磁共振成像与CT在眼内非磁性异物诊断和定位中的比较

目的探讨磁共振成像（ｍａｇｎｅｔｉｃｒｅｓｏｎａｎｃｅｉｍａｇｉｎｇ，ＭＲＩ）和ＣＴ在眼内异物诊断和定位中的特点。方法以手术结果作为验证标准，比较２８例（４２枚）眼内非磁性异物在ＭＲＩ和ＣＴ图像上的显示及定位情况。结果４２枚眼内非磁性异物，ＭＲＩ和ＣＴ的检出率分别为９０．５％和９５．２％（ｘ２检验，Ｐ＞０．５）。ＭＲＩ与ＣＴ显示异物位置的准确率分别为８９．５％和６０．０％（ｘ２检验，Ｐ＜０．０５）。结论ＭＲＩ可用于眼内非磁性异物的诊断和定位，检出率高，在揭示异物与眼内组织的位置关系及显示眼内非磁性低密度异物方面优于ＣＴ，但对于眼球壁异物的显示则不如ＣＴ可靠。ＭＲＩ不宜用于眼内磁性异物的检查。     

Magnetic resonance imaging and computed tomography in the detection and localization of intraocular foreign bodies

In this experimental study, various foreign bodies were inserted into fresh bovine eyes, in different localizations. Twenty-one magnetic and non-magnetic foreign bodies, dimensions of which varied from 1.5 × 1.5 × 2 mm to 3.5 × 6 × 7 mm, were tried to detect by computed tomography (CT) and magnetic resonance imaging (MRI) scanning. In addition, further dissections were applied to check the ocular damage attributable to movement of the foreign bodies. Ferromagnetic foreign bodies have been shown to move in the eye and the risk of torsional forces being applied to the ferromagnetic foreign body seemed to cause intraocular complications during MRI scanning. All of the foreign bodies that were implanted in bovine eyes were recognized on CT scanning, except intraocular lenses. As a general rule, metallic foreign bodies produced beamhardening artifacts, but these artifacts did not cause any problem in detecting the localizations of foreign bodies.     

Orbital helical computed tomography in the diagnosis and management of eye trauma

OBJECTIVE: To prospectively determine the accuracy of helical computed tomography (CT) and multiplanar reconstruction and its value in surgical planning for the management of ocular trauma with suspected intraocular and orbital foreign bodies using surgical and clinical follow-up findings as the gold standard. DESIGN: Prospective, observational case series. PARTICIPANTS: Thirty-six patients with ocular trauma and suspected foreign bodies were studied. INTERVENTION: All patients were examined using a standardized scanning protocol with helical CT direct scanning in the axial plane and multiplanar reconstruction of coronal and sagittal planes. MAIN OUTCOME MEASURES: The images were analyzed for the presence and number of intraocular and orbital foreign bodies, anatomic location, and foreign body size. The surgical and clinical follow-up findings (contact lens examination, gonioscopy, indirect ophthalmoscopy and scleral depression, perimetry, color testing, measurement of size) were used as the gold standard to which the image results were compared. RESULTS: Helical CT showed a single intraocular foreign body in 14 patients, a single orbital foreign body in 9 patients, and multiple orbital foreign bodies in 2 patients. Intraocular or orbital foreign bodies were excluded in 11 patients. Twenty foreign bodies were correlated with surgical results. Surgical and clinical follow-up findings were in agreement with helical CT results regarding the detection and determination of the number of presumed foreign bodies. Localization to intraocular versus orbital compartment and proximity to the optic nerve was accurate in all patients. Determination of size of the foreign bodies on the helical CT images was reliable and repeatable. CONCLUSIONS: Helical CT axial scanning with multiplanar reconstruction is accurate at detecting and localizing intraocular and orbital metallic, glass, and stone foreign bodies. This imaging method aids the surgeon in choosing the surgical approach to retained intraocular and orbital foreign bodies.     

