角膜板栗刺异物伤的临床诊断与治疗观察  

Removal of penetrating chestnut thorns from the eye

作　　者：曹凤芝[1] 

机构地区：[1]重庆市梁平县人民医院眼科,405200

出　　处：《中华眼科医学杂志（电子版）》2014年第2期22-25,共4页Chinese Journal of Ophthalmologic Medicine(Electronic Edition)

摘　　要：目的 探讨角膜板栗刺异物患者的诊断及治疗方法。方法 回顾性分析2010年9月至2012年10月重庆市梁平县人民医院眼科收治的38例(43只眼)角膜异物患者的临床资料。所有患者经裂隙灯显微镜检查确诊后,根据板栗刺的深浅及刺入部位采取相应的手术进行治疗。术后观察患者的角膜恢复情况、并发症的发生情况及视力变化情况,并积极治疗并发症。结果 38例(43只眼)患者采用裂隙灯显微镜检查,均可见棕色植物刺样异物刺入角膜内,长度约1~3 mm,最多者11根,最少者2根。多数异物垂直刺入,尖端位于前房内,尾端埋于角膜基质内。少数板栗刺较长者,尖端刺入虹膜组织及晶状体内。38例(43只眼)角膜板栗刺异物患者中,刺入角膜浅层(刺入深度达到角膜上皮层和前弹力层)者2例(2只眼);刺入角膜深层(刺入深度达到角膜基质层、后弹力层和角膜内皮层)者36例(41只眼),其中未穿透角膜全层者8例(12只眼),穿透角膜全层者26例(29只眼)。38例(43只眼)患者均1次性将角膜板栗刺异物取净。其中,于裂隙灯显微镜下摘除异物的患者共18例(21只眼);于手术显微镜下以皮试针头穿刺入前房顶压异物法摘除异物的患者共17例(19只眼);于手术显微镜下以黏弹剂静态回抽法摘除异物的患者共2例(2只眼);采用板栗刺摘出联合白内障囊外摘除及人工晶状体植入术进行异物摘除的患者共1例(1只眼)。并发角膜炎及角膜溃疡者11例(22只眼),虹膜睫状体炎者5例(5只眼),外伤性白内障者1例(1只眼),经过相应的对症治疗,所有患者的并发症均治愈。治疗后38例(43只眼)患者的视力均有所提高,无视力下降者。治疗前患眼最佳矫正视力【0.1的患者3例(3只眼),治疗后患眼最佳矫正视力全部提高至0.3~0.5;治疗前患眼最佳矫正视力为0.1~0.3的患者18例(21只眼),治疗后患眼最佳矫正视力全部提高至0.5~1.0;治疗前患眼最佳矫正�Objective To comparatively evaluate the efficacy of different modalities to remove penetrating chestnut thorns from the eye.Methods Clinical charts of 38 patients(43 eyes) who underwent slit lamp examination of corneal foreign bodies and removal of penetrating chestnut thorns with different modalities in Department of Ophthalmology, Liangping People′s Hospital of Chongqing City between September 2010 and October 2012 were reviewed.Data on complications and visual acuity after 6-month follow-up were extracted and analyzed.Results According to the recorded slit lamp examination results, multiple (2-11) chestnut thorns of 1-3 mm in length were found in all 38 cases (43 eyes);most of the thorns were inserted vertically to the eye with points in anterior chamber and tails in corneal stroma while a small proportion of the thorns were inserted into lens or iris.Thorns were inserted superficially to the cornea ( e.g., epithelium,bowman′s membrane) in 2 cases (2 eyes) but deeply to the cornea ( e.g.,stroma,descemet′s membrane or endothelial layer ) in 36 cases ( 41 eyes ) .Complete penetration of the cornea occurred in 8 cases (12 eyes) while no corneal penetration was observed in the remaining 26 cases (29 eyes) in the 36 cases of deep corneal insertion.Treatment wise,chestnut thorns were completely removed with one procedure in all cases.Thorn removal was surgically accomplished by direct pulling under a slit-lamp microscope in 18 cases ( 21 eyes ) , by penetrating the anterior chamber and squeezing with a needle under an operating microscope in 17 cases (19 eyes) ,by extraction with sodium hyalurantae under an operating microscope in 2 cases ( 2 eyes ) , and by phacoemulsification and intraocular lens implantation in 1 case ( 1 eye ) . Aftersurgery,keratitis and keratohelcosis occurred in 11 cases (22 eyes) ,secondary iridocyclitis in 5 cases (5 eyes),traumatic cataract in 1 case (1 eye) and they were all cured with corresponding treatments.Visual acuity was improved in all patients after surgical removal of the

关 键 词：角膜 角膜异物 手术 摘除 

分 类 号：R779.1[医药卫生—眼科]