Erakgun Tansu, Egrilmez Sait
Department of Ophthalmology, Ege University Hospital, Izmir, Turkey.
J Trauma. 2008 Apr;64(4):1034-7. doi: 10.1097/TA.0b013e318047dff4.
The aim of this study was to identify the prognostic factors influencing outcome after the removal of retained posterior segment intraocular foreign bodies (IOFBs) by pars plana vitrectomy.
We reviewed the records of 42 consecutive patients (39 men and 3 women with a mean age of 26.8 years) operated between January 2001 and January 2005 by the same surgeon for IOFB after penetrating ocular injury. All eyes underwent IOFB removal via pars plana vitrectomy. Postoperative retinal detachment was considered as the anatomic failure. Associations between anatomic outcome and various preoperative, operative, and postoperative variables were statistically analyzed. Chi-square test and Mann-Whitney U test were used to evaluate the association between two categorical variables.
The mean time interval between the trauma and the IOFB removal was 5.3 days (range, 1 day to 30 days). The mean length of follow-up was 18.3 months (range, 6 months to 3 years). Preoperative retinal detachment was present in 19% of patients. After the IOFB removal, the retina was detached in 28.5% of patients (12 of 42 patients). After a second vitrectomy performed in 10 patients, final anatomic success rate was 89.8% (37 of 42 patients). Time between trauma and IOFB extraction, presence of intraocular hemorrhage, preoperative retinal detachment and primary surgical repair combined with the IOFB removal were significantly associated with the postoperative retinal detachment. Age, sex, entrance wound location, presence of endophthalmitis, location of IOFB, nature of IOFB, preoperative visual acuity, use of an encircling band, type of endotamponade, use of lensectomy were not significantly associated with the presence of postoperative retinal detachment.
Delay in IOFB extraction, presence of intraocular hemorrhage, preoperative retinal detachment, primary surgical repair combined with IOFB removal are the predictive factors for anatomic failure.
本研究的目的是确定影响经扁平部玻璃体切除术取出眼后段眼内异物（IOFBs）后预后的因素。
我们回顾了2001年1月至2005年1月间由同一位外科医生为穿透性眼外伤后的IOFB进行手术的42例连续患者（39例男性和3例女性，平均年龄26.8岁）的记录。所有患眼均通过扁平部玻璃体切除术取出IOFB。术后视网膜脱离被视为解剖学上的失败。对解剖学结果与各种术前、术中及术后变量之间的关联进行了统计学分析。采用卡方检验和曼-惠特尼U检验评估两个分类变量之间的关联。
外伤与IOFB取出之间的平均时间间隔为5.3天（范围为1天至30天）。平均随访时间为18.3个月（范围为6个月至3年）。19%的患者术前存在视网膜脱离。IOFB取出后，28.5%的患者（42例患者中的12例）视网膜发生脱离。在10例患者进行二次玻璃体切除术后，最终解剖学成功率为89.8%（42例患者中的37例）。外伤与IOFB取出之间的时间、眼内出血的存在、术前视网膜脱离以及与IOFB取出联合进行的一期手术修复与术后视网膜脱离显著相关。年龄、性别、入口伤口位置、眼内炎的存在、IOFB的位置、IOFB的性质、术前视力、环扎带的使用、眼内填充类型、晶状体切除术的使用与术后视网膜脱离的存在无显著相关性。
IOFB取出延迟、眼内出血的存在、术前视网膜脱离、与IOFB取出联合进行的一期手术修复是解剖学失败的预测因素。
