrectomy, foreign body removal and silicone oil tamponade is an effective treatment for patients with penetrating eyeball injury with IOFB.