玻璃体切除术治疗眼内异物疗效及预后分析
发布时间：2019-06-14 16:29
【摘要】：背景:开放性眼外伤是年轻人或者劳动人群中丧失视力的一个最重要的因素,其中又以眼后段眼内异物对眼球结构及视力的影响最大。我们选取了开放性眼外伤IOFBs行玻璃体切割术取出眼内异物的患者,收集了可能影响患者视力预后的各因素频数进行分析,了解患者IOFBs对眼球的影响和玻璃体切割术对患者视力预后的影响。目的:分析开放性眼外伤眼后段异物患者玻璃体切割术治疗效果及视力预后的相关因素。方法:回顾性分析2015年12月至2017年1月于重庆医科大学附属第一医院眼科入院诊断为眼后段眼内异物共40眼,所有眼后段眼内异物均通过玻璃体切割术取出。统计了年龄、性别、术前/术后最佳矫正视力(BCVA),眼后段异物性质、大小,眼内异物移除时间,眼内异物进入区域,眼内异物残留位置,手术时机,手术方式和并发症等因素,使用SPSS19.0进行数据分析。结果:患者平均年龄为43.15岁,男性患者37例(92.5%),女性患者3例(7.5%),治疗有效的患者25例(62.5%),16例患者恢复有效视力(40%),未恢复有效视力患者24例(60%),其中失明患者2例(5%)。异物残留在玻璃体腔内的有12例眼(30%),嵌于视网膜上18例眼(45%),穿透眼球壁的有10例眼(25%)。并发前房积血10例眼(25%),并发玻璃体积血24例眼(60%),合并视网膜脱离的有19例眼(47.5%),合并视网膜裂孔的有28例眼(70%),合并眼内炎的有8例(20%)。异物3mm的有18例眼(45%),异物≥3mm的有22例眼(55%),眼内异物在两天内取出的有26例眼(65%),2天后取出的有14例眼(35%)。术前BCVA≥4.0的有8例眼(20%),术前BCVA4.0有32例眼(80%)。术后BCVA≥4.0的有16例眼(40%),术后BCVA4.0有24例眼(60%)。患者视力的主要影响因素为视网膜脱离(P=0.000)、视网膜裂孔(P=0.001)、眼内异物的大小(P=0.023)、异物取出的时间(P=0.006)、前房积血(P=0.032)、玻璃体积血(P=0.025)以及术前BCVA(P=0.014)。眼内炎与预后视力无明显相关性(r=-0.089,P0.05)。眼后段异物的长度与术前、术后最佳矫正视力呈负相关(P0.05)。视网膜脱离与最终的最佳矫正视力(BCVA)有关(P0.05)。视网膜裂孔与术后B CVA相关(P0.05),异物取出的时间也与视力预后相关(P0.05),异物越早取出,术后BCVA越好。前房积血和玻璃体积血也影响术后BCVA(P0.05),清除了前房积血和玻璃体积血可以提高术后BCVA。术前BCVA越好,术后BCVA越佳(P0.05)。眼内异物的移除时间与眼内炎发病率没有直接联系(r=-0.183,P0.05),眼内炎基本不影响视力。异物进入部位与前房积血发病率具有相关性(P0.05),异物从Ⅲ区进入眼球更易引起前房积血。结论:更大的眼内异物、合并视网膜脱离、视网膜裂孔、前房积血、玻璃体积血、延长异物取出时间,在开放性眼外伤中会引起更严重的后果,视力预后会更差。护目镜在预防工伤中起很大的作用。在我们的研究中,是否行Ⅰ期缝合+玻璃体腔内注药术或者直接行玻璃体切割联合眼球清创缝合对视力及解剖学的恢复并无显著影响,但是异物取出的早晚对视力预后有影响,因此,可先行Ⅰ期缝合及玻璃体腔内注药术,玻璃体切除术可以稍延迟至24-48小时,仍需尽快行PPV取出眼内异物。
[Abstract]:BACKGROUND: Open-eye trauma is one of the most important factors in the loss of vision in young people or working groups. We selected the patients with open eye trauma IOFBs to remove the intraocular foreign body, and collected the frequency of each factor that may affect the visual prognosis of the patient, and to know the effect of IOFBs on the eye and the effect of vitrectomy on the patient's visual prognosis. Objective: To analyze the effect of vitrectomy and the related factors of visual prognosis in patients with open eye injury. Methods: From December 2015 to January 2017,40 eyes of intraocular foreign bodies were diagnosed as intraocular foreign bodies in the first hospital of Chongqing Medical University from December 2015 to January 2017. All the intraocular foreign bodies in the posterior segment of the eye were taken out by vitrectomy. The data were analyzed by using SPSS19.0, such as age, sex, pre-operation/ post-operative best corrected vision (BCVA), foreign body property, size, intraocular foreign body removal time, intraocular foreign body entry area, intraocular foreign body residual position, operation timing, operation mode and complications. Results: The average age of the patients was 43.15,37 (92.5%),3 (7.5%),25 (62.5%),16 (40%),24 (60%), and 2 (5%). There were 12 eyes (30%) in the vitreous cavity,18 eyes (45%) embedded in the retina, and 10 eyes (25%) penetrating the wall of the eye. There were 10 eyes (25%) in the anterior chamber,24 eyes (60%) with vitreous hemorrhage,19 eyes (47.5%) with retinal detachment,28 eyes (70%) with retinal tears, and 8 (20%) combined with endophthalmitis. There were 18 eyes (45%) of the foreign body,22 eyes (55%) with a foreign body of 3 mm,26 eyes (65%) taken out of the intraocular foreign body in two days, and 14 eyes (35%) taken out after 2 days. There were 8 eyes (20%) of BCVA-4.0 before operation, and 32 eyes (80%) in preoperative BCVA4.0. There were 16 eyes (40%) and 24 eyes (60%) of BCVA-4.0 after operation. The main factors of the patient's vision were the retinal detachment (P = 0.000), the retinal hole (P = 0.001), the size of the intraocular foreign body (P = 0.023), the time of foreign body removal (P = 0.006), the hyphema of the anterior chamber (P = 0.032), the vitreous hemorrhage (P = 0.025), and the preoperative BCVA (P = 0.014). There was no significant correlation between endophthalmitis and prognosis (r =-0.089, P0.05). The length of the foreign body in the posterior segment of the eye was negatively correlated with the best corrected vision before and after the operation (P0.05). The retinal detachment was related to the final corrected visual acuity (BCVA) (P0.05). The retinal hole was related to the postoperative B-CVA (P0.05). The time of the foreign body removal was related to the prognosis of the visual acuity (P0.05). The earlier the foreign body was taken out, the better the BCVA after operation. The postoperative BCVA (P0.05) was also affected by the hyphema of the anterior chamber and the volume of the vitreous, and the postoperative BCVA could be enhanced by clearing the hyphema of the anterior chamber and the vitreous hemorrhage. The better the preoperative BCVA, the better the BCVA after operation (P0.05). The removal time of intraocular foreign body was not directly related to the incidence of endophthalmitis (r =-0.183, P0.05). There was a correlation between the incidence of foreign bodies and the incidence of hyphema in the anterior chamber (P0.05). Conclusion: The larger intraocular foreign body, combined with retinal detachment, retinal tear, hyphema, vitreous hemorrhage, extension of foreign body take-out time, can cause more serious consequence in open eye injury, and the prognosis of vision is worse. Goggles play a major role in the prevention of work-related injuries. In our study, whether I-phase suture + vitreous cavity injection or direct-line vitrectomy combined with ocular debridement and suture has no significant effect on the recovery of vision and anatomy, but the sooner or later the foreign body is taken out will have an effect on the visual prognosis, so, Vitrectomy can be delayed to 24-48 hours in the first stage and in the vitreous cavity, and the intraocular foreign body should be removed as soon as possible.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R779.6
本文编号：2499524
[Abstract]:BACKGROUND: Open-eye trauma is one of the most important factors in the loss of vision in young people or working groups. We selected the patients with open eye trauma IOFBs to remove the intraocular foreign body, and collected the frequency of each factor that may affect the visual prognosis of the patient, and to know the effect of IOFBs on the eye and the effect of vitrectomy on the patient's visual prognosis. Objective: To analyze the effect of vitrectomy and the related factors of visual prognosis in patients with open eye injury. Methods: From December 2015 to January 2017,40 eyes of intraocular foreign bodies were diagnosed as intraocular foreign bodies in the first hospital of Chongqing Medical University from December 2015 to January 2017. All the intraocular foreign bodies in the posterior segment of the eye were taken out by vitrectomy. The data were analyzed by using SPSS19.0, such as age, sex, pre-operation/ post-operative best corrected vision (BCVA), foreign body property, size, intraocular foreign body