比较23G玻璃体切除术经巩膜或角膜切口眼内异物摘出术的效果  

Comparison of efficacy of 23 G vitrectomy through limbal corneal incision or scleral incision for the extraction of intraocular foreign body

作　　者：伍端晓[1] 蔡锦红[1] 李海波[1] 黄艳明[1] 吴东海[1] 黄秋萍[1] 陈秋莲[1] 

机构地区：[1]厦门大学附属厦门眼科中心,福建361005

出　　处：《中华眼外伤职业眼病杂志》2015年第1期1-5,共5页Chinese Journal of Ocular Trauma and Occupational Eye Disease

摘　　要：目的对比研究应用23G微创玻璃体切除术经巩膜或角膜切口摘出后段眼内异物的效果及安全性。方法后段眼内异物采用23G微创玻璃体切除异物摘出手术34例（34只眼），随机分两组。A组经巩膜切口摘出异物，B组经角膜切口摘出异物。对比研究两种不同术式术中出现葡萄膜、玻璃体脱出及异物脱落情况，术后门诊随访3～12个月，对比研究视网膜脱离、眼压、视力、角膜内皮细胞计数等情况。结果所有异物均顺利摘出，A组17例，术中扩大巩膜穿刺口，出现葡萄膜、玻璃体脱出3例，术中异物脱落损伤后极部视网膜2例；B组17例，术中自原创口或扩大角膜缘切口，未出现葡萄膜、玻璃体脱出，未发生术中异物脱落。随访3～12个月，未出现眼内炎，视力均不同程度提高，其中A组术后出现视网膜脱离1例，再次行网膜复位手术。随访期间，两组角膜内皮细胞计数、眼压等差异无统计学意义。结论应用23G微创玻璃体切除术经巩膜或角膜切口摘出后段眼内异物，均安全有效。其中经巩膜切口摘出异物能避免角膜二次损伤，维持前房稳定性，避免晶状体二次损伤；经角膜切口摘出异物充分利用23G微创玻璃体切除系统密闭性优势，避免扩大巩膜切口，防止巩膜切口葡萄膜及玻璃体脱出，而且经角膜异物摘出操作可视性强，术中异物有晶状体囊及虹膜衬托，不容易脱落，避免二次损伤视网膜组织，尤其适用于非磁性异物的摘出，术后随访观察对角膜组织影响较小。经角膜切口的方法对于特定后段眼内异物摘出具有更安全，有效的优势。Objective To compare the clinical effects and safety of 23 G vitrectomy through limbal corneal incision or scleral incision for the extraction of posterior segment intraocular foreign bodies. Methods Thirty-four eyes of 34 patients who underwent 23 G vitrectomy for the extraction of posterior segment in- traocular foreign body were randomly divided into two groups. Seleral incision was made to extract the foreign body in group A. Limbal corneal incision was made in group B. The prolapse rate of uvea and vitreous and the difficulty of extraction of intraocular foreign bodies by two surgical ways were compared. The follow up time was 3 ～12 months. The retinal detachment rate, intraoeular pressure, visual acuity and corneal endo- thelial cells were analyzed postoperatively. Results All foreign bodies were successfully removed. Vitreous and uvea prolapse happened in 3 cases and foreign bodies dropped and caused the damage of posterior retina in 2 cases in group A when the sclera incision was enlarged during the surgery, while no one happened in group B. During the follow-up of 3 ～ 12 months, the visual acuity was improved postoperatively and no en- dophthalmitis happened. Retinal detachment oceured in 1 case in group A and the retinal reattaehment oper- ation was performed again. The difference in intraocular pressure, corneal endothelial cell counting between two groups was not statistically significant. Conclusion 23 G vitrectomy through limbal corneal incision or scleral incision for the extraction of posterior segment intraocular foreign body all are safe and effective. It can avoid secondary injury of cornea and lens and maintain anterior chamber stabihty when through scleral incision, while it can avoid uvea and vitreous prolapse and the foreign body dropping during the surgery due to the lens capsule and iris, and get clear way out through limbal corneal incision, which is a safer and more effective way especially for posterior segment intraocular foreign bodies extraction.

关 键 词：异物 眼后段 玻璃体切除术 异物摘出 

分 类 号：R779.6[医药卫生—眼科]