Clinical characteristics and prognostic factors for visual outcome in 669 patients with intraocular foreign bodies

AIM: To describe the clinical characteristics and analyze prognostic factors that influence visual outcome in 669 patients with intraocular foreign bodies(IOFBs).METHODS: Medical records of 669 patients with IOFBs from West China Hospital were reviewed. Best corrected visual acuity(BCVA) values were recorded using standard Snellen acuity chart and were converted to logarithm of the minimum angle of resolution(log MAR) scale for statistical analysis. The visual outcome was defined by the final BCVA(excellent visual outcome: final BCVA of 20/40 or better;poor visual outcome: final BCVA less than 20/200). Statistical analysis of collected data was performed using IBM SPSS Statistics version 23. A 2-tailed P value of less than 0.05 was considered statistically significant throughout the study. RESULTS: The average age ranged from 1 to 79 years old(mean age, 34.8±12.7 SD) and the majority of patients were men(626, 93.6%). The major cause of ocular injury was hammering(383, 57.2%). Almost all the patients(97.8%) underwent surgeries(97.8%) and the average time interval between injury and surgery was 26.4±322.3 d(0-7300), while 327 patients received surgeries within 24 h(48.9%) and 590 patients received surgeries within seven days(88.2%) after IOFBs injury. The poor BCVA was associated with older age(P=0.013), larger IOFBs size(P<0.001), presence of complications(P<0.001) and worse presenting BCVA(P<0.001). On the contrary, younger age(P=0.005), smaller IOFBs size(P<0.001), absence of complications(P<0.001) and better presenting BCVA(P<0.001) were considered to relate to excellent BCVA.CONCLUSION: Multiple prognostic factors may influence the final visual outcome, including age, size of IOFBs, complications and presenting BCVA. Meanwhile, further education and promotion on eye protection should be taken for the improvement on self-protection and selfhealth awareness.

A New Method of 3-Dimensional Localization of Intraocular Foreign Bodies Using CT Imaging:A Role of Optic Nerve

Computed tomography（CT） is considered the most sensitive method for the detection of intraocular foreign bodies（IOFBs）. The purpose of this study was to evaluate a new method of 3-dimentional（3D） localization of IOFBs that takes advantage of the anatomical structure of the optic nerve and to assess the clinical outcomes using this new method. Twenty-two trauma patients with IOFBs or suspected IOFBs admitted to our hospital were scanned with multislice CT（MSCT） between July and December 2003. All scanning was performed with a 16-row spiral CT in axial plane using a sequential scanning protocol. During the scanning, the eyeball of the patient was kept stable and was not allowed to rotate internally or externally. Section collimation was set at 16 mm × 0.75 mm. Table feed was 12 mm. Reconstruction index was 0.75 mm. After scanning, the reconstructed images were loaded into a workstation to create the multiplanar reconstruction images with the aid of the 3D software. We compared the localization results with the operative findings. Multiplanar reconstruction images showed IOFBs in all 22 patients. IOFBs occurred in the eyeball of 14 patients, in the wall of the eyeball of 5 patients and in the posterior orbits of 3 patients. Different surgical procedures were designed according to the localization by this new method and all IOFBs were successfully removed. All of these foreign bodies were metallic and the localization of IOFB using MSCT was consistent with that found by operative findings. It was suggested that MSCT is a simple and effective imaging modality for the localization of IOFBs. In our study, we localized the IOFBs more quickly and accurately by taking advantage of the fixed position of the intraocular segment of the optic nerve, and determined the necessary surgical parameters.

Removal of Intralenticular Magnetic Foreign Bodies with Intraocular Magnet

Purpose: To investigate the possibility of conservation of the lens after removal of intralenticular magnetic foreign bodies with intraocular magnet.Methods: Intralenticular magnetic foreign bodies of 15 patients were removed by using an intraocular magnet. The lens of each injury eye was conserved. Follow-up observation of these cases ranged from one to four years.Results: The intralenticular magnetic foreign bodies of 15 patients were successfully removed.The lens of each injury eye was conserved and the transparence of the lens was properly maintained. Sizes of these foreign bodies were measured, ranging from 0.3 mm to 3mm in diameter. The follow-up observation showed that the corrected visual acuity of 14 cases was not changed after operation.Conclusions: The intraocular magnet is very helpful for removal of magnetic foreign bodies from the transparent lens. This magnet allows removing of the foreign body by the surgeon and no damage to the lens was induced during the operation. Thus, maintenance of visual acuity of most of the patients can be achieved.

