Clinical Application of X-ray,B-scan,and CT in the Diagnosis of Ocular Foreign Bodies

Purpose:To analyze the sensitivity and specificity of X-ray, B-ultrasound, and CT scan in diagnosing ocular foreign bodies, and to compare the accuracy of these three imaging tools in locating these foreign bodies. Methods:A retrospective review was conducted of radio graphic and clinical eye examination data from 62 patients (66 eyes),suspected of having ocular foreign bodies at time of first presentation to the Zhongshan Ophthalmic Center (Guangzhou, China) between August 2007 and October 2011. The sensitivity and specificity of X-ray, B-ultrasound and CT scan in the diagnosis of ocular foreign bodies were investigated and their accuracy in locating these foreign bodies was compared. Results: A total of 75.8% (n=47) subjects had ocular foreign bodies; 66% of these were metallic. Patients with intraocular, eye wall,and extraocular foreign bodies accounted for 46, 28, and 26% of the total, respectively. The sensitivities of X-ray,CT scan,and B-ultrasound in the diagnosis of ocular foreign bodies were 58.3%, 61.7%, and 75%, the specificityies were 63.3%, 100%, and 87.5%, and the accuracy in locating foreign bodies was 73.4%, 94.7%, and 86.5%, respectively. The properties of foreign bodies affected the diagnosistic accuracy of X-ray,but exerted little impact upon B-ultrasound and CT scan. Conclusion:A fairly high incidence of ocular foreign bodies was noted in patients suspected with ocular foreign bodies at their first presentations.X-ray combined with CT scan or X-ray in combination with B-ultrasound showed a relatively high sensitivity and specificity in diagnosing ocular foreign bodies. CT scan had the highest accuracy in locating ocular foreignbodies. (Eye Science 2013; 28:11-14)

Reliability of the ocular trauma score for the predictability of traumatic and post-traumatic retinal detachment after open globe injury

AIM: To elucidate the question of whether the ocular trauma score(OTS) and the zones of injury could be used as a predictive model of traumatic and post traumatic retinal detachment(RD) in patients with open globe injury(OGI).METHODS: A retrospective observational chart analysis of OGI patients was performed. The collected variables consisted of age, date, gender, time of injury, time until repair, mechanism of injury, zone of injury, injury associated vitreous hemorrhage, trauma associated RD, post traumatic RD, aphakia at injury, periocular trauma and OTS in cases of OGI. RESULTS: Totally 102 patients with traumatic OGI with a minimum of 12 mo follow-up and a median age at of 48.6 y(range: 3-104 y) were identified. Final best corrected visual acuity(BCVA) was independent from the time of repair, yet a statistically significant difference was present between the final BCVA and the zone of injury. Severe trauma presenting with an OTS score Ⅰ(P<0.0001) or Ⅱ(P<0.0001) revealed a significantly worse BCVA at last follow up when compared to the cohort with an OTS score >Ⅲ. OGI associated RD was observed in 36/102 patients(35.3%), whereas post traumatic RD(defined as RD following 14 d after OGI) occurred in 37 patients(36.3%). OGI associated RD did not correlate with the OTS and the zone of injury(P=0.193), yet post traumatic RD correlated significantly with zone Ⅲ injuries(P=0.013). CONCLUSION: The study shows a significant association between lower OTS score and zone Ⅲ injury with lower final BCVA and a higher number of surgeries, but only zone Ⅲ could be significantly associated with a higher rate of RD.

Disappeared intralenticular foreign body:A case report

BACKGROUND Intralenticular foreign body is rarely encountered in ophthalmic practice.In most cases,subsequent traumatic cataract requires cataract surgery for visual rehabilitation.CASE SUMMARY A 35-year-old man was injured by iron filings in his left eye.After the injury,the patient tried to draw the object out by himself using a magnet;however,the foreign body(FB)was pushed to the equator of the lens.The FB was removed by a magnet through the anterior chamber accessed through the original capsular wound.Since most of the lens was transparent and only partially opaque after the operation,the lens was kept under close observation.After the surgery,the patient’s visual acuity reached 20/20 from 2/20,visual function recovered very well,and local opacity of the lens remained stable.CONCLUSION For intralenticular FB in the anterior cortex under the capsule,magnet may be a more advantageous way to remove the object.

