眼内异物摘出术后视网膜脱离

目的 报告并分析眼内异物摘出术后视网膜脱离发生率及有关病因。方法 眼内异物２０例（２０眼）,用玻璃体切除术摘出眼内异物。结果 ２０眼中术后视网膜脱离４眼（２０％）。术后视力提高１４眼（７０％）,视力不变３眼（１５％）,视力下降３眼（１５％）。结论 眼内异物摘出术后视网膜脱离发生原因：⑴残留玻璃体形成牵拉;⑵激光封闭裂孔不确切;⑶术中未发现的小裂孔;⑷术前玻璃体积血浑浊未能及时激光治疗;⑸异物较大,     

Visual outcome and prognostic factors after magnetic extraction of posterior segment foreign bodies in 40 cases

AIMS—To evaluate the clinical features as well as the visual and anatomical outcome in eyes with magnetic posterior segment foreign bodies, to identify prognostic factors after removal using an electromagnet.
METHODS—The records of 40 patients with posterior segment foreign bodies were retrospectively reviewed for 6 years (1989-94). Post-traumatic cataracts and secondary retinal detachments were treated using conventional surgical techniques. Pars plana vitrectomy was used only for late complications. The mean follow up was 30 months (6-71). Clinical factors were studied using univariate analysis.
RESULTS—The most common findings before treatment of these 40 eyes were lens wound, hyphaema, vitreous haemorrhage, and retinal impairment. The foreign body was in the vitreous (85%) or minimally embedded in the retina (15%). Initial visual acuity was worse or equal to 20/40 in 70% of the cases. Subsequent to surgical treatment, a cataract was reported in 60% of the patients. Postoperative complications included retinal detachment (15%) and phthysis (5%). The prognosis was worse in cases with intraocular foreign body of largest diameter 3 mm, an initial visual acuity less than 20/200, or the presence of post-traumatic retinal detachment. Presence of initial intravitreous haemorrhage, hyphaema, or intraocular tissue prolapse did not appear to affect the prognosis.
CONCLUSION—The long term visual acuity results indicated that wound repair associated with conventional magnet extraction in an emergency is a viable treatment for posterior segment magnetic foreign bodies in this selected group. At the time of diagnosis, size of foreign body (<3 mm) and initial visual acuity 20/200 were predictors of good visual outcome after primary magnetic extraction.

Keywords: intraocular foreign body; penetrating ocular injury; pars plana magnetic extraction     

Primary intraocular lens implantation during pars plana vitrectomy and intraretinal foreign body removal.

PURPOSE: To evaluate visual and surgical outcomes as well as complication rates after cataract extraction and primary intraocular lens (IOL) implantation during pars plana vitrectomy for removal of foreign bodies embedded or impacting in the retina. METHODS: Six consecutive cases of simultaneous cataract extraction and IOL implantation combined with vitreous surgery and intraocular foreign body extraction were retrospectively analyzed. In five cases, the foreign body was intraretinal; in one case, it was preretinal with retinal impact site. The follow-up period ranged from 5 to 45 months (mean 21.3 months). RESULTS: Visual acuity improved by two or more lines in five of six eyes. In five eyes, best-corrected postoperative visual acuity was better than 20/40. One eye was successfully reoperated for retinal detachment that developed 2 months postoperatively. In four eyes, the IOL was implanted into the capsular bag; in two cases, the IOL was placed in the ciliary sulcus. No postoperative complication was attributed to IOL implantation. CONCLUSION: Primary IOL implantation after combined cataract and vitreoretinal surgery is a safe and attractive option, reducing the need for two separate operations in selected patients with penetrating ocular injury and retained intraocular foreign bodies. The main advantage is more rapid visual rehabilitation with a single operation, reducing costs and patient discomfort.     

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。     

Combined phacoemulsification, vitrectomy, foreign-body extraction, and intraocular lens implantation

PURPOSE: To assess the outcome of simultaneous phacoemulsification, pars plana vitrectomy, intraocular foreign-body extraction, and intraocular lens (IOL) implantation. SETTING: SSK Ankara Eye Hospital, Department of Vitreoretinal Surgery, Ankara, Turkey. METHODS: Seventeen patients with corneal perforation, intraocular foreign body, vitreous hemorrhage, and lens opacity had simultaneous clear corneal phacoemulsification, pars plana vitrectomy, intraocular foreign-body extraction, and IOL implantation. RESULTS: Postoperative complications included massive retinal fibrosis in 2 patients, retinal detachment in 1, and cilioretinal artery occlusion in 1. At a mean follow-up of 15.2 months, best corrected visual acuity improved in the remaining 13 eyes (76%). The IOL was stable in all cases. CONCLUSION: Combined phacoemulsification with IOL implantation and vitreoretinal surgery was safe in selected cases of penetrating ocular trauma resulting from an intraocular foreign body.     

