摘要
目的 探讨23G微创玻璃体切除系统在外伤性白内障合并后段眼内异物患者手术治疗中的应用效果。方法 回顾性分析2011年1月至2013年5月期间,河南省郑州市第二人民医院眼科收治的39例(39只眼)外伤性白内障合并后段眼内异物患者的临床资料,所有患者均实施白内障摘除联合23G微创玻璃体切除术进行治疗,手术者在直视下取出患者眼内异物。随访观察患者术后1~6个月最佳矫正视力(BCVA)、增生性玻璃体视网膜病变(PVR)发生情况、视网膜复位情况及并发症发生情况。结果 本组39例(39只眼)患者均一次性成功将异物摘除,术后1个月BCVA【0.05者22只眼(56.41%),BCVA≥0.05者17只眼(43.58%);术后6个月,BCVA【0.05者18只眼(46.15%),BCVA≥0.05者21只眼(53.84%)。术后视力提高者28只眼(71.79%),视力不变者8只眼(20.51%),视力下降者3只眼(7.69%)。本组患者术前及术中发现视网膜脱离者12例(12只眼),术中视网膜全部一次性复位,术后C3F8气体填充8例(8只眼),硅油填充4例(4只眼);合并眼内炎症者2例(2只眼)行白内障摘除联合玻璃体切除及异物摘出后均行硅油填充,术后炎症得到控制。术后1个月4例(4只眼)患者出现PVR,其中前部PVR者3例(3只眼),后部PVR者1例(1只眼),所有患者再次行巩膜外环扎+外垫压+剥膜+光凝+注油术治疗,PVR发生率为10.26%(4/39只眼);术后6个月发现9例(9只眼)患者出现PVR,其中前部PVR者4例(4只眼),后部PVR者5例(5只眼),除两名患者放弃治疗外,其余患者再次行巩膜外环扎+外垫压+剥膜+光凝+注油术治疗,PVR发生率为23.08%(9/39只眼)。术后9例(9只眼)患者出现不同程度的前房积血,患者在对症治疗后积血吸收;7例(7只眼)患者发生一过性低眼压,经包扎处理后眼压均恢复正常;10例(10只眼)患者发生继发性青光眼,经过糖皮质激素药物治疗及降眼压对症处理后8例(8只眼)患者痊愈,其余2例(2只眼)患者行Ahmed青光眼阀植入术,术后患者眼压得以控制。结论 对外伤性白内障合并后段眼内异物患者实施23G微创玻璃体手术进行治疗,能成功取出其眼内异物,降低术后并发症的发生率,提高手术质量。
Objective To explore the therapeutic effect of 23-gauge transconjunctival sutureless vitrectomy system for traumatic cataract with posterior segment intraocular foreign bodies.Methods The clinical data of 39 patients ( 39 eyes ) with traumatic cataract combined with posterior segment intraocular foreign bodies in department of ophthalmology, the Second People′s Hospital of Zhengzhou City from Jan.2011 to May 2013 was retrospectively analyzed.All the patients were treated with 23G TSV combined with phacoemulsification.The extraction of intraocular foreign bodies were removed under operating microscope.The best corrected visual acuity( BCVA) , the location of retinal ,the incidence of prevalence of perliferativevitreoretinopathy ( PVR) and other complications after surgery was observed and patients were followedup for 6 months.Results All the 39 cases (39 eyes) obtained successful extraction of intraocular foreign bodies.BCVA was less than 0.05 in 22 eyes (56.41%) and more than or equal to 0.05 in 17 eyes (43.58%) 1 month after surgery.BCVA was less than 0.05 in 18 eyes (46.15%) and more than or equal to 0.05 in 21 eyes (53.84%) 6 months after surgery.Twenty-eight eyes (71.79%) improved their visual acuity after surgery,8 eyes (20.51%) had no change and 3 eyes (7.69%) got worse.Twelve eyes were found with retinal detachment pre-or during the operation.All the retinas were one-time successful reposition during which 8 cases (8 eyes ) were gas-filled and 4 cases (4 eyes) were silicone oil-filled.Two cases with intraocular inflammation were filled with silicone oil after 23G TSV combined with phacoemulsification,and the inflammation were controlled.PVR occurred in 4 cases ( 4 eyes ) postoperative 1 month, 3 cases (3 eyes) with anterior PVR and 1 case (1 eye) with posterior PVR.All patients were treated again with sclera buckling+scleral cerclage+stripping+photocoagulation surgery+oil injecton.The incidence of PVR was 10.25%.Six months after operation,PVR occurred in 9 cases (9 eyes),including 4 cases (4 eyes)anterior PVR and 5 cases (5 eyes) posterior PVR.Except 2 patients who gave up the treatment,the others were treated again with sclera buckling+scleral cerclage+stripping+photocoagulation surgery+oil injecton.The incidence of PVR was 23.07%.Different degrees of hyphema occurred in 9 cases,and was absorped after proper treatment.There were 7 cases (7 eyes) with transient lower intraocular pressure,and the intraocular pressure turned normal after presser bandaging.There were 10 cases (10 eyes) with secondary glaucoma. Eight cases (8 eyes) were recovered after corticosteroid drug treatment,and 2 cases (2 eyes) were recovered after ahmed glaucoma valve implantation.Conclusion The application of 23 gauge transconjunctival sutureless vitrectomy system for traumatic cataract with posterior segment intraocular foreign bodies can obtain successful extraction of intraocular foreign bodies, reduce the incidence of postoperative complications and improve the quality of surgery.
出处
《中华眼科医学杂志（电子版）》
2014年第1期27-31,共5页
Chinese Journal of Ophthalmologic Medicine(Electronic Edition)
关键词
眼内异物
外伤性白内障
23G微创玻璃体手术
Intraocular foreign bodies
Traumatic cataract
23 gauge transconjunctival sutureless vitrectomy