Ocular Siderosis

Ocular siderosis refers to intraocular iron deposition in ocular tissues caused by the long-time retention of penetrating iron-containing foreign bodies, commonly leading to a series of characteristic alterations and severe disorder of visual function. Ocular siderosis, rarely seen in the clinic, can cause irreversible retinal injuries and visual function damage and can even affect the appearance of the eyeballs.These effects significantly decrease the quality of life of patients and lead to poor prognosis.This study summarizes ocular siderosis with respect to pathogenesis,clinical manifestations,diagnosis, treatment, and sequelae,with the aim of assisting clinicians in the diagnosis and treatment of ocular siderosis.

Vitreoretinal surgery combined with C-arm fluoroscopic-guided removal of intraorbital foreign body following ocular perforating injury

Perforating ocular trauma with retained intraorbital foreign body （IOrFB） is a severe injury with a poor prognosis. The injury involves the posterior segment of the eye, and foreign bodies are mostly lodged posterior to the globe. Vitreoretinal surgery and IOrFB removal are always performed separately in patients with ocular perforating injury and IOrFBs. Obviously, separate procedures increase the cost and patient discomfort, lntraoperative fluoroscopy,

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。

25G微创玻璃体切割术治疗球内异物的临床观察

目的探讨25G微创玻璃体切割术治疗眼后段球内异物的临床疗效。方法回顾性分析眼后段球内异物并接受25G微创玻璃体切割术联合球内异物取出术的21例21眼患者临床资料,其中17例17眼为磁性异物,4例4眼为非磁性异物。20例(20眼)并发白内障,3例3眼伴眼内炎,12例12眼伴视网膜脱离。根据不同的病情分别联合了白内障摘出、视网膜复位、硅油填充等操作,术后随访6个月,对其并发症和手术效果进行分析。结果所有患眼均于完善术前检查后尽快行25G微创玻璃体切割手术联合球内异物取出术,Ⅰ期球内异物取出率为100%,眼内炎3眼炎症均得到控制,术中摘出混浊的晶状体,20例20眼球内异物由角膜切口取出,1例由巩膜切口取出。共19眼术后矫正视力较术前视力有所提高,14眼进行了II期人工晶状体植入,2眼硅油存留。术后未见与微创手术相关的并发症。结论 25G微创玻璃体切割术在眼后段球内异物取出术中显示出良好的临床效果,手术创伤小,视功能恢复快,并发症少,但要注意其适应证的选择。

眼外伤致眶蜂窝组织炎

目的 探讨眼外伤致眶蜂窝组织炎的临床特点及治疗方法。方法 总结 7例眼外伤致眶蜂窝组织炎 ,其中 3例取出眶内异物、3例取出球内异物、1例眼球贯通伤 ;均配合足量敏感抗生素治疗。结果 6例炎症控制、1例瘘管形成。病例中 5例视功能丧失。 5例眼球运动恢复正常。 5例脓性分泌物细菌培养 3例阳性。结论 眼外伤所致眶蜂窝组织炎预后差 ;及时取出球内或眶内异物、足量敏感抗生素的使用是治疗眼外伤所致眶蜂窝组织炎及预防并发症的关键。

球内异物74例手术疗效分析

目的:分析不同的手术方法治疗眼球开放性外伤后球内异物的手术效果。方法:对74例(均为单眼受伤)开放性眼外伤合并球内异物的临床资料进行回顾性分析。结果:手术取出异物后保住眼球71眼(96%),未保住眼球3眼(4%)。成功的71例,均完整取出异物。其中42例并发外伤性白内障(42/74,57%),18例并发玻璃体积血(18/74,24%),2例并发视网膜脱离(2/74,3%),9例继发性青光眼(9/74,12%)。其中44眼行巩膜外路电磁铁吸出异物,30眼采用玻璃体切除术取出异物。失败3例(3/74,4%)皆未完整取出异物,术后合并真菌性眼内炎而行眼球摘除术。结论:对于合并有晶状体、玻璃体混浊的眼内异物、后极部异物需行玻璃体切除术,赤道前、定位准确的磁性异物,以巩膜外路磁吸术为宜。而最终能否保住眼球和手术是否完整取出异物有一定关联。