Intraocular foreign bodies. Factors influencing final visual outcome.

PURPOSE: To identify the prognostic factors of poor visual outcome (visual acuity < or =6/240) in eyes with intraocular foreign bodies. METHODS: The records of 95 consecutive patients were retrospectively reviewed for 6 years (1990-1995). All eyes underwent a primary surgical repair and foreign-body removal (electromagnet or vitrectomy). The mean follow-up period was 25 months (6-72 months). Single analysis and multiple logistic stepwise regression analysis were performed to determine predictors of poor vision. RESULTS: Thirty patients (31.6%) showed 6/240 or worse vision at the end of their follow-up period. Three significant predictive factors had independent and combined effects on post-operative visual outcome: a corneo-scleral entry wound (odds ratio (OR)=14.5, p=0.001), largest diameter of IOFB (OR=1.21, p=0.01) and the presence of secondary retinal detachment (OR=9.48, p=0.0002). Post-operative complications included traumatic cataracts (51%), retinal detachments (28%) and phthisis bulbi (8%). CONCLUSION: Using multivariate analysis, corneo-scleral entry wound, largest diameter of foreign body and secondary retinal detachment were found to be predictors of poor visual outcome after intraocular foreign body removal. Our results suggest that patients with high-risk intraocular foreign body trauma should be candidates for pars plana vitrectomy rather than electromagnet procedure.     

Management of posterior segment intraocular foreign bodies: 14 years' experience

BACKGROUND: Penetrating ocular injuries with retained posterior segment foreign bodies are challenging cases requiring urgent attention by vitreoretinal surgeons. Posteriorly located injuries can result in serious immediate and delayed vitreoretinal sequelae, such as retinal detachment and endophthalmitis. We report our experience with posterior segment intraocular foreign bodies. METHODS: We reviewed the records of all patients with penetrating ocular injury with retained intraocular foreign bodies treated at a university-based referral practice in Toronto between April 1981 and December 1995. We noted the pre- and postoperative Snellen visual acuity, type and volume of foreign body, diagnostic technique, surgical management, and pre- and postoperative complications. RESULTS: Forty-one patients (all male with a mean age of 38 [range 8 to 78] years) were treated during the study period. The length of follow-up ranged from 1 to 118 (mean 20) months. Eighteen patients (44%) experienced a delay in diagnosis or management, or both, of 1 day to 3 years. The rates of retinal detachment and endophthalmitis were 41% (17/41) and 17% (7/41) respectively; culture gave positive results in 5 cases. Two of the eyes required enucleation. A final visual acuity of 6/60 or better was obtained in 33 eyes (80%) and of 6/12 or better in 21 eyes (51%). Multiple linear regression analysis showed that only immediate retinal detachment and the presence of a relative afferent pupillary defect had a significant independent effect on final visual acuity. In our previous series (1971-81) the retinal detachment rate was 14% (4/28), and there were no cases of culture-positive endophthalmitis; final visual acuities of 6/60 or better and of 6/12 or better were obtained in 46% and 32% of the eyes respectively. INTERPRETATION: Reasons for the better outcomes in our more recent series may include improved localization of posterior segment foreign bodies with computed tomography, more frequent intravitreal surgery with improved vitrectomy techniques and the use of the intraocular magnet.     

Combined lens and vitreoretinal surgery in patients with traumatic cataract and intraocular foreign body

