CAJ | 학술논문

目的对比研究应用23 G微创玻璃体切除术经巩膜或角膜切口摘出后段眼内异物的效果及安全性.方法后段眼内异物采用23 G微创玻璃体切除异物摘出手术34例(34只眼),随机分两组.A组经巩膜切口摘出异物,B组经角膜切口摘出异物.对比研究两种不同术式术中出现葡萄膜、玻璃体脱出及异物脱落情况,术后门诊随访3～12个月,对比研究视网膜脱离、眼压、视力、角膜内皮细胞计数等情况.结果所有异物均顺利摘出,A组17例,术中扩大巩膜穿刺口,出现葡萄膜、玻璃体脱出3例,术中异物脱落损伤后极部视网膜2例;B组17例,术中自原创口或扩大角膜缘切口,未出现葡萄膜、玻璃体脱出,未发生术中异物脱落.随访3～ 12个月,未出现眼内炎,视力均不同程度提高,其中A组术后出现视网膜脱离1例,再次行网膜复位手术.随访期间,两组角膜内皮细胞计数、眼压等差异无统计学意义.结论应用23 G微创玻璃体切除术经巩膜或角膜切口摘出后段眼内异物,均安全有效.其中经巩膜切口摘出异物能避免角膜二次损伤,维持前房稳定性,避免晶状体二次损伤;经角膜切口摘出异物充分利用23 G微创玻璃体切除系统密闭性优势,避免扩大巩膜切口,防止巩膜切口葡萄膜及玻璃体脱出,而且经角膜异物摘出操作可视性强,术中异物有晶状体囊及虹膜衬托,不容易脱落,避免二次损伤视网膜组织,尤其适用于非磁性异物的摘出,术后随访观察对角膜组织影响较小.经角膜切口的方法对于特定后段眼内异物摘出具有更安全,有效的优势.
목적 대비연구응용23 G미창파리체절제술경공막혹각막절구적출후단안내이물적효과급안전성.방법 후단안내이물채용23 G미창파리체절제이물적출수술34례(34지안),수궤분량조.A조경공막절구적출이물,B조경각막절구적출이물.대비연구량충불동술식술중출현포도막、파리체탈출급이물탈락정황,술후문진수방3～12개월,대비연구시망막탈리、안압、시력、각막내피세포계수등정황.결과 소유이물균순리적출,A조17례,술중확대공막천자구,출현포도막、파리체탈출3례,술중이물탈락손상후겁부시망막2례;B조17례,술중자원창구혹확대각막연절구,미출현포도막、파리체탈출,미발생술중이물탈락.수방3～ 12개월,미출현안내염,시력균불동정도제고,기중A조술후출현시망막탈리1례,재차행망막복위수술.수방기간,량조각막내피세포계수、안압등차이무통계학의의.결론 응용23 G미창파리체절제술경공막혹각막절구적출후단안내이물,균안전유효.기중경공막절구적출이물능피면각막이차손상,유지전방은정성,피면정상체이차손상;경각막절구적출이물충분이용23 G미창파리체절제계통밀폐성우세,피면확대공막절구,방지공막절구포도막급파리체탈출,이차경각막이물적출조작가시성강,술중이물유정상체낭급홍막츤탁,불용역탈락,피면이차손상시망막조직,우기괄용우비자성이물적적출,술후수방관찰대각막조직영향교소.경각막절구적방법대우특정후단안내이물적출구유경안전,유효적우세.
Objective To compare the clinical effects and safety of 23 G vitrectomy through limbal corneal incision or scleral incision for the extraction of posterior segment intraocular foreign bodies.Methods Thirty-four eyes of 34 patients who underwent 23 G vitrectomy for the extraction of posterior segment intraocular foreign body were randomly divided into two groups.Scleral incision was made to extract the foreign body in group A.Limbal corneal incision was made in group B.The prolapse rate of uvea and vitreous and the difficulty of extraction of intraocular foreign bodies by two surgical ways were compared.The follow up time was 3 ～ 12 months.The retinal detachment rate,intraocular pressure,visual acuity and corneal endothelial cells were analyzed postoperatively.Results All foreign bodies were successfully removed.Vitreous and uvea prolapse happened in 3 cases and foreign bodies dropped and caused the damage of posterior retina in 2 cases in group A when the sclera incision was enlarged during the surgery,while no one happened in group B.During the follow-up of 3 ～12 months,the visual acuity was improved postoperatively and no endophthalmitis happened.Retinal detachment occured in 1 case in group A and the retinal reattachment operation was performed again.The difference in intraocular pressure,corneal endothelial cell counting between two groups was not statistically significant.Conclusion 23 G vitrectomy through limbal corneal incision or scleral incision for the extraction of posterior segment intraocular foreign body all are safe and effective.It can avoid secondary injury of cornea and lens and maintain anterior chamber stability when through scleral incision,while it can avoid uvea and vitreous prolapse and the foreign body dropping during the surgery due to the lens capsule and iris,and get clear way out through limbal corneal incision,which is a safer and more effective way especially for posterior segment intraocular foreign bodies extraction.