玻璃体切除联合眼内异物摘出术的临床分析  

Clinic analyse of pars plana vitrectomy associating with extirpation of intraocular foreign bodies

作　　者：刘少章[1] 贺翔鸽[1] 王维光[1] 

机构地区：[1]第三军医大学大坪医院野战外科研究所眼科,重庆400042

出　　处：《中国实用眼科杂志》2005年第10期1116-1119,共4页Chinese Journal of Practical Ophthalmology

摘　　要：目的探讨玻璃体切除联合眼内异物摘出的手术时机和手术方法。方法对经睫状体平坦部玻璃体切除联合眼内异物摘出术30例(30眼)进行回顾性分析。结果本组30例(30眼)眼内异物均一次手术摘出,其中27例采用经睫状体平坦部玻璃体切除取出异物;1例锯齿缘附近磁性大异物,经玻璃体切割后,从巩膜切口用磁铁将异物吸出;1例锯齿缘巨大非磁性异物,行晶体摘除后经角膜缘切口取出。本组病例术后视力改善19眼(63.3%),无变化6眼(20%),视力下降5眼(16.7%)。早期视力下降的原因与术后角膜水肿,视网膜出血,玻璃体混浊、玻璃体腔内填充物等因素有关。术后有3例(3眼,1%)发生视网膜脱离,其中1例行巩膜扣带术+玻璃体切除+晶体切除+冷凝+注气术后治愈,1例放弃治疗;1例因眼球萎缩行眼球摘出。结论对穿通伤口小且已自行闭合者、穿通伤口已缝合但角膜透明不影响观察者和有化脓性眼内炎征象者均应尽早手术。对于<35岁晶体已混浊者,建议采取玻璃体切割切除晶体和眼内异物摘出同时进行,术中应尽量保留晶体前囊膜,以利于人工晶体植入。对位于周边部的非磁性异物,虹膜后粘连瞳孔无法扩大者建议术中切除晶体,以扩大视野有利于异物的寻找取出和病变玻璃体的切除。对巩膜裂伤伴球内异物存留的患者,建议玻璃体切除的同时行巩膜扣带术以降低视网膜脱离的风险。Objective To discuss occasions and methods of operation of pars plana vitrectomy associating with extirpation of intraocular foreign bodies. Methods 30 cases （30 eyes） pars plana vitrectomy asso- ciating with extirpation of intraocular forgign bodies were analyzed restrospectively. Results Intraocular foreign bodies were all extirpated with one operation int his group＇s 30 cases （30 eyes）, 27 cases of them were treated with pars plana vitrectomy to extirpate intraocular foreign bodies; After vitrectomy, a big magnetic intraocular foreign bodies near ora serrata was aspirated out by permanent magnet via sclera＇s incision; a huge nonmagnetic intraocular foreign bodies on ora serrata was extirpated via limhal incision, through dissociating vitreous body by vitrectomy. Vision of 19 eyes （63.3 % ） in this group were improved after operation, 6 eyes （20%） were not changed, eyesight of 5 eyes （16.7%） declined. Causes of vision decline at forepart had something to do with some factors, such as corneal edema, retinal hemorrhage, vitreous body turbidity, stuffing inVitreous cavity. 3 cases （3 eyes, 1% ） occurred retinal detachment after operation, one of them cured by Seleral buckling operation ＋ vitrectomy ＋ lens removal ＋ cryo-application ＋ intraocular injection gas; One of them gave up treatment; One of them was treated by extraction bulbi because of antrophy of eyeball. Conclusions The cases of which tiny penetrating injury and the injury that can be cured automatically, penetrating injury were oversewed but corneal clarity didn＇t affect observation and which had symptom of purulent endophthalmitis should be operated as soon as possible. 〈35 years old patients with turbid lens are advised to take extraction of lens by vitrectomy and extraction of intraocular foreign bodies at the same time. Lens anterior capsules should be kept under operations as possible as man can in order to plant in manual lens. The cases of which nonmagnetic intraocular foreign bodies on circumference and p

关 键 词：玻璃体切除手术 眼内异物摘出术 临床分析 巩膜裂伤 眼球萎缩 

分 类 号：R779.14[医药卫生—眼科]