微创玻切"L"形切口在眼内大异物摘出术中的应用  

The application of "L" -shaped incision in the extraction of large posterior intraocular foreign bodies with minimal invasive vitrectomy

作　　者：钟雪梅 杨新怀 Zhong Xuemei;Yang Xinhuai(Department of Ophthamology,Xiaolan Hospital Affiliated to Southern Medical University,The Second Clinical School of Southern Medical University,Zhongshan,Guangdong 528415,China)

机构地区：[1]南方医科大学附属小榄医院眼科,南方医科大学第二临床医学院,中山528415

出　　处：《中华眼外伤职业眼病杂志》2021年第4期287-291,共5页Chinese Journal of Ocular Trauma and Occupational Eye Disease

基　　金：中山市重大科技项目 (2016B1010)。

摘　　要：目的:评估在微创玻璃体切除术中应用睫状体平坦部"L"形切口摘出后段眼内大异物的效果。方法:采用双向性队列研究,分析2013年1月至2019年6月南方医科大学附属小榄医院后段眼内大异物29例(29眼)。根据术前CT和(或)B超检查确定后段眼内异物的长及宽,根据异物最大宽度(W)分组,以W≤3 mm、3 mm5 mm分成A、B、C 3组。A组及C组分别通过常规与角膜缘平行的睫状体平坦部"一"形扩大切口和角膜缘切口摘出异物。B组通过睫状体平坦部"L"形切口摘出异物。术后随访6个月以上。结果:A组13例,B组8例,C组8例;其中B组摘出异物长度为(5.4±2.9)mm,最大宽度为(2.2±0.8)mm,厚度为(1.6±0.9)mm。所有异物均一次手术摘出成功,末次随访视网膜均在位。术后增生性玻璃体视网膜病变发生率:C组(4例,50%)>B组(2例,25.0%)>A组(2例,15.4%);C组合并术后角膜溃疡穿孔1例(12.5%)。术后B组1例(12.5%)复发性视网膜脱离,手术后复位。3组均无严重并发症。结论:在微创玻璃体切除术摘出后段较大异物中,经睫状体平坦部"L"形切口手术成功率高,术后并发症少。Objective To evaluate the clinical efficacy of extraction of large intraocular foreign bodies in the posterior segment of the eye through a"L"shaped incision in the pars plana of the ciliary body during minimal invasive vitrectomy.Methods A two-way cohort study was used to analyze 29 eyes of 29 cases diagnosed as large posterior intraocular foreign bodies from Jan.2013 to Jun.2019 in Xiaolan Hospital Affiliated to Southern Medical University.Based on the preoperative orbital CT and(or)B-ultrasound examination,the length and width of the foreign body in the posterior segment were determined.Baesd on the maximum width(W)of the foreign body by a standard of W≤3 mm,3 mm<W≤5 mm and W>5 mm,the patients were divided into group A,group B,and group C.The intraocular foreign body of group A and C were extracted through a conventional"一"shaped pars plana incision and a limbal incision respectively.The intraocular foreign body of group B was extracted through an"L"-shaped pars plana incision.The patients were followed up for morethan 6 months.Results A total of 13 cases were included in group A,8 cases in group B,and 8 cases in group C.The length of foreign body was(5.4±2.9)mm,the maximum width was(2.2±0.8)mm and the thickness was(1.6±0.9)mm in group B.All the foreign bodies were successfully extracted by one operation and the retinal detechment was cured at the last follow-up.The incidence of postoperative proliferative vitreoretinopathy:group C(4 cases,50%)>group B(2 cases,25.0%)>group A(2 cases,15.4%).One case(12.5%)of corneal ulcer perforation occurred in group C.One case(12.5%)of recurrent retinal detachment occurred in group B.There were no serious complications during the follow-up.Conclusion In the extraction of larger posterior intraocular foreign bodies with minimal invasive vitrectomy,the"L"-shaped incision through the pars plana of the ciliary body has high successful rate,with fewer complications.

关 键 词：玻璃体切除术 微创切口 "L"形 摘出术 大异物 眼内 后段 

分 类 号：R779.6[医药卫生—眼科]