Extraction of Posterior Polar Intraocular Foreign Bodies with Sodium Hyaluronate Backsiphon Technique

Purpose: To explore the new technique on the removal of posterior polar intraocular foreign bodies (IOFBs).Methods: Dint of viscoelasticity and cohesiveness of ophthalmic viscoelastics (sodium hyaluronate) was used to wrap, dissociate and suspend IOFBs. Then IOFBs were approached and backsiphoned by using self-made backsiphon syringe needles which were selected according to the size and shape of IOFBs. The IOFBs are removed with the inflow of sodium hyaluronate naturally surging into the needles.Results: Posterior polar IOFBs in 13 cases (13 eyes) were all removed successfully at one time. There were no accidental injuries or complications. The postoperative vision in 11 cases (11 eyes) was improved, unchanged in 1 case (1 eye) and decreased in 1 case ( 1 eye).Conclusions: The technique using viscoelastics to dissociate, suspend and backsiphon IOFBs during the removal of the posterior polar IOFBs can evidently decrease operative difficulty, injury and complications.

A presumed iridocyclitis developed to panophthalmitis caused by a non-metallic intraocular foreign body

Dear Editor,I write to present one case report of a patient suffered the panophthalmitis caused by non-metallic foreign body with no etiologic agent and recovered quickly by phacoemulsification and vitrectomy with silicone oil tamponade.Ocular trauma remains a major cause of blindness, particularly in the working-age population.

Extracting intraocular foreign body at or near the ciliary body with scleral indentation in direct visualization

Dear Editor,I＇m Dr. Qing-Huai Liu from Department of Ophthalmology, the First Affiliated Hospital of Nanjing Medical University,Nanjing, China. I write to present four cases diagnosed with the intraocular foreign body （IOFB） at or near the ciliary body and to evaluate the effect of extracting IOFB with scleral indentation in direct visualization.

Endotamponades in pars plana vitrectomy for metallic intraocular foreign body associated with endophthalmitis

AIM: To study the criterion-reference of endotamponades in pars plana vitrectomy for metallic intraocular foreign body (MIOFD) associated with endophthalmitis. METHODS:Thirty-six patients of MIOFD with endophthalmitis accorded with Exclusion and inclusion criteria were retrospectively analyzed. A detailed analysis of the patients' natural factors, preoperative examinations, intraoperative endotamponades choice, postoperative complications and therapeutic effects was performed. RESULTS: BSS was used in 4 eyes without obvious retinal damage. There was no postoperative complication and their visual acuity (VA) was improved. Sixteen eyes that had mild retinal damage filled with C3F8 gas. The postoperative VA improved in 10 eyes (62.5%), 4 eyes (25.0%) remained unchanged and 2 eyes (12.5%) decreased. Only 2 cases occurred postoperative retinal detachment in gas group. Another 16 eyes with serious retinal damage were treated with silicone oil. Postoperative VA of 9 eyes (56.3%) improved, 3 eyes (18.8%) remained unchanged and 4 eyes (25.0%) decreased. The silicone oil group had higher incidence of postoperative complications, but the incidence of secondary treatment had no significant different between silicone oil and gas group. CONCLUSION: An appropriate choice of endotamponades in vitrectomy surgery for MIOFB with endophthalmitis is important for prognosis.

Removal of intraocular foreign body in anterior chamber angle with prism contact lens and 23-gauge foreign body forceps

AIM：To introduce a novel approach in removal of anterior chamber angle foreign body（ACFB） using a prism contact lens and 23-gauge foreign body forceps.METHODS：Data of 42 eyes of 42 patients who had undergone removal of ACFB using a prism contact lens and 23-gauge foreign body forceps from January 2008 to October 2013 were collected and analyzed. Twenty eyes in group A received the conventional approach by using toothed forceps through corneal limbus incision, and 22 eyes in group B underwent the novel method through the opposite corneal limbus incision. RESULTS：The success rate of ACFB once removal was 75%（15/20） in group A, and 100%（22/22） in group B. The average operation time of group A was significantly longer compared with group B（34.9±9.88 min vs 22.13±8.85min; P〈0.05）. The average size of corneal limbus incision in group A was significantly larger than that of group B（4.85±1.89 mm vs 3.95±1.17 mm; P〈0.05）. The corneal limbus incision suturing were conducted in all eyes in group A, and only 5 eyes in group B. CONCLUSION：Removal of ACFB using a prism contact lens and 23-gauge foreign body forceps is a safer, more effective, and convenient technique compared with the conventional approach.