AIM: To analyze the postoperative anatomical and functional outcomes as well as complications after combined phacoemul- sification, pars plana vitrectomy (PPV), removal of the intraocular foreign body (IOFB) and intraocular lens (IOL) implantation in patients with traumatic cataract and intraocular foreign body. METHODS: Medical records of 13 patients(13 eyes) with traumatic cataract and IOFB who had undergone combined phacoemulsification, PPV, foreign body extraction and IOL implantation were retrospectively analyzed. The postoperative follow-up ranged from 2 to 12 months. The main measure- ments of outcomes were the extraction success of cataract and intraocular foreign body, intraoperative and postoperative complications and the final best corrected visual acuity (BCVA). ·RESULTS: The mean age of 13 patients(10 male, 3 female )was 36.8 years (range: 17-65 years). All eight IOFBs were removed. Four intraocular lenses were implanted after vitrectomy intraoperatively. In 5 cases, intraocular lenses were implanted during the second operation. Intraocular lenses were not implanted in 4 cases. BCVA at last ranged from 0.8 to hand movement. BCVA was 0.5 or better in four eyes, 0.1 to 0.4 in five eyes, less than 0.1 in four eyes. Intraoperative complications were encountered in 3 patients. They had vitreous hemorrhage. Postoperative complications were encounter- ed in 2 patients. They had retinal detachment. The reoperations of the two patients were successful. CONCLUSION: The combined phacoemulsification, PPV, removal of IOFB and IOL implantation is safe and effective for patients with traumatic cataract and intraocular foreign body. The visual outcome depended primarily on the corneal or scleral wound and underlying posterior segment pathology and sites.     

Managment of Intraretinal Foreign Bodies

Closed posterior intraocular microsurgery with vitreous instruments and bimanual surgical techniques have markedly altered the management of intraocular foreign bodies (IOFB). This paper presents an approach to 14 metallic intraretinal foreign bodies (IRFB) that could not be removed by conventional methods. In all cases, posterior vitrectomy was required to visualize the foreign body or to facilitate its removal through a pars plana incision with intraocular forceps under microscopic visualization. Although successful removal of the intraretinal foreign body was possible in all 14 patients, central visual acuity of 20/400 or better was obtainable in only 40% of this series., An important observation in these patients was a tendency to macular pucker from subsequent epiretinal membrane formation and retinal detachment with massive periretinal proliferation (MPP), which occurred in 90% of these eyes. Despite an obviously enhanced ability to remove foreign bodies from the retina, made possible by vitreous instruments and surgical techniques, the magnitude of the secondary complications in this variety of ocular trauma suggests a poor visual prognosis for such injuries.     

玻璃体切除治疗眼内异物继发视网膜脱离

目的　探讨眼内异物继发视网膜脱离的临床特点 ,评价玻璃体切除手术的治疗效果。方法　回顾性分析 1999年2月～ 2 0 0 2年 10月期间 3 2例经玻璃体切除手术治疗的眼内异物继发视网膜脱离的病例资料。结果　本组 3 2例 (3 4眼 )均成功摘出异物 ,3 0例 (3 0眼 )占 88.2 4% ,术后视力得到不同程度的提高或稳定在术前水平 ,视网膜复位 2 9例 ,占 85 .2 9% .结论　玻璃体牵引、裂孔形成是眼内异物继发视网膜脱离的关键。玻璃体切除手术可成功地摘出眼内异物 ,有效地处理视网膜脱离等并发症。     

闭合式玻璃体切除术472例分析

本文总结了４７２例４９１眼玻璃体除术的疗效，临床上分为６组，外伤性玻璃体浑浊机化，外伤性玻璃浑浊机化合并视网膜玻璃，眼内异物合并玻璃体混浊机化，眼内异物合并玻璃体浑浊及视网膜脱离，眼内炎及视网膜血管病所致的玻璃体浑浊机化，４９１眼中有３４７眼进行了联合手术，本文对各组的视力结果，手术时机，手术并发症，外伤性视网膜脱离的特点及预后作了分析讨论。     

玻璃体手术治疗眼内异物分析

目的：探讨眼内异物的玻璃体手术取出方法的优缺点。方法：35例（35只眼）眼内异物患者，伴严重眼内炎3只眼，外伤性白内障22只眼，玻璃体出血机化16只眼。经眼底和超声检查伴视网膜脱离12只眼。玻璃体部分后脱离5只眼。异物为铁、铜、不锈钢、玻璃、石块、矿砂等，大小自0．5mm-25mm，大部分伴屈光间质混浊，异物停留在玻璃体、视网膜或球壁，经玻璃体手术取出，再结合切除混浊晶状体、环扎、气液交换、注硅油等。结果：异物一次取出成功34只眼，占97．1％。手术后并发症主要有出血、高眼压、白内障和视网膜脱离等。术后视力下降6只眼，不变10只眼，好转19只眼。结论：玻璃体手术取异物能同时解除屈光间质混浊、眼内炎，治疗视网膜脱离，是一种较好的手术。但也有不少并发症，手术复杂，需仔细检查、设计周密，术中配合良好，才能达到取异物成功、并发症少的最理想后果。     

