玻璃体切割术治疗异物引起的眼球贯通伤

摘要

目的 评价异物引起的眼球贯通伤行玻璃体切割术的治疗效果,探讨异物取出的手术路径和玻璃体切割手术时机的选择.方法 回顾性系列病例研究.由异物导致的眼球贯通伤56例(56眼).根据CT和B超检查结果联合定位,分为球壁异物组(24例)和眶内异物组(32例).24例球壁异物在伤后1周内均通过玻璃体视网膜手术取出异物.32例眶内异物中有22例先行眶内异物取出联合后巩膜伤口缝合术.10例因异物位于后极部或眶深部未行取出术.所有眶内异物组患眼均于伤后2周左右行玻璃体视网膜手术修复眼内组织.随访3～12个月,观察术后视力和并发症.以卡方检验分析影响术后视力的因素.结果 玻璃体切割术后,50例(89％)患者视力较术前提高,34例(61％术后最佳矫正视力≥0.05.异物入口位置(x2=7.69,P=0.01)、出口位置(x2=21.83,P＜0.01)、视网膜脱离(x2=16.64,P＜0.01)、脉络膜脱离(x2=7.73,P=0.01)以及眼内感染(x2=6.89,P=0.01)对术后视力影响较大.术后6例发生视网膜脱离,2例低眼压,12例发生黄斑前膜或皱褶.结论 根据异物的位置和眼内情况选择恰当的手术路径和玻璃体切割的手术时机,最大限度地减少手术对视网膜组织的损伤及预防增殖性玻璃体视网膜病变是成功治疗眼球贯通伤的关键.%Objective To evaluate the effect of vitrectomy for ocular perforating wounds caused by foreign bodies;to investigate the surgical approach for removing foreign bodies and the timing of the vitrectomy.Methods This was a retrospective case-series study.Fifty-six cases (56 eyes) of ocular perforating wounds were analyzed.Patients were divided into an eye-wall foreign body group (24 cases) and an intraorbital foreign body group (32 cases) based on the results of computer tomography (CT) and ultrasonography positioning.Twenty-four cases with eye-wall foreign bodies underwent vitrectomy within 1 week after the injury.Twenty-two cases of intraorbital foreign bodies underwent orbital foreign body removal combined with scleral wound closure.The other 10 cases were not candidates for foreign body removal because the foreign bodies were located in the posterior pole or deep orbit.All eyes with intraorbital foreign bodies underwent vitreoretinal surgery about 2 weeks after injury.Patients were followed up for 3 to 12 months,visual acuity (VA) was evaluated and complications were noted.The factors affecting visual acuity were analyzed using Chi-square tests.Results Postoperative VA improved in 50 patients (89％).The VA of 34 patients (61％) was greater or equal to 0.05.The factors that influenced VA included the position of the anterior (x2=7.69,P=0.01) and posterior wound (x2=21.83,P＜0.01),retinal (x2=16.64,P＜0.01) and choroidal detachment (x2=7.73,P=0.01) and endophthalmitis (x2=6.89,P=0.01).After surgery,retinal detachment occured in 6 cases,hypotension in 2 cases and macular preretinal membrane or macular pucker in 12 cases.Conclusion The following factors are crucial in successfully dealing with ocular perforating wounds caused by foreign bodies:choose the right surgical approach and the timing of the vitrectomy based on the position of the foreign body and intraocular conditions,minimize the damage to the retina and prevent proliferative vitreoretinopathy.