玻璃體切除術(shù)治療眼內(nèi)異物療效及預(yù)后分析
發(fā)布時(shí)間：2019-06-14 16:29
【摘要】：背景:開放性眼外傷是年輕人或者勞動(dòng)人群中喪失視力的一個(gè)最重要的因素,其中又以眼后段眼內(nèi)異物對(duì)眼球結(jié)構(gòu)及視力的影響最大。我們選取了開放性眼外傷IOFBs行玻璃體切割術(shù)取出眼內(nèi)異物的患者,收集了可能影響患者視力預(yù)后的各因素頻數(shù)進(jìn)行分析,了解患者IOFBs對(duì)眼球的影響和玻璃體切割術(shù)對(duì)患者視力預(yù)后的影響。目的:分析開放性眼外傷眼后段異物患者玻璃體切割術(shù)治療效果及視力預(yù)后的相關(guān)因素。方法:回顧性分析2015年12月至2017年1月于重慶醫(yī)科大學(xué)附屬第一醫(yī)院眼科入院診斷為眼后段眼內(nèi)異物共40眼,所有眼后段眼內(nèi)異物均通過玻璃體切割術(shù)取出。統(tǒng)計(jì)了年齡、性別、術(shù)前/術(shù)后最佳矯正視力(BCVA),眼后段異物性質(zhì)、大小,眼內(nèi)異物移除時(shí)間,眼內(nèi)異物進(jìn)入?yún)^(qū)域,眼內(nèi)異物殘留位置,手術(shù)時(shí)機(jī),手術(shù)方式和并發(fā)癥等因素,使用SPSS19.0進(jìn)行數(shù)據(jù)分析。結(jié)果:患者平均年齡為43.15歲,男性患者37例(92.5%),女性患者3例(7.5%),治療有效的患者25例(62.5%),16例患者恢復(fù)有效視力(40%),未恢復(fù)有效視力患者24例(60%),其中失明患者2例(5%)。異物殘留在玻璃體腔內(nèi)的有12例眼(30%),嵌于視網(wǎng)膜上18例眼(45%),穿透眼球壁的有10例眼(25%)。并發(fā)前房積血10例眼(25%),并發(fā)玻璃體積血24例眼(60%),合并視網(wǎng)膜脫離的有19例眼(47.5%),合并視網(wǎng)膜裂孔的有28例眼(70%),合并眼內(nèi)炎的有8例(20%)。異物3mm的有18例眼(45%),異物≥3mm的有22例眼(55%),眼內(nèi)異物在兩天內(nèi)取出的有26例眼(65%),2天后取出的有14例眼(35%)。術(shù)前BCVA≥4.0的有8例眼(20%),術(shù)前BCVA4.0有32例眼(80%)。術(shù)后BCVA≥4.0的有16例眼(40%),術(shù)后BCVA4.0有24例眼(60%)�；颊咭暳Φ闹饕绊懸蛩貫橐暰W(wǎng)膜脫離(P=0.000)、視網(wǎng)膜裂孔(P=0.001)、眼內(nèi)異物的大小(P=0.023)、異物取出的時(shí)間(P=0.006)、前房積血(P=0.032)、玻璃體積血(P=0.025)以及術(shù)前BCVA(P=0.014)。眼內(nèi)炎與預(yù)后視力無明顯相關(guān)性(r=-0.089,P0.05)。眼后段異物的長(zhǎng)度與術(shù)前、術(shù)后最佳矯正視力呈負(fù)相關(guān)(P0.05)。視網(wǎng)膜脫離與最終的最佳矯正視力(BCVA)有關(guān)(P0.05)。視網(wǎng)膜裂孔與術(shù)后B CVA相關(guān)(P0.05),異物取出的時(shí)間也與視力預(yù)后相關(guān)(P0.05),異物越早取出,術(shù)后BCVA越好。前房積血和玻璃體積血也影響術(shù)后BCVA(P0.05),清除了前房積血和玻璃體積血可以提高術(shù)后BCVA。術(shù)前BCVA越好,術(shù)后BCVA越佳(P0.05)。眼內(nèi)異物的移除時(shí)間與眼內(nèi)炎發(fā)病率沒有直接聯(lián)系(r=-0.183,P0.05),眼內(nèi)炎基本不影響視力。異物進(jìn)入部位與前房積血發(fā)病率具有相關(guān)性(P0.05),異物從Ⅲ區(qū)進(jìn)入眼球更易引起前房積血。結(jié)論:更大的眼內(nèi)異物、合并視網(wǎng)膜脫離、視網(wǎng)膜裂孔、前房積血、玻璃體積血、延長(zhǎng)異物取出時(shí)間,在開放性眼外傷中會(huì)引起更嚴(yán)重的后果,視力預(yù)后會(huì)更差。護(hù)目鏡在預(yù)防工傷中起很大的作用。在我們的研究中,是否行Ⅰ期縫合+玻璃體腔內(nèi)注藥術(shù)或者直接行玻璃體切割聯(lián)合眼球清創(chuàng)縫合對(duì)視力及解剖學(xué)的恢復(fù)并無顯著影響,但是異物取出的早晚對(duì)視力預(yù)后有影響,因此,可先行Ⅰ期縫合及玻璃體腔內(nèi)注藥術(shù),玻璃體切除術(shù)可以稍延遲至24-48小時(shí),仍需盡快行PPV取出眼內(nèi)異物。
[Abstract]:BACKGROUND: Open-eye trauma is one of the most important factors in the loss of vision in young people or working groups. We selected the patients with open eye trauma IOFBs to remove the intraocular foreign body, and collected the frequency of each factor that may affect the visual prognosis of the patient, and to know the effect of IOFBs on the eye and the effect of vitrectomy on the patient's visual prognosis. Objective: To analyze the effect of vitrectomy and the related factors of visual prognosis in patients with open eye injury. Methods: From December 2015 to January 2017,40 eyes of intraocular foreign bodies were diagnosed as intraocular foreign bodies in the first hospital of Chongqing Medical University from December 2015 to January 2017. All the intraocular foreign bodies in the posterior segment of the eye were taken out by vitrectomy. The data were analyzed by using SPSS19.0, such as age, sex, pre-operation/ post-operative best corrected vision (BCVA), foreign body property, size, intraocular foreign body removal time, intraocular foreign body entry area, intraocular foreign body residual position, operation timing, operation mode and complications. Results: The average age of the patients was 43.15,37 (92.5%),3 (7.5%),25 (62.5%),16 (40%),24 (60%), and 2 (5%). There were 12 eyes (30%) in the vitreous cavity,18 eyes (45%) embedded in the retina, and 10 eyes (25%) penetrating the wall of the eye. There were 10 eyes (25%) in the anterior chamber,24 eyes (60%) with vitreous hemorrhage,19 eyes (47.5%) with