【摘要】：目的評(píng)價(jià)經(jīng)玻璃體切除手術(shù)和經(jīng)鞏膜切口或非玻璃體切除取出異物手術(shù)治療后段眼內(nèi)磁性異物傷的臨床療效,以及對(duì)玻璃體切除手術(shù)治療后視力預(yù)后的主要影響因素。 方法回顧性分析2006年6月至2010年12月,后段眼內(nèi)異物傷住院治療換者113例113眼,其中經(jīng)玻璃體切除聯(lián)合異物取出者61眼,非玻璃體切除取出眼內(nèi)異物者52眼。并分別對(duì)手術(shù)方式、術(shù)前最佳矯正視力(BCVA)、異物大小、異物位置、外傷嚴(yán)重程度、手術(shù)時(shí)間、視網(wǎng)膜脫離(RD)與術(shù)后BCVA的關(guān)系進(jìn)行分析。統(tǒng)計(jì)軟件采用SPSS 13.0 for Windows,顯著性檢驗(yàn)水準(zhǔn)以P0.05為有顯著性差異。 結(jié)果 1.經(jīng)玻璃體切除手術(shù)眼內(nèi)異物取出成功率為100%,經(jīng)鞏膜切口取出異物手術(shù)眼內(nèi)異物取出成功率為86.54%。 2.兩組病例手術(shù)前BCVA分布及外傷程度無(wú)明顯統(tǒng)計(jì)學(xué)差異。經(jīng)玻璃體切除手術(shù)治療組70.49%的患眼術(shù)前BCVA力低于0.1,非玻璃體切除治療組75.00%的患眼術(shù)前BCVA低于0.1。 3.經(jīng)玻璃體切除治療組患者術(shù)后BCVA0.1者48眼(78.69%),≥0.5者18眼(29.51%),玻璃體切除治療組手術(shù)前后BCVA有顯著統(tǒng)計(jì)學(xué)差異。非玻璃體切除組術(shù)后BCVA0.1者5眼(5.77%),≥0.5者2眼(3.85%),非玻璃體切除組手術(shù)前后BCVA無(wú)統(tǒng)計(jì)學(xué)意義。兩組患者手術(shù)后視力分布統(tǒng)計(jì)學(xué)上有顯著差異(Z二一6.453,P=0.0000.05)。 4.經(jīng)玻璃體切除手術(shù)治療組術(shù)后并發(fā)癥少于非玻璃體切除手術(shù)治療組,P0.05,有統(tǒng)計(jì)學(xué)意義。玻璃體切除手術(shù)治療組術(shù)后發(fā)生RD者4眼,外傷性增生性玻璃體視網(wǎng)膜病變(tPVR)者3眼,玻璃體出血者1眼；6眼(9.84%)再次行玻璃體切除手術(shù),術(shù)后視網(wǎng)膜均復(fù)位。非玻璃體切除治療組術(shù)后發(fā)生RD者24眼,tPVR者26眼,玻璃體出血者36眼,眼內(nèi)炎者3眼；43眼(82.69%)于術(shù)后5-20d行Ⅱ期玻璃體切割或聯(lián)合視網(wǎng)膜復(fù)位手術(shù),2眼視網(wǎng)膜無(wú)法復(fù)位,1眼眼內(nèi)容物剜除。 5.玻璃體切除聯(lián)合眼內(nèi)異物取出手術(shù)后影響B(tài)CVA的因素包括傷口長(zhǎng)度、術(shù)前BCVA、手術(shù)時(shí)機(jī)、RD、眼內(nèi)炎、異物損傷區(qū)域。 結(jié)論 1.后段眼內(nèi)異物傷眼,經(jīng)玻璃體切除手術(shù)治療較經(jīng)鞏膜路徑手術(shù)取出異物的取出率高、術(shù)后視力恢復(fù)好、并發(fā)癥少。 2.對(duì)伴有眼內(nèi)炎和視網(wǎng)膜脫離的后段眼內(nèi)異物傷患者,應(yīng)首選玻璃體切除手術(shù)治療。 3.玻璃體切除取出后段眼內(nèi)異物手術(shù)后,影響B(tài)CVA的主要相關(guān)因素包括傷口長(zhǎng)度、術(shù)前BCVA、手術(shù)時(shí)機(jī)、視網(wǎng)膜脫離、眼內(nèi)炎、異物損傷區(qū)域。 4.RD和tPVR是眼內(nèi)異物傷及經(jīng)玻璃體切除手術(shù)取出異物后常見(jiàn)的嚴(yán)重并發(fā)癥,視力預(yù)后較差。 5.后段眼內(nèi)異物傷合并眼內(nèi)炎者宜應(yīng)盡早行玻璃體切割手術(shù)治療,但術(shù)后視力恢復(fù)極差。
[Abstract]:Objective to evaluate the clinical effect of transvitrectomy and scleral incision or non-vitrectomy in the treatment of posterior intraocular magnetic foreign body injury and the main factors influencing the prognosis of visual acuity after vitrectomy. Methods 113 cases (113 eyes) with posterior intraocular foreign body injury were treated retrospectively from June 2006 to December 2010. Among them, 61 eyes were removed by vitrectomy combined with foreign body, and 52 eyes were removed intraocular foreign body by non-vitrectomy. The relationship between (BCVA), foreign body size, location of foreign body, severity of trauma, operation time, retinal detachment (RD) and postoperative BCVA were analyzed respectively. Statistical software using SPSS 13.0 for Windows, significant test level of P0.05 as a significant difference. Result 1. The success rate of intraocular foreign body removal was 100% after vitrectomy and 86.54% through scleral incision. 2. There was no significant difference in the distribution of BCVA and the degree of trauma between the two groups before operation. The preoperative BCVA strength of 70.49% of the affected eyes was lower than 0.1 in the vitrectomy group, and the preoperative BCVA of 75.00% of the non-vitrectomy group was lower than 0.1. 3. BCVA0.1 in 48 eyes (78.69%) and 鈮，

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