眼内异物CT定位图的设计和应用

目的 评价眼内异物CT定位图在眼内异物定位中的有效性和准确性。方法 参阅CT水平或冠状扫描序列片将显影异物按照测量结果标画在相应的眼内异物CT定位图上，然后根据异物所在的经线和深度进行手术摘出异物。结果 47例(47眼)眼内异物中，有40例为眼内磁性金属异物，采用此法定位，全部迅速、准确地摘出异物。结论 眼内异物CT定位图应用在眼内异物的定位中，简便易行、迅速准确，特别适用眼内磁性金属异物定位。     

眼球穿孔伤292例临床分析

目的分析眼球穿孔伤的易发人群,致伤原因,并发症及治疗效果。方法对我院2006年1月-2007年12月收治的眼球穿孔伤292例回顾性统计分析。结果统计结果显示,男∶女=5.49∶1,右眼∶左眼=1.05∶1,多发年龄为20-50岁。致伤物种类主要为异物。并发症主要为外伤性白内障,眼内异物和前房积血。出院时视力低于0.05者169眼,占57.29%。结论眼球穿孔伤是主要致盲原因之一,从眼球穿孔伤的致伤人群及性质的分析中可知大部分眼球穿孔伤是可以预防的。     

螺旋CT在眼部异物诊断中的应用

目的 运用螺旋CT对眼部异物进行定性和定位检查，以期了解螺旋CT在眼部异物诊断中的优缺点。方法 对52例可疑眼部异物患者，采用螺旋CT的横切、冠状位扫描、CT多平面重建和／或表面覆盖法重建。结果 发现眼内或眶内异物存留者20例，其中普通X线未显影而螺旋CT显影者8例，并可基本确诊异物的位置，漏诊1例。结论 螺旋CT对眼内、眶内异物的诊断具有特殊的价值，尤其对细小异物和重要部位异物的诊断具有重要意义。     

超声活体显微镜和CT诊断眼前段异物的对比分析

目的 探讨超声活体显微镜(UBM)和CT两种不同成像方法 对眼前段异物诊断的优缺点及联合应用的价值.方法 为比较研究,收集2000年7月至2007年5月共44例疑诊为眼前段异物的患者同时行UBM和CT检查的资料,并与其手术结果 相对照.结果 CT扫描发现其中40例表现为高密度影,分别为铁、铜、石块、玻璃等;2例稍高密度影,均为塑料;2例无异常发现者分别为竹签和板栗刺.44例患者UBM检查均表现为强回声光斑伴声影.结论 CT对眼前段异物难以精确定位和发现并发症.UBM对所有眼前段异物均可准确定位,并能发现异物相关并发症.但其操作复杂,扫描视野小,检查费时.眼前段异物诊断的最佳方案为先行CT扫描确定异物方位及异物种类,再行UBM检查确定异物准确位置,发现并发症.(中华眼科杂志,2008,44:229-232)     

多层螺旋CT在眼球异物立体精确定位的临床应用

目的探讨多层螺旋CT眼球异物立体定位方法及临床应用价值。方法98例眼外伤中35只眼球内、39枚异物行多层螺旋CT扫描立体定位,以入院术中取出为“金标准”来衡量多层螺旋CT对眼球异物立体定位的准确率,球内壁、球外壁空间定位的精确性。结果多层螺旋CT对39枚球内异物的诊断,35枚完全符合,符合率89.7%,4例非金属异物于眼球前部未显示而不符,达10.3%。35枚异物的方位及角巩膜缘距,对照术中定位准确率100%;异物位于球内壁、球外壁的判断的空间精确率（18/18）100%;同时明确球内并发症及周围解剖关系。结论多层螺旋CT对所能显示的异物的精确定位,具有简便准确可靠特点,因此有条件尽可能用多层螺旋CT一次性解决眼球内异物定位。     

Ocular spectrum of kite injury: A six-year trend at a tertiary eye care center

Purpose:To assess ocular morbidity attributable to kites (patang) with emphasis on the cause, type and severity of the injury, complications, and final visual outcome.Methods:All the patients with a history of kite injury during months of Makar Sankranti for consecutive 6 years (2014–2019) were included in this study. A B-scan, orbital X-ray, and CT scan were performed for extensive ocular evaluation.Results:Out of 68 patients with kite-related injury, 58 were male and 10 were female. Globe rupture (20), lid laceration (18), penetrating injury (9), wooden foreign body in the anterior or posterior chamber (7), superficial foreign body (4), hyphema (7), and vitreous hemorrhage (3) due to falling from height were noted. Factors associated with a poor final visual outcome in our study were poor initial visual acuity, globe rupture, intraocular foreign body, and development of endophthalmitis.Conclusion:Kites can cause serious preventable injuries mostly among pediatric males. The use of protective eyewear and public awareness can decrease ocular injury significantly.     

