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。     

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。     

Localization of intraocular foreign bodies using computed tomography

PURPOSE: To present the evaluation of computed tomography (CT) application for detecting the intraocular foreign bodies. MATERIAL AND METHODS: Sixteen computed tomographies of orbit to localise a foreign body were performed in the 2nd Radiology Department at Lublin University School of Medicine from May 1995 to October 1998. During examination 2 mm computed tomography cuts were taken. In almost all cases fundus examination was not possible because of hazy media (cataract, vitreous haemorrhage, endophthalmitis). Pars plana vitrectomy was applied to remove foreign body in all cases. RESULTS: In 14 cases a foreign body was localised inside the eye (3 of them were embedded in the wall of the eye) and in 2 cases a double perforation was noticed. With pars plana vitrectomy 12 of 14 intraocular foreign bodies were removed. Two foreign bodies deeply embedded in the wall of the eye were left. One of the two foreign bodies after double perforation was removed from the orbit and the second, which was localized deeply in the orbit, was left. CONCLUSION: The localisation of the foreign bodies using the computed tomography is a very accurate and sensitive method, facilitating further surgery.     

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。     

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)     

微创玻切"L"形切口在眼内大异物摘出术中的应用

目的:评估在微创玻璃体切除术中应用睫状体平坦部"L"形切口摘出后段眼内大异物的效果。方法:采用双向性队列研究,分析2013年1月至2019年6月南方医科大学附属小榄医院后段眼内大异物29例(29眼)。根据术前CT和(或)B超检查确定后段眼内异物的长及宽,根据异物最大宽度(W)分组,以W≤3 mm、3 mm5 mm分成A、B、C 3组。A组及C组分别通过常规与角膜缘平行的睫状体平坦部"一"形扩大切口和角膜缘切口摘出异物。B组通过睫状体平坦部"L"形切口摘出异物。术后随访6个月以上。结果:A组13例,B组8例,C组8例;其中B组摘出异物长度为(5.4±2.9)mm,最大宽度为(2.2±0.8)mm,厚度为(1.6±0.9)mm。所有异物均一次手术摘出成功,末次随访视网膜均在位。术后增生性玻璃体视网膜病变发生率:C组(4例,50%)>B组(2例,25.0%)>A组(2例,15.4%);C组合并术后角膜溃疡穿孔1例(12.5%)。术后B组1例(12.5%)复发性视网膜脱离,手术后复位。3组均无严重并发症。结论:在微创玻璃体切除术摘出后段较大异物中,经睫状体平坦部"L"形切口手术成功率高,术后并发症少。     

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。     

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.     

眼内磁性异物摘出的临床观察

探讨64排螺旋CT定位下眼球内磁性异物摘出的临床效果。 方法：对48例48眼眼球内磁性异物患者进行回顾性分析。其中32例巩膜探查摘出异物后,24例再行白内障超声乳化并人工晶状体植入术,8例行玻璃体切割,摘出异物的同时清除玻璃体积血或积脓。 结果：一期异物全部摘出。术后视力全部不同程度地提高。 结论：64排螺旋CT定位下眼球内磁性异物摘出是眼球内异物摘出的一种有效方法