未发现眼内金属异物的外伤性白内障病例1例报告

外伤性白内障在临床中较常见,通常非金属异物进入眼内,患者无眼内反应,只表现为外伤性白内障,而金属异物进入眼内易引起并发症。异物进入眼内可通过眼科检查发现,或行白内障手术找到异物。然而,临床中极少部分患者会出现漏诊。本文报告1例眼内金属异物消失的外伤性白内障病例(有眼部外伤异物进入眼内病史以及体征,但术前、术中、术后均未发现异物),并分析金属异物消失的原因。

眼球穿通伤并球内异物手术疗效分析

目的探讨眼球穿通伤并球内异物手术治疗效果。方法对2019年1月至2019年9月共9例外伤导致的眼球穿通伤并球内异物的临床资料进行回顾性分析.根据伤口位置、异物性质及滞留部位等分组,根据具体情形选择不同手术方式,通过观察术前术后视力变化情况,评估不同外伤对视力影响情况。结果一期手术均顺利取出异物,二期手术3例行人工晶体悬吊术,1例行硅油取出+人工晶体悬吊术,术后随访3~5个月,随访期末最佳矫正视力手动者2例,0.05者1例,0.1~1.2者6例,相对于术前视力,及时手术的患者,视力明显提升。术前与术后视力比较P<0.05,差异有统计学意义。结论眼球损伤病情比较复杂,需要根据具体问题具体分析才能取得较好的临床效果,预后恢复情况与受伤程度相关。

全球劳动人口眼内异物伤流行趋势分析

目的:探讨1990—2019年全球劳动人口眼内异物伤患病情况及发展趋势。方法:使用2019年全球疾病负担研究(Global Burden of Disease 2019,GBD 2019)数据库。以眼内异物伤年龄标准化患病率为因变量,年份为自变量构建Joinpoint回归模型。采用Joinpoint 5.0.2软件进行模型构建和1990—2019年全球眼内异物伤年龄标准化患病率的平均年度变化百分比的计算,比较全球不同国家或地区劳动人口眼内异物伤年龄标准化患病率的变化趋势。结果:2019年,全球各区域劳动人口眼内异物伤年龄标准化患病率最高为中国(180.4/10万),最低为大洋洲(66.2/10万)。1990—2019年,全球各区域年龄标准化患病率流行趋势不一致,除西欧、中欧、东南亚等5个区域呈现小幅度上升外,其余大部分地区呈不同幅度的下降趋势,其中以中国和东亚的下降幅度最大,平均年度变化百分比分别为-1.43%(95%CI:-1.65%~-1.22%)和-1.42%(95%CI:-1.63%~-1.21%)。全球劳动人口眼内异物伤患病率最高的年龄组为45~49岁;在不同社会人口指数地区,患病率最高的年龄组普遍集中在40~44岁和45~49岁;在不同GBD区域,患病率最高的年龄组各有不同,中国主要集中在60~64岁。结论:1990—2019年全球劳动人口眼内异物伤年龄标准化患病率分布不均,整体呈下降趋势。

Delayed presentation of intracameral graphite foreign body in a child: school trauma

We report a case of large graphite foreign body(FB) in the anterior chamber of eye of a 4-yearold child,incurred during unsupervised play.Despite delayed presentation,the eye had few signs of resolved inflammation which allowed safe extraction of the FB bimanually through limbus.School play,especially in young children,should be under supervision and free of sharp objects.Graphite is inert while inside the eye,and even large pieces can be well tolerated for long time in absence of infection.