玻璃体切割术治疗异物引起的眼球贯通伤

目的评价异物引起的眼球贯通伤行玻璃体切割术的治疗效果,探讨异物取出的手术路径和玻璃体切割手术时机的选择。方法回顾性系列病例研究。由异物导致的眼球贯通伤56例（56眼）。根据CT和B超检查结果联合定位,分为球壁异物组（24例）和眶内异物组（32例）。24例球壁异物在伤后1周内均通过玻璃体视网膜手术取出异物。32例眶内异物中有22例先行眶内异物取出联合后巩膜伤口缝合术。10例因异物位于后极部或眶深部未行取出术。所有眶内异物组患眼均于伤后2周左有行玻璃体视网膜手术修复眼内组织。随访3-12个月,观察术后视力和并发症。以卡方检验分析影响术后视力的冈素。结果玻璃体切割术后,50例（89％）患者视力较术前提高,34例（61％）术后最佳矫正视力≥0．05。异物人口位置（X^2=7．69,P=0．01）、出口位置（X^2=21．83,P〈0．01）、视网膜脱离（X^2=-16．64,P〈0．01）、脉络膜脱离（X^2=7．73,P=0．01）以及眼内感染（X^2=6．89．P=0．01）对术后视力影响较大。术后6例发生视网膜脱离,2例低眼压,12例发生黄斑前膜或皱褶。结论根据异物的位置和眼内情况选择恰当的手术路径和玻璃体切割的手术时机,最大限度地减少手术对视网膜组织的损伤及预防增殖性玻璃体视网膜病变是成功治疗眼球贯通伤的关键。     

燃放烟花爆竹所致眼外伤临床分析

目的分析探讨燃放烟花爆竹所致眼外伤的类型、程度、治疗重点及预防办法。方法回顾分析被烟花爆竹炸伤的病例138例(158眼)的受伤情况,包括爆炸物种类、损伤类型、损伤程度、治疗方法及治疗结果等。结果138例(158眼)中男136例(156眼),女2例(2眼)。其中20岁以下50例,占36.24%。致伤原因中礼花弹炸伤42例(55眼),二踢脚炸伤43例(48眼),其它种类鞭炮炸伤53例(55眼)。单眼伤占89.47%。损伤类型主要为角膜巩膜破裂伤、前房积血、外伤性白内障、玻璃体积血、睫状体脱离、虹膜根部断离、视网膜脱离、眼内异物及视神经挫伤等。所有病例每人至少存在以上2种类型的损伤。治疗后视力<0.05者占53.85%。结论燃放烟花爆竹是眼外伤致盲和致残的重要原因之一。     

Clinical Application of X-ray, B-scan, and CT in the Diagnosis of Ocular Foreign Bodies

 PURPOSE:To analyze the sensitivity and specificity of X-ray, B-ultrasound, and CT scan in diagnosing ocular foreign bodies, and to compare the accuracy of  these three imaging tools in locating these foreign bodies. METHODS:A retrospective review was conducted of radiographic and clinical eye examination data from 62 patients (66 eyes), suspected of having ocular foreign bodies at time of first presentation to the Zhongshan Ophthalmic Center (Guangzhou, China) between August 2007 and October 2011. The sensitivity and specificity of X-ray, B-ultrasound and CT scan in the diagnosis of ocular foreign bodies were investigated and their accuracy in locating these foreign bodies was compared. RESULTS:A total of 75.8% (n = 47) subjects had ocular foreign bodies; 66% of these were metallic. Patients with intraocular, eye wall, and extraocular foreign bodies accounted for 46, 28, and 26% of the total, respectively. The sensitivities ofX-ray, CT scan, and B-ultrasound in the diagnosis of ocular foreign bodies were 58.3%, 61.7%, and 75%, the specificityies were 63.3%, 100%, and 87.5%, and the accuracy in locating foreign bodies was 73.4%, 94.7%, and 86.5%, respectively. The properties of foreign bodies affected the diagnosistic accuracy of X-ray, but exerted little impact upon B-ultrasound and CT scan.  CONCLUSION:A fairly high incidence of ocular foreign bodies was noted in patients suspected with ocular foreign bodies at their first presentations. X-ray combined with CT scan or X-ray in combination with B ultrasound showed a relatively high sensitivity and specificity in diagnosing ocular foreign bodies. CT scan had the highest accuracy in locating ocular foreign bodies.     

