眼铁质沉着症的临床分析

目的:探讨眼铁质沉着症(ocular siderosis)的临床特点及治疗方案。方法:对我院2002年1月至2006年12月收治的64例眼铁沉着症患者进行回顾性分析。结果:56例手术取出残留的异物,其中33例异物最大长径≤2.0mm,位于下方睫状体扁平部或锯齿缘附近26例;眼眶X光正侧位照片联合薄骨位照片异物显影阳性率76.56%,超声生物显微镜(Ultrasound biomicroscope,UBM)异物显影阳性率47.62%;晶状体前囊铁锈沉着发生率100%,继发性青光眼发生率7.69%,视网膜脱离发生率13.84%;视网膜电流图(Electroretino-gram,ERG)karpe分期Ⅲ期占7/10和Ⅳ期占3/10;56例患者作了眼内异物取出,异物取出率100%,术中发现16.07%病例异物磁性消失。结论:眼铁质沉着症残留的异物以最大长径≤2.0mm为主,主要位于下方睫状体扁平部或锯齿缘附近;眼眶X光照片为首选的检查方法,UBM可作为眼前段异物影像学检查辅助手段;ERG改变以karpe分期的Ⅲ期和Ⅳ期为主;玻璃体手术是取出眼内异物最有效的治疗手段。眼科学报2007;23:231-237.

Clinical Analysis of Ocular Siderosis

PURPOSE: To study the clinical characteristics of ocular siderosis and discuss the way for treatment. METHODS: Sixty-four patients (64 eyes) with ocular siderosis treated in Ophthalmic Center of Zhongshan University from January 2002 to December 2006 were retrospectively analyzed. RESULTS: The intraocular foreign body (IOFB) was found in 56 cases, with maximum length < or = 2.0 mm in 33 cases; 26 eyes with foreign body located on pars plane or near the ora serrate. The positive rate of foreign body was 76.56% by orbital posteroanterior and lateral radiogram combined with Belot's radiogram and 47.62% by ultrasound biomicroscope (UBM). The occurrence rate of iron deposits in the epithelial cells of the anterior capsule was 100%, secondary glaucoma was 7.69% and retina detachment was 13.84% respectively. Electroretinogram (ERG) was abnormal in 10 case, 7 cases with stage III and 3 cases with stage IV. The intraocular foreign body extraction was done in 56 cases and the success rate was 100%. The magnetism of the intraocular foreign body disappeared in 16.07% of the cases. CONCLUSIONS: The intraocular foreign body < or = 2.0 mm was most frequently found in ocular siderosis and mainly located on pars plane or near the ora serrate. Orbital radiogram has advantage to diagnose the intraocular foreign bodies, and UBM can be used as an assistant image-related approach for checking the intraocular foreign body on the anterior segment. Most cases were in Stage III and IV by ERG. Vitrectomy is the most effective approach to remove the intraocular foreign bodies.