中山市黄圃镇与职业相关角膜异物的危险因素分析

目的:采用病例对照对发生角膜异物的相关危险因素进行分析,并探讨预防的方式。方法:采用病例对照研究,选取我院门、急诊确诊的角膜异物病例123例作为病例组,246例非眼外伤病患,既往无眼外伤史的普通患者对照组,按年龄、性别及类似工作进行1∶2配对,其中年龄差异不超过5岁。调查为问卷调查。结果:外来务工人员比本地工更易发生角膜异物(OR4.73);临时工较固定工人发生角膜异物的几率大(OR9.60);金属加工行业有关的工人较非金属加工行业更易发生角膜异物(OR10.50);高中以下的教育程度在调查中显示较高中以上者易发生角膜异物(OR4.60);工作中不配戴防护镜是发生角膜异物的主要影响因素,调查显示病例组中配戴防护镜的比例明显偏低于对照组(OR7.30)。结论:在多元回归模型中显示临时工、外来务工与金属加工相关工种及不配戴防护镜是发生角膜异物的危险因素。

曲安奈德辅助玻璃体切除取出眼内异物的疗效观察

目的观察和分析曲安奈德辅助玻璃体切除取出眼内异物的临床疗效。方法选择伴有视网膜损伤且行玻璃体手术的眼内异物伤患者23例(23只眼),玻璃体切除手术中辅助应用曲安奈德染色玻璃体。结合高负压人工玻璃体后脱离法,尽可能切除全玻璃体,同时处理损伤的视网膜,必要时眼内填充C3F8或硅油。结果所有患者异物均一次性取出,15例成功实施玻璃体后脱离,术后视网膜脱离3例。结论玻璃体切除治疗眼内异物伤,术中辅助应用曲安奈德染色,有利于充分切除玻璃体,降低术后视网膜脱离的发生率。

玻璃体手术联合人工晶体植入治疗经选择的复杂眼外伤103例

目的:观察累及眼球前后节的复杂外伤患者施行玻璃体手术联合人工晶体植入术的视力效果。方法:对103例(104只眼)复杂眼外伤经一次玻璃体手术联合人工晶体植入的病例进行回顾性研究。结果:本组眼内异物35例,眼球穿通伤37例,无眼内异物的爆炸伤9例(10只眼),眼球钝挫伤22例。除3例儿童视力不能检查外,在100例101只眼中,手术前视力为无光感～指数的88只眼(87.1％);手术后94只眼(93.1％)视力提高,其中74只眼(73.3％)为0.1～1.5。随访中1只眼发生视网膜脱离,经玻璃体手术复位。结论:玻璃体手术联合人工晶体植入对经过选择的复杂眼外伤患者,是一种安全、快速和有效的重建视力的方法。眼科学报2000;16:109-111。

球内异物的性质与外伤性眼内炎的关系

目的探讨各种性质球内异物与外伤性眼内炎的关系。方法回顾分析2002年至2012年10年间唐山地区开放性眼外伤球内异物伴发外伤性眼内炎患者345例,对不同性质的球内异物其外伤性眼内炎的发生率进行比较。结果金属异物的眼内炎的发病率为31.2%,占62.1%;非金属的眼内炎的发病率为24.6%,占37.9%。二者对比差异有显著性意义;金属异物中磁性金属异物的眼内炎的发病率为28.7%,占48.8%;非磁性金属异物的眼内炎的发病率为34.1%,占51.2%,二者对比差异无显著性意义;在所有可鉴别异物中,各种异物眼内炎的发生率从高到低排列依次为铜、植物性异物、铅、毛发、铝、铁、石子、有机物、其它金属、其它非金属、塑料。结论金属异物与植物性异物易引起眼内炎的发生,磁性异物与非磁性异物在现代玻璃体手术条件下意义不大,二者眼内炎的发生机率大致相当且无统计学差异,提示球内异物的性质可能也是影响外伤性眼内炎发生的一个因素。