40例行PPV取出眼后段眼内异物的疗效分析

目的:分析眼后段眼内异物行玻璃体切除术(pars plana vitrectormy,PPV)取出异物对视力的影响。方法:回顾性分析2015年12月至2017年1月于重庆医科大学附属第一医院眼科入院诊断为眼后段眼内异物共40例40眼,所有眼后段眼内异物均通过23G微创PPV取出。研究统计了年龄、性别、术前/术后最佳矫正视力(best corrected visual acuity,BCVA),眼后段异物性质、大小,眼内异物移除时间,眼内异物进入位置,眼内异物残留位置,手术时机,手术方式和并发症等因素。结果:40例患者异物均被取出,取出率为100%,术后平均BCVA较术前平均BCVA明显增高(t=4.295,P=0.000),具有统计学意义。患者视力的主要影响因素为视网膜脱离(P=0.000)、视网膜裂孔(P=0.001)、眼内异物的大小(P=0.023)、异物取出的时间(P=0.006)、前房积血(P=0.032)、玻璃体积血(P=0.025)等。结论:更大的眼内异物、合并视网膜脱离、视网膜裂孔、前房积血、玻璃体积血、异物取出时间越长,在开放性眼外伤中会引起更严重的后果,视力预后会更差。本研究中,是否行Ⅰ期缝合+玻璃体腔内注药术或者直接行PPV联合眼球清创缝合对视力及解剖学的恢复并无显著影响,但是异物取出的早晚对视力预后有影响,PPV能够更好地取出眼内异物并发现眼内并发症,及时处理,对患者的视力恢复起重要作用。

玻璃体切割术结合巩膜扣带术治疗眼球内异物伴视网膜脱离的临床疗效

目的探讨玻璃体切割术结合巩膜扣带术治疗眼球内异物伴视网膜脱离的临床疗效。方法选取2016年4月至2021年4月建湖建阳眼科医院眼科收治的60例眼球内异物伴视网膜脱离患者作为研究对象,按照随机掷骰子法分为常例组与结合组,每组30例。常例组行单一玻璃体切割术治疗,结合组在常例组基础上联合巩膜扣带术治疗。比较两组最佳视力水平(BCVA)、眼压情况、并发症发生率、术视网膜复位率、脱离复发率及治疗认可度。结果治疗后3、6个月,结合组BCVA(LogMAR)均高于常例组,差异有统计学意义(P<0.05)。治疗后3、6个月,结合组眼压均低于常例组,差异有统计学意义(P<0.05)。治疗6个月后,结合组并发症发生率为6.67%,低于常例组的30.00%,差异有统计学意义(P<0.05)。两组视网膜复位成功率比较差异无统计学意义;结合组脱离复发率为3.33%,低于常例组的26.67%,差异有统计学意义(P<0.05)。结合组治疗认可度为100.00%,高于常例组的80.00%,差异有统计学意义(P<0.05)。结论玻璃体切割术结合巩膜扣带术治疗眼球内异物伴视网膜脱离有利于快速提高患者BCVA,降低并发症发生率及术后脱离复发风险,视网膜复位良好,利于术后恢复,患者对治疗的认可度更高,值得临床推广应用。

20G与23G玻璃体切割手术治疗后段眼内异物的临床评价

【目的】分析20G与23G玻璃体切割手术治疗后段眼内异物的临床疗效,探讨两者有效性及安全性差异。【方法】回顾性病例研究。选取接受不同玻璃体切割手术治疗的后段眼内异物71例71只眼,根据术式不同分为20G玻璃体切割手术组(20G组)及23G玻璃体切割手术组(23G组),前者37例37只眼,后者34例34只眼。对象均予创口缝合,合并外伤性白内障者联合白内障手术,行20G/23G玻璃体切割联合球内异物取出,术中酌情行视网膜激光光凝、冷凝及眼内填充治疗。记录异物取出及视网膜复位情况、手术时间、术后炎症反应及眼部刺激症状、住院时间、最佳矫正视力以及术后并发症等情况,随访至少6个月。【结果】两组眼内异物取出率及初期视网膜复位率均100%;除术后低眼压发生率两组比较差异有统计学意义(P<0.05)外,其余并发症比较差异均无统计学意义(P>0.05)。两组的手术时间、平均住院日、术后炎症反应评分与眼部刺激症状以及两组手术前后的视力分布进行自身比较,差异有统计学意义(P<0.05)。至末次随访,两组各自接受的非计划再次手术例数、视网膜复位情况以及术后视力分布情况比较,差异均无统计学意义(P>0.05)。【结论】20G与23G玻璃体切割手术治疗后段眼内异物均安全有效,两者临床疗效及手术安全性相当;23G组术后低眼压发生率更高,但在缩短手术时间及住院时间、减轻术后炎症反应及眼部刺激症状方面较20G组更有优势。