Retinal redetachment after removal of intraocular silicone oil tamponade

AIM: To evaluate frequency and risk factors of retinal redetachment after removal of intraocular silicone oil tamponade. METHODS: The study included 225 patients who consecutively underwent intraocular silicone oil removal at a mean interval of 10 months after pars plana vitrectomy had been performed by one of two surgeons. Mean follow up time was 17.37 (SD 14.40) months (range 3.02-67.42 months). RESULTS: In 57 of 225 (25.3%) patients, the retina detached after removal of silicone oil. Risk factors for retinal redetachment were the following: number of previously unsuccessful retinal detachment surgeries (p=0.0008); surgeon (p=0.007); visual acuity before silicone oil removal (p=0.009); incomplete removal of vitreous base (p=0.01); absence of an encircling band in eyes with proliferate vitreoretinopathy in which an inferior retinotomy had not been performed (p=0.01); and indication for pars plana vitrectomy. Rate of retinal redetachment was statistically (p>0.05) independent of the technique of silicone oil removal and duration of silicone oil endotamponade. CONCLUSION: Retinal redetachment after removal of silicone oil endotamponade can occur in approximately a fourth of patients, depending on the criteria to use and to remove silicone oil. Risk factors for recurrent detachment included the following: number of previously unsuccessful retinal detachment surgeries, surgeon, preoperative visual acuity, incomplete removal of the vitreous base, absence of an encircling band, and reason for pars plana vitrectomy. The rate of retinal redetachment is independent of the technique of silicone oil removal and duration of silicone oil endotamponade, with a minimal duration of silicone oil tamponade of about 3 months in the present study.     

Pars plana vitrectomy for severe penetrating injury with posterior segment involvement

We studied 50 consecutive cases of severe penetrating ocular trauma with posterior segment involvement for which vitreous surgery and scleral buckling were performed as secondary reparative procedures. Eyes with a better prognosis, such as those with anterior segment injuries alone and intraocular foreign bodies, were excluded. Of 50 eyes, 31 (62%) had a successful outcome. There was a significant difference in visual outcome between those eyes that had received blunt and sharp penetrating trauma. Visual acuity of 20/50 or better was more frequently attained in eyes with sharp penetrating trauma (P = .002). Thirty-three eyes had initial retinal detachment; 17 (52%) were successfully repaired. Blunt penetrating trauma produced retinal detachment more frequently than sharp penetrating trauma (22 of 29 vs 11 of 21). Retinal detachment was more often successfully repaired after sharp penetrating trauma (8 of 11 vs 9 of 22). Contusive damage to the choroid and retina limited final visual and anatomic results after blunt rupture of the globe.     

Comparison between clinical and ultrasound findings in patients with vitreous hemorrhage

PURPOSE: To ascertain the causes of vitreous hemorrhage and to determine the accuracy of ultrasound (U/S) in these cases, based on the degree of agreement between ultrasound and clinical findings. METHODS: A chart review of 96 consecutive patients (106 eyes) with dense vitreous hemorrhage who underwent A- and B-scan U/S by one examiner between June 1996 and June 1999. U/S records were evaluated to determine the presence and exact distribution of areas of retinal detachment and the presence of posterior vitreous detachment, retinal tear, intraocular foreign body, or choroidal detachment. Clinical information was obtained from the medical records after the vitreous hemorrhage was reabsorbed or following vitreous surgery. Clinical and U/S findings were compared. False-positive and False-negative rates for U/S were calculated based on clinical findings. RESULTS: In 37 eyes (35%) the vitreous hemorrhage was because of proliferative diabetic retinopathy and in 33 eyes (31%) because of ocular trauma. The false-positive rate for retinal detachment (retinal detachment by U/S without clinical confirmation) was 18.9% (seven of 37 eyes). Retinal tears were diagnosed and localized accurately in only four of nine eyes (44%). CONCLUSIONS: The most common cause of vitreous hemorrhage was proliferative diabetic retinopathy, followed by ocular trauma. U/S correctly diagnosed all cases of retinal detachment, but less than 50% of retinal tears. A total of 18.9% of the eyes were falsely diagnosed as having retinal detachment. U/S is an effective diagnostic tool in patients with vitreous hemorrhage.     

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.     