玻璃体切除术治疗眼部创伤的临床效果分析

目的:探讨玻璃体手术治疗眼部创伤的临床相关因素及治疗效果。方法:对70例72眼眼创伤导致视功能受损患者行玻璃体切除手术的资料进行回顾性分析。结果:一次手术视功能较术前改善58眼(80%),不变12眼(17%),下降2眼(3%),30例视网膜脱离患者中,27眼达到视网膜解剖复位(90%)。3眼(10%)视网膜脱离严重与增殖机化粘连无法完全复位,或脉络膜脱离无法复位。结论:玻璃体切除手术是目前治疗严重眼后段创伤的理想方法,伤眼受伤程度、视网膜受伤程度、手术过程是影响手术预后的重要因素。

准分子激光治疗性角膜切削术治疗角膜弥漫性火药伤

目的:探讨准分子激光治疗性角膜切削术在角膜浅层弥漫性火药伤中的应用,为角膜弥漫性火药伤提供一种新的有效的治疗方法。方法:收集1999年12月至2003年12月期间在我院就诊的25例(39只眼)角膜浅层弥漫性火药伤患者,采用准分子激光治疗性角膜切削术进行异物清除。术后观察视力、角膜上皮恢复时间、眼压、远视状态和Haze等状况。结果:该手术与常规手术相比,缩短了手术时间,一只眼激光手术过程在10min以内。一次手术即可完成绝大部分的异物剔除,手术损伤小,一般在1周内角膜上皮可以完全恢复。术后在角膜光学区基本不残留角膜斑翳,术后视力显著提高。术后10d平均视力为0.6。术后患者轻度远视38例,中度远视1例。该手术产生的并发症在术中和术后也能得到良好的控制,安全性和预测性较高。结论:准分子激光治疗性角膜切削术在角膜浅层弥漫性火药伤中是一种方便、效果好、费用低廉并值得推广的治疗方法。

建筑工人角膜异物伤原因及视力分析

目的分析建筑工人角膜异物伤发病情况及影响视力有关危险因素,探讨有效的防治方法。方法采用回顾性分析的方法,总结我院2016年3—10月眼科诊治的建筑工人角膜异物伤临床资料。包括患者的性别,年龄,致伤原因,眼部损伤状况,伤后救治时间,接受治疗情况和视力结局。结果角膜异物多发生在中青年男性,损伤以铁屑为主,影响预后的因素包括异物性质、位置,就诊时间,自救方式,感染情况。结论角膜异物是建筑工人眼外伤中最常见的职业相关性眼损害。建筑工人需增强眼的保护意识,做好个人防护,可有效的防止角膜异物的发生,角膜异物发生后应尽快到正规医院诊治,减少并发症的发生。

裂隙灯显微镜联合荧光素染色检查法在眼表隐匿性异物诊治中的应用

目的介绍一种眼表隐匿性异物诊治的方法。方法回顾分析了27例眼表隐匿性异物的眼部临床特点及检查、治疗方法。结果 27例患者均为单眼患病,其中男14例,女13例,年龄的中位数为29岁,四分位间距为25岁、39岁,症状持续时间的中位数为2.0d,四分位数间距为0.5d、4.0d。各类异物中,角膜异物9例,结膜异物18例。在异物取出之前,所有患眼用裂隙灯显微镜检查时均未见明显的眼表损害。裂隙灯显微镜联合荧光素染色检查时发现,眼表隐匿性异物具有特征性改变,包括"荧光素着色"和"荧光素边集",其中表现为"荧光素着色"的比例为44.4%,表现为"荧光素边集"的比例为92.6%。15例异物可直接用湿棉签抹除,4例用显微镊夹出,其余8例采用联合异物取出法。在异物取出之后,裂隙灯显微镜联合荧光素染色结果显示,4眼未见明显着色,2眼呈片状着色,21眼为点状或线状着色。所有患者均未见因异物导致的眼部感染。结论通过查找特征性改变,裂隙灯显微镜联合角膜荧光素染色检查法有助于眼表隐匿性异物的诊治。