多平面重建在CT眼内金属异物测量和定位中的应用

目的 探讨 CT多平面重建 (MPR)在眼内金属异物测量和定位中的应用。材料与方法 48枚眼内金属异物 ,在横断面上分别于软组织窗和骨窗下进行异物最大径的测量 ;异物在冠状面上的高度分别采用异物两端所在平面床的位置之差和在冠状面或矢状面重建图像上直接测量。将上述结果分别进行比较 ,并与手术所取出异物的测量值比较。将 MPR和传统的坐标定位图 2种定位结果与手术结果进行比较。结果 骨窗和软组织窗下异物大小的测量值有显著性差异 ,在冠状面或矢状面 MPR图像上直接测量异物的高度和异物两端所在平面床的位置之差有显著性差异 ,骨窗下异物的测量值与标本测量值无显著性差异。MPR在观察异物的形态、测量其大小和定位方面较坐标图准确和直观。结论 对眼内金属异物大小的测量应以骨窗为准 ,并适时进行

玻璃体切割术摘除眼内异物的临床观察

目的:探讨玻璃体切割术治疗眼外伤眼内异物存留的方法、效果和并发症。方法:分析36例眼内异物玻璃体切割术的病例,采用常规睫状体平坦部三切口闭合式玻璃体切割,异物经睫状体平坦部用异物镊夹出。结果:异物取出率100%,术后视力:提高25例,不变4例,下降7例。结论:玻璃体切割术可以准确有效地取出各种异物,而且损伤小,能最大限度地恢复视功能。

眼内异物误诊原因分析及防止措施

目的 探讨如何避免眼内金属异物误诊和漏诊。方法 对 12例 ( 12眼 )眼内金属异物误诊、漏诊原因进行总结分析。结果 12眼被误诊为葡萄膜炎 8眼、白内障 1眼、玻璃体浑浊 3眼。由于延误了治疗 ,导致视力下降。结论 必须提高医生对本病的警惕性 ,全面分析病情 ,借助X线等辅助手段 。

眼球内异物玻璃体手术治疗结果分析

目的 探讨玻璃体手术治疗眼球内异物及其并发症的临床效果。方法 对我院 1999年 1月～ 2 0 0 1年 12月收治的各种眼球内异物 6 2例 6 4眼进行回顾性分析 ,男 5 8例 ,女 4例 ,年龄 8～ 4 6岁 ,平均 2 3岁。除 1例 1眼采用扁平部巩膜切口 ,磁铁吸出异物外 ,其余 6 1例 6 3眼均采用玻璃体切割术。术后视力≥ 0 .0 2作为功能成功的标准 ;术后视力<0 .0 2 ,眼球结构完整 ,作为解剖成功的标准 ,视力≥ 0 .0 5作为脱盲成功的标准。结果 所有眼球内异物均一次手术成功取出。共有 10眼发生眼内炎 ( 15 .6 3% ) ,随访 3～ 36月 (平均 12 .5月 ) ,最终视力 <0 .0 2者 14眼 ,≥ 0 .0 2者 5 0眼 ,≥ 0 .0 5者 36眼 ,≥ 0 .10者 2 5眼 ,≥ 0 .30者 6眼 ,≥ 0 .5 0者 10眼。功能成功率 (VA≥ 0 .0 2 )为 78.79% ,解剖成功率 (VA <0 .0 2 ,眼球结构完整 )为 93.75 % ,总脱盲率 (VA≥ 0 .0 5 )为5 6 .2 5 % .结论 眼内异物的治疗最好采用玻璃体切割术 。

眼球飞弹伤后脉络膜体积和血管形态变化的研究

目的观察和测定兔眼飞弹伤后脉络膜的血管形态、体积变化,为研究飞弹伤后眼球血循环变化提供病理依据。方法利用气钉枪在6kg/cm2始动气压下打击眼球建立兔眼飞弹伤模型,于伤后1、3d和1、2、4周取眼球进行HE染色观察脉络膜病理学改变,并采用生物体视学方法测定脉络膜的体积和脉络膜血管的体积密度、体积。结果伤后1d,脉络膜血管体积与正常眼球相比明显减小,在伤后3d达到最低值,之后逐渐恢复,在伤后4周仅为正常值的55.99%。脉络膜体积在伤后各时间点均较正常值显著减小,各时间点之间无统计学差异。结论飞弹伤后脉络膜受到明显损害,脉络膜血管体积明显减小,可能导致脉络膜循环血量减少,从而影响飞弹伤后视网膜功能的恢复。