25G微创玻璃体切割术治疗球内异物的临床观察

目的　探讨25G微创玻璃体切割术治疗眼后段球内异物的临床疗效。方法　回顾性分析眼后段球内异物并接受25G微创玻璃体切割术联合球内异物取出术的21例21眼患者临床资料,其中17例17眼为磁性异物,4例4眼为非磁性异物。20例（20眼）并发白内障,3例3眼伴眼内炎,12例12眼伴视网膜脱离。根据不同的病情分别联合了白内障摘出、视网膜复位、硅油填充等操作,术后随访6个月,对其并发症和手术效果进行分析。结果　所有患眼均于完善术前检查后尽快行25G微创玻璃体切割手术联合球内异物取出术,Ⅰ期球内异物取出率为100%,眼内炎3眼炎症均得到控制,术中摘出混浊的晶状体,20例20眼球内异物由角膜切口取出,1例由巩膜切口取出。共19眼术后矫正视力较术前视力有所提高,14眼进行了II期人工晶状体植入,2眼硅油存留。术后未见与微创手术相关的并发症。结论　25G微创玻璃体切割术在眼后段球内异物取出术中显示出良好的临床效果,手术创伤小,视功能恢复快,并发症少,但要注意其适应证的选择。     

伴有视网膜裂孔的眼内异物玻璃体手术摘除的临床观察

目的 :总结与分析眼外伤眼内异物同时伴有视网膜裂孔的病例手术方式选择及临床疗效。方法 :对 15例眼外伤眼内异物同时伴有视网膜裂孔的 15只眼进行回顾性疗效分析。结果 :本组 15例 15只眼采用玻璃体视网膜手术 ,异物一次性取出 ,根据视网膜裂孔及损伤情况 ,2只眼因裂孔小未行光凝 ,其余 13只眼行裂孔周围视网膜光凝 ,其中 2只眼气液交换眼内空气填充 ,3只眼C3 F8填充 ,4只眼硅油填充。主要并发症 :视网膜再出血 3只眼 ,术后增生性玻璃体视网膜病变 5只眼 ,其中视网膜脱离 3只眼。术后矫正视力 :光感～指数 2只眼 ,0 0 2～ 0 0 9者 3只眼 ,0 1～ 0 2者 6只眼 ,>0 3者 4只眼。结论 :采用玻璃体视网膜手术 ,有效地眼内光凝 ,并选择合适的眼内填充物对伴有视网膜裂孔的眼内异物伤有较好的疗效。     

后入路玻璃体切割术治疗眼球贯通伤伴球内异物

目的:探索早期后入路玻璃体切割术治疗眼球贯通伤伴球内异物的有效性.方法:近2a来我院急诊收治的10例10眼眼球贯通伤伴球内异物患者,急诊行玻璃体切割+眼内异物取出+硅油填充术,术后给予积极预防感染、消炎处理,根据伤道周围视网膜生长情况补充视网膜光凝.结果:患者1眼因化脓性眼内炎、术中视网膜脉络膜损毁严重视网膜未能复位,最终眼球萎缩,患者9眼成功施行玻璃体切割手术,取出异物,随诊时间3~18mo,其中2例患者因复发性视网膜脱离行二次玻切硅油置换手术,其余患者视网膜复位良好,无再出血,眼压维持8~21mmHg;最后一次随访时患者3眼最佳矫正视力>0.1,2眼矫正视力0.01~0.1,患者4眼因后极部脉络膜视网膜损伤严重矫正视力光感~指数/50cm,眼球萎缩患者视力无光感.结论:早期后入路玻璃体切割、异物取出联合硅油填充术为一种有效地治疗眼球贯通伤伴球内异物的手术治疗方法.     

Outcome of Complex Retinal Detachment Surgery after Silicone Oil Removal

BACKGROUND AND OBJECTIVE: To evaluate anatomical prognosis after silicone oil removal. PATIENT AND METHODS: Sixty-eight eyes which underwent silicone oil removal were enrolled into the study. The underlying ocular pathology for pars plana vitrectomy, surgical methods, and time of silicone oil removal were analysed. RESULTS: Sixteen of 68 eyes (23.5%) redetached following the removal of silicone oil. According to etiology redetachment rates: PVR C 9.5% (2/21), PVR D 25% (4/16), trauma without intraocular foreign body 27.3% (3/11), with intraocular foreign body 33.3% (2/6), giant retinal tear 37.5% (3/8), and proliferative diabetic retinopathy with tractional retinal detachment 33.3% (2/6). The rate of redetachment was 22% in patients with encircling band and 27.8% without encircling band. Retina was redetached in the first 10 days in 81.3% of patients after silicone oil removal. CONCLUSION: The residual vitreoretinal traction especially at the vitreous base is the most likely reason for retinal redetachment after silicone oil removal, which is most commonly seen during the first 10 days.