CAJ | 학술논문

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。目的：探討23G微創玻璃體切除繫統在外傷性白內障閤併後段眼內異物患者手術治療中的應用效果。方法迴顧性分析2011年1月至2013年5月期間，河南省鄭州市第二人民醫院眼科收治的39例（39隻眼）外傷性白內障閤併後段眼內異物患者的臨床資料，所有患者均實施白內障摘除聯閤23G微創玻璃體切除術進行治療，手術者在直視下取齣患者眼內異物。隨訪觀察患者術後1～6箇月最佳矯正視力（BCVA）、增生性玻璃體視網膜病變（PVR）髮生情況、視網膜複位情況及併髮癥髮生情況。結果本組39例（39隻眼）患者均一次性成功將異物摘除，術後1箇月BCVA＜0．05者22隻眼（56．41％），BCVA≥0．05者17隻眼（43．58％）；術後6箇月，BCVA＜0．05者18隻眼（46．15％），BCVA≥0．05者21隻眼（53．84％）。術後視力提高者28隻眼（71．79％），視力不變者8隻眼（20．51％），視力下降者3隻眼（7．69％）。本組患者術前及術中髮現視網膜脫離者12例（12隻眼），術中視網膜全部一次性複位，術後C3F8氣體填充8例（8隻眼），硅油填充4例（4隻眼）；閤併眼內炎癥者2例（2隻眼）行白內障摘除聯閤玻璃體切除及異物摘齣後均行硅油填充，術後炎癥得到控製。術後1箇月4例（4隻眼）患者齣現PVR，其中前部PVR者3例（3隻眼），後部PVR者1例（1隻眼），所有患者再次行鞏膜外環扎＋外墊壓＋剝膜＋光凝＋註油術治療，PVR髮生率為10．26％（4/39隻眼）；術後6箇月髮現9例（9隻眼）患者齣現PVR，其中前部PVR者4例（4隻眼），後部PVR者5例（5隻眼），除兩名患者放棄治療外，其餘患者再次行鞏膜外環扎＋外墊壓＋剝膜＋光凝＋註油術治療，PVR髮生率為23．08％（9/39隻眼）。術後9例（9隻眼）患者齣現不同程度的前房積血，患者在對癥治療後積血吸收；7例（7隻眼）患者髮生一過性低眼壓，經包扎處理後眼壓均恢複正常；10例（10隻眼）患者髮生繼髮性青光眼，經過糖皮質激素藥物治療及降眼壓對癥處理後8例（8隻眼）患者痊愈，其餘2例（2隻眼）患者行Ahmed青光眼閥植入術，術後患者眼壓得以控製。結論對外傷性白內障閤併後段眼內異物患者實施23G微創玻璃體手術進行治療，能成功取齣其眼內異物，降低術後併髮癥的髮生率，提高手術質量。
목적：탐토23G미창파리체절제계통재외상성백내장합병후단안내이물환자수술치료중적응용효과。방법회고성분석2011년1월지2013년5월기간，하남성정주시제이인민의원안과수치적39례（39지안）외상성백내장합병후단안내이물환자적림상자료，소유환자균실시백내장적제연합23G미창파리체절제술진행치료，수술자재직시하취출환자안내이물。수방관찰환자술후1～6개월최가교정시력（BCVA）、증생성파리체시망막병변（PVR）발생정황、시망막복위정황급병발증발생정황。결과본조39례（39지안）환자균일차성성공장이물적제，술후1개월BCVA＜0．05자22지안（56．41％），BCVA≥0．05자17지안（43．58％）；술후6개월，BCVA＜0．05자18지안（46．15％），BCVA≥0．05자21지안（53．84％）。술후시력제고자28지안（71．79％），시력불변자8지안（20．51％），시력하강자3지안（7．69％）。본조환자술전급술중발현시망막탈리자12례（12지안），술중시망막전부일차성복위，술후C3F8기체전충8례（8지안），규유전충4례（4지안）；합병안내염증자2례（2지안）행백내장적제연합파리체절제급이물적출후균행규유전충，술후염증득도공제。술후1개월4례（4지안）환자출현PVR，기중전부PVR자3례（3지안），후부PVR자1례（1지안），소유환자재차행공막외배찰＋외점압＋박막＋광응＋주유술치료，PVR발생솔위10．26％（4/39지안）；술후6개월발현9례（9지안）환자출현PVR，기중전부PVR자4례（4지안），후부PVR자5례（5지안），제량명환자방기치료외，기여환자재차행공막외배찰＋외점압＋박막＋광응＋주유술치료，PVR발생솔위23．08％（9/39지안）。술후9례（9지안）환자출현불동정도적전방적혈，환자재대증치료후적혈흡수；7례（7지안）환자발생일과성저안압，경포찰처리후안압균회복정상；10례（10지안）환자발생계발성청광안，경과당피질격소약물치료급강안압대증처리후8례（8지안）환자전유，기여2례（2지안）환자행Ahmed청광안벌식입술，술후환자안압득이공제。결론대외상성백내장합병후단안내이물환자실시23G미창파리체수술진행치료，능성공취출기안내이물，강저술후병발증적발생솔，제고수술질량。
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.