removal time, intraocular foreign body entry area, intraocular foreign body residual position, operation timing, operation mode and complications. Results: The average age of the patients was 43.15,37 (92.5%),3 (7.5%),25 (62.5%),16 (40%),24 (60%), and 2 (5%). There were 12 eyes (30%) in the vitreous cavity,18 eyes (45%) embedded in the retina, and 10 eyes (25%) penetrating the wall of the eye. There were 10 eyes (25%) in the anterior chamber,24 eyes (60%) with vitreous hemorrhage,19 eyes (47.5%) with retinal detachment,28 eyes (70%) with retinal tears, and 8 (20%) combined with endophthalmitis. There were 18 eyes (45%) of the foreign body,22 eyes (55%) with a foreign body of 3 mm,26 eyes (65%) taken out of the intraocular foreign body in two days, and 14 eyes (35%) taken out after 2 days. There were 8 eyes (20%) of BCVA-4.0 before operation, and 32 eyes (80%) in preoperative BCVA4.0. There were 16 eyes (40%) and 24 eyes (60%) of BCVA-4.0 after operation. The main factors of the patient's vision were the retinal detachment (P = 0.000), the retinal hole (P = 0.001), the size of the intraocular foreign body (P = 0.023), the time of foreign body removal (P = 0.006), the hyphema of the anterior chamber (P = 0.032), the vitreous hemorrhage (P = 0.025), and the preoperative BCVA (P = 0.014). There was no significant correlation between endophthalmitis and prognosis (r =-0.089, P0.05). The length of the foreign body in the posterior segment of the eye was negatively correlated with the best corrected vision before and after the operation (P0.05). The retinal detachment was related to the final corrected visual acuity (BCVA) (P0.05). The retinal hole was related to the postoperative B-CVA (P0.05). The time of the foreign body removal was related to the prognosis of the visual acuity (P0.05). The earlier the foreign body was taken out, the better the BCVA after operation. The postoperative BCVA (P0.05) was also affected by the hyphema of the anterior chamber and the volume of the vitreous, and the postoperative BCVA could be enhanced by clearing the hyphema of the anterior chamber and the vitreous hemorrhage. The better the preoperative BCVA, the better the BCVA after operation (P0.05). The removal time of intraocular foreign body was not directly related to the incidence of endophthalmitis (r =-0.183, P0.05). There was a correlation between the incidence of foreign bodies and the incidence of hyphema in the anterior chamber (P0.05). Conclusion: The larger intraocular foreign body, combined with retinal detachment, retinal tear, hyphema, vitreous hemorrhage, extension of foreign body take-out time, can cause more serious consequence in open eye injury, and the prognosis of vision is worse. Goggles play a major role in the prevention of work-related injuries. In our study, whether I-phase suture + vitreous cavity injection or direct-line vitrectomy combined with ocular debridement and suture has no significant effect on the recovery of vision and anatomy, but the sooner or later the foreign body is taken out will have an effect on the visual prognosis, so, Vitrectomy can be delayed to 24-48 hours in the first stage and in the vitreous cavity, and the intraocular foreign body should be removed as soon as possible.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R779.6
【参考文献】
相关期刊论文 前1条
1 吴淑凤;李玉涛;;球内异物的性质与外伤性眼内炎的关系[J];临床眼科杂志;2015年03期
，本文编号：2499524
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