retinal detachment,28 eyes (70%) with retinal tears, and 8 (20%) combined with endophthalmitis. There were 18 eyes (45%) of the foreign body,22 eyes (55%) with a foreign body of 3 mm,26 eyes (65%) taken out of the intraocular foreign body in two days, and 14 eyes (35%) taken out after 2 days. There were 8 eyes (20%) of BCVA-4.0 before operation, and 32 eyes (80%) in preoperative BCVA4.0. There were 16 eyes (40%) and 24 eyes (60%) of BCVA-4.0 after operation. The main factors of the patient's vision were the retinal detachment (P = 0.000), the retinal hole (P = 0.001), the size of the intraocular foreign body (P = 0.023), the time of foreign body removal (P = 0.006), the hyphema of the anterior chamber (P = 0.032), the vitreous hemorrhage (P = 0.025), and the preoperative BCVA (P = 0.014). There was no significant correlation between endophthalmitis and prognosis (r =-0.089, P0.05). The length of the foreign body in the posterior segment of the eye was negatively correlated with the best corrected vision before and after the operation (P0.05). The retinal detachment was related to the final corrected visual acuity (BCVA) (P0.05). The retinal hole was related to the postoperative B-CVA (P0.05). The time of the foreign body removal was related to the prognosis of the visual acuity (P0.05). The earlier the foreign body was taken out, the better the BCVA after operation. The postoperative BCVA (P0.05) was also affected by the hyphema of the anterior chamber and the volume of the vitreous, and the postoperative BCVA could be enhanced by clearing the hyphema of the anterior chamber and the vitreous hemorrhage. The better the preoperative BCVA, the better the BCVA after operation (P0.05). The removal time of intraocular foreign body was not directly related to the incidence of endophthalmitis (r =-0.183, P0.05). There was a correlation between the incidence of foreign bodies and the incidence of hyphema in the anterior chamber (P0.05). Conclusion: The larger intraocular foreign body, combined with retinal detachment, retinal tear, hyphema, vitreous hemorrhage, extension of foreign body take-out time, can cause more serious consequence in open eye injury, and the prognosis of vision is worse. Goggles play a major role in the prevention of work-related injuries. In our study, whether I-phase suture + vitreous cavity injection or direct-line vitrectomy combined with ocular debridement and suture has no significant effect on the recovery of vision and anatomy, but the sooner or later the foreign body is taken out will have an effect on the visual prognosis, so, Vitrectomy can be delayed to 24-48 hours in the first stage and in the vitreous cavity, and the intraocular foreign body should be removed as soon as possible.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R779.6
本文編號(hào)：2499524
[Abstract]:BACKGROUND: Open-eye trauma is one of the most important factors in the loss of vision in young people or working groups. We selected the patients with open eye trauma IOFBs to remove the intraocular foreign body, and collected the frequency of each factor that may affect the visual prognosis of the patient, and to know the effect of IOFBs on the eye and the effect of vitrectomy on the patient's visual prognosis. Objective: To analyze the effect of vitrectomy and the related factors of visual prognosis in patients with open eye injury. Methods: From December 2015 to January 2017,40 eyes of intraocular foreign bodies were diagnosed as intraocular foreign bodies in the first hospital of Chongqing Medical University from December 2015 to January 2017. All the intraocular foreign bodies in the posterior segment of the eye were taken