23G玻璃体切割术联合巩膜扣带术在眼球内异物伴视网膜脱离中的临床疗效

摘要

目的 评价23 G玻璃体切割术(PPV)联合巩膜扣带术(SB)在眼球内异物伴视网膜脱离(RD)中的临床疗效.方法 回顾性分析42例(42眼)眼球内异物伴RD患者的临床资料,按手术方式分为观察组和对照组各21例,观察组患者行23 G PPV+SB+眼球内异物取出+硅油填充术+眼内激光光凝或(和)巩膜冷凝术.对照组患者行23 G PPV+眼球内异物取出+硅油填充术+眼内激光光凝或(和)巩膜冷凝术.术后3 ～6个月取出眼内硅油.比较两者术后视力、眼压、解剖复位率及并发症发生率.结果 42例患者眼球内异物均成功取出.取油术后3个月,两组最佳矫正视力均较术前提高(P＜0.05),但组间比较,差异无统计学意义(P＞0.05).不同时间点两组间的眼压比较,差异无统计学意义(P＞0.05);两组PPV术后1 d及1周的眼压均高于术前(P＜0.05),取油术后3个月,观察组的眼压与术前差异无统计学意义(P＞0.05),而对照组低于术前(P＜0.05).PPV术后,观察组21例均解剖复位成功;对照组20例解剖复位成功.取油术后,观察组有2例(9.52%)RD复发,对照组有7例(35.00%)RD复发;观察组最终解剖复位成功率为90.48%(19/21),高于对照组的61.90%(13/21)(P＜0.05).两组术后1周内暂时性高眼压发生率比较,差异无统计学意义(P＞0.05).两组白内障发生率均为100%,均各出现2例(9.52%)硅油乳化、1例(4.76%)低眼压患者.结论 PPV联合SB是治疗眼球内异物合并RD的安全、有效方法,具有较高的解剖复位成功率.%Objective To evaluate the clinical efficacy of 23 gauge pars plana vitrectomy(PPV) combined with scleral buckle (SB) for removal of intraocular foreign bodies(IOFB) companied by retinal detachment(RD).Methods The clinical data of 42 patients (42 eyes) with IOFB companied by RD were retrospectively analyzed.The patients were divided into observation group(n=21) and control group(n=21) according to the surgical approaches.Patients in the observation group received 23 gauge PPV,SB,IOFB removal,silicone oil tamponade,and endolaser photocoagulation and/or transscleral cryotherapy.Patients in the control group underwent 23 gauge PPV,IOFB removal,silicone oil tamponade,and endolaser photocoagulation and/or transscleral cryotherapy.Intraocular silicone oil was removed after three to six months of operation.The postoperative visual acuity,intraocular pressure,anatomical reduction rate and incidence of complications were compared between the two groups.Results All of IOFBs were removed successfully in the 42 cases.After three months of silicone oil removal,the best corrected visual acuity was improved in the two groups compared to the preoperative(P＜0.05),and no statistically significant difference was found between the two groups(P＞0.05).The intraocular pressure showed no statistically significant difference between the two groups at various time points(P＞0.05);the intraocular pressure on the first day or in the first week after PPV was higher than the preoperative in both groups(P＜0.05),compared to the preoperative,the intraocular pressure did not present significant changes in the observation group(P＞0.05) but was lower in the control group(P＜0.05) after three months of silicone oil removal.After PPV,21 cases achieved a success anatomical reduction in the observation group,and 20 in the control group.After silicone oil removal,RD recurrence was observed in two cases(9.52%) of the observation group and seven cases(35.00%) of the control group;and the final success rate of anatomical reduction in the observation group was higher than that in the control group[90.48%(19/21) vs. 61.90%(13/21);P＜0.05].There was no significant difference in the incidence rate of temporary high intraocular pressure within one week after operation between the two groups(P＞0.05).The incidence rate of cataract was 100% in both groups.Two cases(9.52%) of silicone oil emulsification and one case(4.76%) of lower intraocular pressure occurred in each group.Conclusion PPV combined with SB is a safe and effective approach, with a higher success rate of anatomical reduction,for the treatment of IOFB complicated with RD.