CAJ | 학술논문

目的探讨玻璃体切除术中应用显微枪形麦粒钳取出巨大非磁性眼内异物临床疗效.方法对22例(22只眼)巨大非磁性眼内异物患者进行回顾性研究,排除无晶状体损伤眼,完成晶状体、玻璃体切除,暴露异物后玻璃体腔注入重水,麦粒钳经扩大的巩膜穿刺口进入玻璃体腔,钳夹异物递送至前房,前房内注入黏弹剂,有齿镊接力将异物自角巩膜缘隧道切口取出.行眼内激光,选择惰性气体或硅油填充.术后随访3～12个月(平均6个月),根据眼内情况行二期手术.结果 22例22只眼巨大非磁性眼内异物(玻璃异物14只眼,塑料4只眼,石块3只眼,木块1只眼)均一次性取出,未发生因取异物造成眼部二次损伤.19只眼行硅油填充,3只眼行气体填充.3个月后12只眼行人工晶状体植入术,5只眼因矫正视力不佳仅行硅油取出术,5只眼发生复发性视网膜脱离(其中3只眼行再次手术后视网膜复位,2眼硅油依赖(瘢痕增生重,视网膜脱离不易修复,讲明情况后患者选择暂不取油).随访期间2只眼(9.1％)矫正视力≥0.3(1只眼视力0.6,1只眼视力0.4),5只眼(22.7％)视力0.12～0.25,7只眼(31.8％)视力0.06～0.1,8只眼(36.4％)视力≤0.05.结论显微枪形麦粒钳在巨大非磁性眼内异物取出术中钳夹异物牢靠,有利于异物的一次性取出,避免异物的二次损伤,术后并发症少,值得在临床推广应用.
목적 탐토파리체절제술중응용현미창형맥립겸취출거대비자성안내이물림상료효.방법 대22례(22지안)거대비자성안내이물환자진행회고성연구,배제무정상체손상안,완성정상체、파리체절제,폭로이물후파리체강주입중수,맥립겸경확대적공막천자구진입파리체강,겸협이물체송지전방,전방내주입점탄제,유치섭접력장이물자각공막연수도절구취출.행안내격광,선택타성기체혹규유전충.술후수방3～12개월(평균6개월),근거안내정황행이기수술.결과 22례22지안거대비자성안내이물(파리이물14지안,소료4지안,석괴3지안,목괴1지안)균일차성취출,미발생인취이물조성안부이차손상.19지안행규유전충,3지안행기체전충.3개월후12지안행인공정상체식입술,5지안인교정시력불가부행규유취출술,5지안발생복발성시망막탈리(기중3지안행재차수술후시망막복위,2안규유의뢰(반흔증생중,시망막탈리불역수복,강명정황후환자선택잠불취유).수방기간2지안(9.1％)교정시력≥0.3(1지안시력0.6,1지안시력0.4),5지안(22.7％)시력0.12～0.25,7지안(31.8％)시력0.06～0.1,8지안(36.4％)시력≤0.05.결론 현미창형맥립겸재거대비자성안내이물취출술중겸협이물뢰고,유리우이물적일차성취출,피면이물적이차손상,술후병발증소,치득재림상추엄응용.
Objective To evaluate the effect of extraction of giant nonmagnetic intraocular foreign body (IOFB) with microscopy gun-shaped kernels clamp.Methods Twenty two cases (22 eyes) with giant nonmagnetic intraocular foreign body were studied for retrospective analysis.The eyes without traumatic cataract were excluded.Firstly lentectomy and vitrectomy were done,infused the perfluorocarbon liquid after the IOFB was exposed.The IOFB was transferred into anterior chamber by kernels clamp,and then the IOFB was extracted through limbus incision.The photocoagulation was performed,and C3F8 gas or silicon oil was used for internal tam-ponade.The postoperative follow up periods ranged from 3 to 12 months (mean=6 months).Results All giant nonmagnetic intraocular foreign bodies were removed successfully in 22 cases (22 eyes),none of patients occurred intraoperative complications.Silicone oil for internal tam-ponade was used in 19 eyes and C3F8 gas in 3 eyes.Three months after operation,the extraction of silicon oil was performed only in 5 eyes because of the less corrected visual acuity; the intraocular lens implantation was performed in 12 eyes.Retinal detachment occurred in 5 eyes (Retinal reattached after second vitreous surgery in 3 eyes,silicone oil dependency in 2 eyes).The corrected visual acuity was greater than 0.3 (≥0.3) in 2 eyes (9.1％),greater than 0.12 (0.12-0.25) in 5 eyes (22.7％),greater than 0.06 (0.06-0.1) in 7 eyes,the rest (8 eyes,39.4％) had visual acuity of less than 0.05 (≤0.05).Conclusions The extraction of giant nonmagnetic intraocular foreign body with microscopy gun-shaped kernels clamp is a safe and effective choice which is helpful to reduce serious complications.