out by vitrectomy. The data were analyzed by using SPSS19.0, such as age, sex, pre-operation/ post-operative best corrected vision (BCVA), foreign body property, size, intraocular foreign body removal time, intraocular foreign body entry area, intraocular foreign body residual position, operation timing, operation mode and complications. Results: The average age of the patients was 43.15,37 (92.5%),3 (7.5%),25 (62.5%),16 (40%),24 (60%), and 2 (5%). There were 12 eyes (30%) in the vitreous cavity,18 eyes (45%) embedded in the retina, and 10 eyes (25%) penetrating the wall of the eye. There were 10 eyes (25%) in the anterior chamber,24 eyes (60%) with vitreous hemorrhage,19 eyes (47.5%) with retinal detachment,28 eyes (70%) with retinal tears, and 8 (20%) combined with endophthalmitis. There were 18 eyes (45%) of the foreign body,22 eyes (55%) with a foreign body of 3 mm,26 eyes (65%) taken out of the intraocular foreign body in two days, and 14 eyes (35%) taken out after 2 days. There were 8 eyes (20%) of BCVA-4.0 before operation, and 32 eyes (80%) in preoperative BCVA4.0. There were 16 eyes (40%) and 24 eyes (60%) of BCVA-4.0 after operation. The main factors of the patient's vision were the retinal detachment (P = 0.000), the retinal hole (P = 0.001), the size of the intraocular foreign body (P = 0.023), the time of foreign body removal (P = 0.006), the hyphema of the anterior chamber (P = 0.032), the vitreous hemorrhage (P = 0.025), and the preoperative BCVA (P = 0.014). There was no significant correlation between endophthalmitis and prognosis (r =-0.089, P0.05). The length of the foreign body in the posterior segment of the eye was negatively correlated with the best corrected vision before and after the operation (P0.05). The retinal detachment was related to the final corrected visual acuity (BCVA) (P0.05). The retinal hole was related to the postoperative B-CVA (P0.05). The time of the foreign body removal was related to the prognosis of the visual acuity (P0.05). The earlier the foreign body was taken out, the better the BCVA after operation. The postoperative BCVA (P0.05) was also affected by the hyphema of the anterior chamber and the volume of the vitreous, and the postoperative BCVA could be enhanced by clearing the hyphema of the anterior chamber and the vitreous hemorrhage. The better the preoperative BCVA, the better the BCVA after operation (P0.05). The removal time of intraocular foreign body was not directly related to the incidence of endophthalmitis (r =-0.183, P0.05). There was a correlation between the incidence of foreign bodies and the incidence of hyphema in the anterior chamber (P0.05). Conclusion: The larger intraocular foreign body, combined with retinal detachment, retinal tear, hyphema, vitreous hemorrhage, extension of foreign body take-out time, can cause more serious consequence in open eye injury, and the prognosis of vision is worse. Goggles play a major role in the prevention of work-related injuries. In our study, whether I-phase suture + vitreous cavity injection or direct-line vitrectomy combined with ocular debridement and suture has no significant effect on the recovery of vision and anatomy, but the sooner or later the foreign body is taken out will have an effect on the visual prognosis, so, Vitrectomy can be delayed to 24-48 hours in the first stage and in the vitreous cavity, and the intraocular foreign body should be removed as soon as possible.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R779.6
【參考文獻(xiàn)】
相關(guān)期刊論文 前1條
1 吳淑鳳;李玉濤;;球內(nèi)異物的性質(zhì)與外傷性眼內(nèi)炎的關(guān)系[J];臨床眼科雜志;2015年03期
，本文編號(hào)：2499524
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