Clinical features, radiological imaging, and treatment strategies of nonmetallic intraorbital foreign bodies: a retrospective analysis

AIM: To provide comprehensive data on nonmetallic intraorbital foreign bodies (IOFBs) by summarizing and analyzing material types, clinical manifestations, imaging features, and treatment strategies. METHODS: Totally 28 nonmetallic IOFB cases treated at Shengjing Hospital of China Medical University from 2012 to 2020 were retrospectively reviewed. The types of foreign bodies, clinical features, imaging manifestations, and treatment outcomes were analyzed. RESULTS: Among all cases, 67.8% (19/28) of the foreign bodies were organic. The top three entrances were the upper eyelid skin (7/28), lower fornix conjunctiva (6/28), and lower eyelid skin (4/28). In most cases (11/28, 39.3%), foreign bodies remained in the medial orbits. The major clinical manifestations included eyelid redness and swelling (20/28, 71.4%), conjunctival congestion and edema (17/28, 60.7%), and ophthalmoptosis (15/28, 53.6%). Infection was the main complication, which occurred in 57.1% (16/28) of all cases. Computerized tomography (CT) values differed for different foreign bodies and varied in the different periods after injury. The plant- and grease-derived foreign bodies and the surrounding pus cysts showed different signals on magnetic resonance imaging (MRI). The prognosis varied with different foreign body types, surgery timing, and intraoperative management. CONCLUSION: The majority of nonmetallic IOFBs are organic and often remain in the superior, medial, and inferior areas of the orbit. Clinical manifestations vary owing to their different textures. CT and MRI facilitate the identification of foreign body materials. Plant-derived foreign bodies should be completely removed, and surgical treatment is a complicated process.     

眼内异物的B型超声扫描诊断分析

目的：分析眼异物在B型超声扫描探查中的声像学特点及定位的优势，为临床诊断提供依据。方法：采用眼科专用A、B型两用超声波扫描仪，对38例眼异物进行探查。结果：本组38例中32例经B超探查发现异物回声，异物检出率为84．2％（32／38）其中眼内异物22例（57．9％）；眼球壁异物9例（23．7％）；眶内异物1例（2．6％）。有30例行X光或CT检查，结果23例发现异物，异物检出率为76．6％（23／30），其中眼内异物16例（53．3％）；球壁异物4例（13．3％）；眶内异物3例（10．0％）。结论：B型超声探查对于眼内异物，特别是眼球壁异物具有特异性的诊断价值。     

23G玻璃体切除术治疗金属异物致眼球穿通伤的疗效及预后

目的：总结金属异物所致眼球穿通伤的特点,评价23G玻璃体切除术治疗金属异物所致眼球穿通伤的疗效和安全性,并应用眼外伤评分系统分析影响患者终视力的因素。

方法：前瞻性连续分析2014-07-01/2016-06-01在我院住院的金属异物所致眼球穿通伤需行23G玻璃体切除手术的患者38例38眼,收集患者年龄、性别、眼别、受伤场所、异物大小、伤口长度、异物位置、初视力与终视力、黄斑情况等资料。应用眼外伤评分系统(ocular trauma score,OTS)评估患者预后。随访时间均超过6mo。

结果：患者38例38眼中,眼外伤主要发生在工作场所,共33例(87%); 其次为运动场所,共3例(8%)。球内异物行23G玻璃体切除术术后矫正视力≥0.1者共21眼(55%)。术前出现视网膜脱离、异物较大(>5.0mm)、晶状体损伤是预后差的重要因素。异物位于玻璃体者23眼(61%),位于视网膜者15眼(39%)。就诊时即出现视网膜脱离者21眼(55%),眼内炎者7眼(18%),球内异物(intraocular foreign bodies,IFOB)直径>5.0mm者7眼(18%),术后出现较严重PVR者6眼(16%),黄斑前膜者5眼(13%)。相同OTS评分下,术后6mo视力明显优于术前; 无论术前还是术后6mo视力,OTS评分越高,视力越好。

