玻璃体切割联合硅油填充治疗球内异物的随访观察  

A long-term outcome ofvitrectomy and silicone oil tamponade in cases with severe intraocular foreign body injuries

作　　者：郑建秋[1] 滕岩[1] 刘丽娟[1] 

机构地区：[1]哈尔滨医科大学第一临床医学院附属眼科医院,哈尔滨150001

出　　处：《中国实用眼科杂志》2009年第2期133-136,共4页Chinese Journal of Practical Ophthalmology

摘　　要：目的评价玻璃体切割联合硅油填充术对严重球内异物伤眼的治疗效果。方法回顾性研究18例严重球内异物伤眼的临床资料。所有患眼均行玻璃体切割术取出异物，硅油填充，术后平均随访27．8个月。随访项目包括最佳矫正视力、PVR发生情况、青光眼、角膜变性、白内障、低眼压及眼球萎缩等。结果术后3、6、12及24个月功能成功（VA≥0．02）率分别为88．9％、100％、100％及100％，与术前27．8％相比明显升高（P〈0．05）；脱肓（VA〉／0．05）率分别为44．4％、72．2％、77．8％及77．8％与术前0相比明显升高（P〈0．05）；脱离低视力（VA≥0.3）率分别为11．1％、27．7％、33．3％及33．3％与术前0相比明显升高，除术后3个月外，均有统计学意义（P〈0．05）。术后12个月时，硅油眼PVR的发生率为28．6％，明显低于无硅油眼的90．9％（P〈0．05）。术后24个月时，硅油填充≥12个月眼的PVR的发生率为42．9％，明显低于硅油填充〈12个月眼的90．9％（P〈O．05）。61．1％眼发生暂时性眼压升高，16．7％眼发生角膜变性，11．1％眼发生低眼压，未发生白内障和眼球萎缩。结论玻璃体切割联合硅油填充术是治疗严重球内异物伤眼的有效手段，在无严重硅油填充并发症的情况下，适当延长硅油填充时间可以明显降低PVR发生的风险。Objective To evaluate the long-term outcome of vitrectomy and silicone oil tamponade in cases with severe intraocular foreign body （IOFB）iniuries.Methods This retrospective consecutive study included 18 cases with severe IOFB injuries.All cases underwent pars plana vitrectomy, removal of the IOFB, and primary silicone oil tamponade and were followed up for a mean 27.8 months.Follow-up data were documented including best-corrected visual activity, proliferative vitreoretinopathy （PVR）, glaucoma, keratopathy, cataract, hypotony, and phthisis bulbi.Results On the 3rd, 6th, 12th, and 24th month after surgery, the functional success （VA≥ 0.02）rates were 88.9%, 100%, 100% and 100% respectivery, and better than that （27.8%）before surgery（P 〈 0.05 ）.The success rates of out of blindness（VA〉 0.05 ）were 44.4%, 72.2%, 77.8% and 77.8% respectivery, and better than that （0%）before surgery （P 〈0.05 ）.The success rates of out of low vision （VA≥ 0.3 ）were 11.1%, 27.7%, 33.3% and 33.3% respectivery, and better than that （0%）before surgery （P 〈0.05 ）, except for 11.1%（P 〉 0.05 ）.PVR occurred in silicone oil eyes was 28.6%, lower than that （90.9%）in silicone oil removal eyes on the 12th month after surgery（P 〈0.05 ）.PVR occurred in eyes with silicone oil tamponade≥ 12 months was 42.9%, lower than that（90.9%）in eyes with silicone oil tamponade〈 12 months on the 24th month after surgery（P 〈 0.05 ）.Temporary increase of intraocular pressure was present in 61.1% of all eyes.Keratopathy occurred in 16.7%, and hypotony 11.1%.There was no cataract and phthisis bulbi in all eyes.Conclusions The cases with severe IOFB injuries can be managed with pars plana vitrectomy and primary silicone oil tamponade satisfactorily.The risk of PVR may be degrade with added the time of silicone oil tamponade in severe IOFB eyes.

关 键 词：球内异物伤 玻璃体切割 硅油 

分 类 号：R779.6[医药卫生—眼科] R774.12[医药卫生—临床医学]