40例行PPV取出眼后段眼内异物的疗效分析

Clinical analysis of 40 cases of removing posterior intraocular foreign bodies with PPV

摘要:

目的： 分析眼后段眼内异物行玻璃体切除术（pars plana vitrectormy，PPV）取出异物对视力的影响。方法： 回顾性分析2015年12月至2017年1月于重庆医科大学附属第一医院眼科入院诊断为眼后段眼内异物共40例40眼，所有眼后段眼内异物均通过23G微创PPV取出。研究统计了年龄、性别、术前/术后最佳矫正视力（best corrected visual acuity，BCVA），眼后段异物性质、大小，眼内异物移除时间，眼内异物进入位置，眼内异物残留位置，手术时机，手术方式和并发症等因素。结果： 40例患者异物均被取出，取出率为100%，术后平均BCVA较术前平均BCVA明显增高（t=4.295，P=0.000），具有统计学意义。患者视力的主要影响因素为视网膜脱离（P=0.000）、视网膜裂孔（P=0.001）、眼内异物的大小（P=0.023）、异物取出的时间（P=0.006）、前房积血（P=0.032）、玻璃体积血（P=0.025）等。结论： 更大的眼内异物、合并视网膜脱离、视网膜裂孔、前房积血、玻璃体积血、异物取出时间越长，在开放性眼外伤中会引起更严重的后果，视力预后会更差。本研究中，是否行Ⅰ期缝合+玻璃体腔内注药术或者直接行PPV联合眼球清创缝合对视力及解剖学的恢复并无显著影响，但是异物取出的早晚对视力预后有影响，PPV能够更好地取出眼内异物并发现眼内并发症，及时处理，对患者的视力恢复起重要作用。

Abstract:

Objective: To analyze the effect of pars plana vitrectormy (PPV) on visual acuity of posterior intraocular foreign body. Methods: Retrospective analysis was made in 40 cases of posterior segment intraocular foreign bodies (40 eyes, all in posterior segment intraocular foreign bodies by 23G minimally invasive PPV) admitted to the Department of Ophthalmology, The First Affiliated Hospital of Chongqing Medical University from December 2015 to January 2017. We studied such following factors as age, gender, preoperative/postoperative best corrected visual acuity (BCVA), posterior segment foreign material properties, size, intraocular foreign body removal time, position of intraocular foreign bodies, intraocular foreign bodies left position, operation time, operation method and complications in the statistics. Results: The 40 foreign bodies were all taken out, and the probability was 100%. The average BCVA after operation was significantly better than that before the operation (t=4.295, P=0.000). The main influencing factors for the vision of patients were retinal detachment (P=0.000), the retina injury (P=0.001), the size of the intraocular foreign bodies (P=0.023), the time of removing the foreign bodies (P=0.006), hyphema (P=0.032), and vitreous hemorrhage (P=0.025). Conclusion: Greater intraocular foreign bodies and combination of retinal detachment, retinal hiatus, hyphema, vitreous hemorrhage, the time of removing foreign bodies longer in the open in trauma can cause more serious consequences, and worse prognosis of eyesight. In our study, whether stage Ⅰ suture + intravitreal infusion or direct vitrectomy combined with ocular debridement and suture had no significant impact on the recovery of vision and anatomy. But vitrectomy can better remove intraocular foreign body complicated with intraocular complications, and timely treatment plays an important role in the recovery of visual acuity for patients.