结论：金属异物所致眼球穿通伤多发生在40岁以下年轻男性,以工作场所为主,未采用防护措施是受伤的主要原因。影响最终视力的主要因素是受伤后出现视网膜脱离、异物>5.0mm和术后PVR的出现。23G玻璃体切除术治疗金属异物所致眼球穿通伤安全、可靠、有效。OTS评分可有效用于金属异物所致眼球穿通伤患者,并作出合理、有用的术后视力预测。     

Missed intraocular foreign body masquerading as intraocular inflammation: two cases

To report two cases with missed intraocular foreign body masquerading as intraocular inflammation. The first patient was referred to our clinic with a diagnosis of a traumatic cataract. She had a history of ocular trauma. The clinical examination revealed intraocular inflammation and a mature cataract. Plain X-ray did not reveal a foreign body. She underwent a successful cataract surgery and intraocular lens implantation 1 month after the initial examination. Two months after the surgery she returned with visual impairment and intraocular inflammation. The foreign body was discovered on the surface of the iris during the follow-up. The second patient was referred to us for endophthalmitis. He denied ocular trauma. Plain X-ray, computerized tomography, and ultrasonography did not show a foreign body, but because of clinical suspicion, surgery was scheduled. In both patients the intraocular foreign bodies in the anterior chamber were removed successfully by a limbal approach. The patients remained symptom free after the foreign bodies were removed. The intraocular inflammation did not persist. A history of ocular trauma, unexplained intraocular inflammation, or intraocular inflammation unresponsive to the standard therapies should alert the physician to the presence of an intraocular foreign body. Further investigations should be performed in these cases to detect the foreign body.     

Role of scheimpflug imaging in traumatic intralenticular foreign body

PURPOSE: The role of Pentacam Scheimpflug imaging in evaluation of penetrating eye injury and intralenticular foreign body (ILFB). DESIGN: Interventional case report. METHODS: A 35-year-old male presented to our clinical practice with penetrating eye injury and endophthalmitis. Scheimpflug imaging helped localize the intralenticular foreign body (ILFB). It confirmed the posterior capsule to be intact. He underwent phacoemulsification, foreign body removal, and intraocular lens (IOL) implant. Postoperatively, IOL was imaged with Pentacam Scheimpflug imaging. RESULTS: Scheimpflug imaging allowed us to confirm the presence and exact location of ILFB and its relation to the intact posterior capsule as well as the postoperative IOL positioning. This helped in better planning of management of traumatic cataract with ILFB. CONCLUSIONS: Pentacam is a potential tool for accurate localization of foreign bodies lodged in the lens and provides an objective basis for better patient counseling and surgical planning.     

Management of magnetic intravitreal foreign bodies in 71 eyes.

BACKGROUND AND OBJECTIVE: To evaluate the management of a series of eyes with magnetic intravitreal foreign bodies. PATIENTS AND METHODS: This retrospective review examined consecutive cases of ocular injury associated with intraocular foreign bodies; 71 eyes included had a single metallic intraocular foreign body (< 5 mm) located in the vitreous cavity removed by external magnet or intraocular forceps. Variables included preoperative and postoperative visual acuity, retinal break formation, retinal detachment, presence of an afferent pupillary defect, intraocular pressure, entrance site, foreign body size, method of extraction, and time between occurrence and surgical extraction. RESULTS: Factors predictive of good visual outcome (visual acuity > 20/200) were: shortest interval between trauma and foreign body extraction, preoperative visual acuity of 20/200 or better, and absence of afferent pupillary defect. CONCLUSIONS: In this nonrandomized study, good visual results could be obtained in eyes undergoing prompt foreign body removal, especially those with good preoperative visual acuity and no afferent pupillary defect.     

Histopathologically proven siderotic cataract with disintegrated intralenticular foreign body

Cataract formation may be an indicator of early siderosis and has been associated with intralenticular foreign bodies. We report a unique case of histopathologically proven lens siderosis in a young man with a preceding history of trauma but no signs of retained intraocular foreign body. He presented with a total white cataract with brownish deposits on anterior capsule and underwent cataract surgery for same followed by histopathological staining of anterior capsule for iron deposits. This case illustrates the importance of close monitoring of patients with history of trauma or previous penetrating injury to the eye, albeit no intraocular foreign body, as they might develop ocular siderosis at a later stage.