经巩膜隧道切口一步法眼后段异物摘出术联合白内障摘出术的疗效观察

Observation on the efficacy of one-step extraction of posterior segment intraocular foreign body combined with cataract extraction via scleral tunnel incision

目的评估经巩膜隧道切口行外伤性白内障摘出联合眼后段异物摘出及25G玻璃体切除术的效果。方法回顾性病例系列研究。收集长沙爱尔眼科医院2021年1月至2022年12月30例(30眼)眼球穿孔伤伴有外伤性白内障及眼后段异物的临床资料,所有患者均行白内障摘出、25G玻璃体切除术及眼后段异物摘出术。以磁力棒或眼内异物镊从12点位巩膜隧道切口经前房伸入玻璃体直接一步法吸出或夹出眼后段异物,部分患者联合人工晶状体植入术。随访6~12个月,观察手术效果及并发症情况。结果本研究手术成功率100.0%。最终视力提高25眼(83.3%),视力不变4眼(13.3%),视力下降1眼(3.3%)。所有患者无巩膜穿刺孔相关并发症和暴发性脉络膜上腔出血发生。结论经巩膜隧道切口行外伤性白内障摘出、一步法眼后段异物摘出及25G玻璃体切除术治疗眼后段异物伴发外伤性白内障效果良好。

Objective To evaluate the efficacy of traumatic cataract extraction,25-gauge pars plana vitrectomy(PPV)and posterior segment intraocular foreign body(IOFB)removal via scleral tunnel incision.Methods In this retrospective case series study,30 eyes of 30 patients with penetrating corneal injury combined with traumatic cataract and large posterior segment IOFB from Jan.2021 to Dec.2022 in the Changsha Aier Eye Hospital were enrolled.After traumatic cataract extraction and 25-gauge PPV treatment,intravitreal foreign body tweezers were used to extend the anterior chamber into the vitreous cavity from the 12-point scleral tunnel incision,and the posterior segment foreign body was directly clamped with magnetic rod or foreign body forceps.Some patients were implanted with intraocular lenses.All cases were followed up for 6-12 months to observe the surgical efficacy and complications.Results The surgical success rate was 100.0%in this study.The final visual acuity improved in 25 eyes(83.3%),remained unchanged in 4 eyes(13.3%),and decreased in 1 eye(3.3%).No complications occurred.There were no realted complications in the scleral puncture hole fulminant suprachoroidal hemorrhage.Conclusion Traumatic cataract extraction followed with 25-gauge PPV and one-step removal of the posterior segment IOFB via a scleral tunnel incision in the treatment of the posterior segment IOFBs combined with traumatic cataract is effective.