眼内异物伤眼内炎的临床观察

目的:探讨眼内异物伤眼内炎的感染因素、诊治情况。方法:收集256例眼内异物伤中42例发生眼内炎病例,从致病因素、微生物学检测及诊断治疗进行回顾性分析。结果:眼内异物伤眼内炎发生率为16.4%。眼后节异物及合并外伤性白内障的眼内异物伤是眼内炎发生的危险因素(P<0.05)。眼内异物伤Ⅰ期给予玻璃体腔注射盐酸去甲万古霉素及头孢他啶可以减少眼内炎的发生率(P<0.05)。异物性质及大小、取出时间及伤口情况对眼内炎发生率无明显影响(P>0.05)。眼内异物伤眼内炎手术分级Ⅲ级最多。玻璃体切除手术是治疗眼内炎的主要手术方式。结论:眼后节异物伤及合并外伤性白内障的眼内异物伤是眼内炎发生的危险因素,Ⅰ期手术需处理白内障时尽量保留完整的晶状体后囊膜。建议眼后节异物伤Ⅰ期行玻璃体腔注射万古霉素及头孢他啶。一旦确诊眼内炎,尽早进行玻璃体切除手术。

23G玻璃体切除术治疗金属异物致眼球穿通伤的疗效及预后

目的:总结金属异物所致眼球穿通伤的特点,评价23G玻璃体切除术治疗金属异物所致眼球穿通伤的疗效和安全性,并应用眼外伤评分系统分析影响患者终视力的因素。方法:前瞻性连续分析2014-07-01/2016-06-01在我院住院的金属异物所致眼球穿通伤需行23G玻璃体切除手术的患者38例38眼,收集患者年龄、性别、眼别、受伤场所、异物大小、伤口长度、异物位置、初视力与终视力、黄斑情况等资料。应用眼外伤评分系统(ocular trauma score,OTS)评估患者预后。随访时间均超过6mo。结果:患者38例38眼中,眼外伤主要发生在工作场所,共33例(87%);其次为运动场所,共3例(8%)。球内异物行23G玻璃体切除术术后矫正视力≥0.1者共21眼(55%)。术前出现视网膜脱离、异物较大(>5.0mm)、晶状体损伤是预后差的重要因素。异物位于玻璃体者23眼(61%),位于视网膜者15眼(39%)。就诊时即出现视网膜脱离者21眼(55%),眼内炎者7眼(18%),球内异物(intraocular foreign bodies,IFOB)直径>5.0mm者7眼(18%),术后出现较严重PVR者6眼(16%),黄斑前膜者5眼(13%)。相同OTS评分下,术后6mo视力明显优于术前;无论术前还是术后6mo视力,OTS评分越高,视力越好。结论:金属异物所致眼球穿通伤多发生在40岁以下年轻男性,以工作场所为主,未采用防护措施是受伤的主要原因。影响最终视力的主要因素是受伤后出现视网膜脱离、异物>5.0mm和术后PVR的出现。23G玻璃体切除术治疗金属异物所致眼球穿通伤安全、可靠、有效。OTS评分可有效用于金属异物所致眼球穿通伤患者,并作出合理、有用的术后视力预测。

角膜异物792例分析

目的:分析和探讨角膜异物的原因、治疗及预后。方法:收集门诊就诊角膜异物伤患者792例803眼,分析患者年龄、性别分布、异物分类、分区及预后情况。结果:角膜异物患者792例803眼中,男747例(94.3%),发病年龄集中在19～40岁。异物中以金属最为多见,占91.7%,184眼(22.9%)的异物位于角膜C区,335眼(41.7%)的异物位于角膜B区,284眼(35.4%)的异物位于角膜A区。有58例(7.2%)就诊时发现合并感染的角膜异物。除部分患者视力下降外未发生严重并发症,视力下降12眼(1.5%)。结论:角膜异物是常见的眼外伤,严重者会影响视力,经适当的治疗后,大多数角膜异物伤可有较好的治疗效果。