25G＋玻璃体切除眼内磁性异物摘出联合手术的效果观察

Observation on the efficacy of 25 G ＋ vitrectomy combined with extraction of intraocular magnetic foreign body

目的观察25G＋玻璃体切除术联合经上方睫状体平坦部切口或角膜缘隧道切口跟内磁性异物摘出的临床效果。方法回顾性分析2015年2月至2017年1月的30例（30只眼）眼球穿孔伤合并眼内磁性异物的临床资料，所有患者均一期行清创缝合联合25G＋玻璃体切除术及经上方睫状体平坦部切口或角膜缘隧道切口眼内磁性异物摘出术。随访4～12个月，对临床资料进行统计分析。结果30只眼均一次摘出异物，22只眼合并晶状体切除，其中19只眼行晶状体完全切除，3只眼保留前囊；24只眼因有视网膜裂孔行硅油填充。术后5只眼眼压〉30mmHg（1mmHg=0．133kPa），降眼压滴眼液滴眼3d恢复正常，无眼内炎、角膜失代偿、眼底再出血或视网膜脱离等并发症发生。术后3～6个月，24例硅油眼二次手术取出硅油，无晶状体眼矫正视力〉0．1者取出硅油的同时行人工晶状体悬吊术，并发白内障者于取出硅油的同时行白内障摘出联合人工晶状体植入术，3只眼玻璃体晶状体切除者术后3个月行二期人工晶状体植入术。末次随访，最佳矫正视力为眼前数指-0．01者7只眼，0．02～0．1者9只眼，0．12～0．3者9只眼，≥0．4者5只眼。4只眼视力下降，视力提高率86．67％。最佳矫正视力优于术前，差异有统计学意义（χ2=9．932，P=0．003）。结论25G＋玻璃体切除联合经上方睫状体平坦部切口或角膜缘隧道切口眼内磁性异物摘出术，微创、快速、安全，手术操作简单，而且并发症少，视力恢复较好。

Objective To observe the clinical efficacy of 25 G ＋ vitrectomy combined with extraction of intraocular magnetic foreign body through the incision of upper pars plana or limbus tunnel incision. Methods Clinical data of 30 eyes of 30 cases with ocular perforating injury and intraocular magnetic foreign bodies from Feb. 2015 to Jan. 2017 were retrospectively analyzed. All cases underwent primary debridement and suturing, 25 G ＋ vitreetomy and extraction of intraocular magnetic foreign body through the incision of upper pars plana or limbus tunnel. Follow-up time was 4-12 months and the clinical data were statistically analyzed. Results Foreign bodies of all cases were extracted successfully at the first time. Lensectomy was performed in 22 eyes. Among them, anterior lens capsule was kept in 3 eyes. Silicone oil tamponade was performed in 24 eyes with retinal tears. The IOP 〉 30 mmHg （ 1 mmHg = 0. 133 kPa） was in 5 eyes and IOP recovered normal after drugs treatment for 3 days. There was no complication such as endoophthalmitis, eorneal decompensation, fundns hemorrhage or retinal detachment. Silicone oil was removed in 24 eyes 3-6 months after surgery. Some aphakic eyes of corrected visual acuity 〉 0.1 reeeived suspensory introcular lens. Some eyes with cataract underwent cataract extraction and intraocular lens implantation. Secondary intraocular lens implantation was performed 3 months after lenseetomy and vitrectomy in 3 eyes. At the end of follow-up time, BCVA was finger counting- 0.01 in 7 eyes, 0.02- 0.1 in 9 eyes, 0.12- 0.3 in 9 eyes and ≥0.4 in 5 eyes. BCVA decreased in 4 eyes. BCVA of improvement rate was 86.67%. The difference in BCVA was statistically significant between before and ＇after surgery （χ2 = 9. 932, P = 0. 003 ）. Conclusion 25（; ＋ vitreetomy combined with extraction of intraocular magnetic foreign body through the upper pars plana incision or limbus tunnel incision is minimally invasive , rapid, simple and safe. Intraoperative and postoperative complications are less and visual acuity improves.