28 毫米眼内异物取出术：玻璃体视网膜外科医生的困境。

A 28-mm intraocular foreign body removal: The vitreoretinal surgeon's dilemma.

机构信息

Vitreo Retina Services, MGMEI, Raipur, Chhattisgarh, India.

出版信息

Indian J Ophthalmol. 2022 Jul;70(7):2778. doi: 10.4103/ijo.IJO_1432_22.

DOI:10.4103/ijo.IJO_1432_22

PMID:35791256

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9426066/

Abstract

BACKGROUND

Intraocular foreign body (IOFB) removal becomes tricky if its large and impacted in the ocular coats. When confronted with such a combination, the vitreoretinal surgeon will need to modify the surgical plan. This surgical video describes one of such situation encountered during removal of a long wooden IOFB impacted in the ocular coats.

PURPOSE

The video describes a scenario when the surgeon becomes aware that injury to ocular structure is inevitable due to inherent length of the IOFB. However, a careful assessment of the situation helps the surgeon to identify how he could minimize the damage to the eye and not put vision at risk.

SYNOPSIS

A young boy presented with painful loss of vision in left eye since 15 days. Examination showed BCVA of 20/32 and limitation movement in up gaze. Fundus showed hazy media and an IOFB in superior quadrant. It was noted that IOFB was moving with eye movement. The impaction in sclera and extraocular extension was suspected. After pars plana vitrectomy, it was observed that IOFB was longer than what was measured by the scan and it was impacted in the coats. Removal using IOFB forceps further pulled the IOFB into vitreous cavity. A rectangular scleral window was created, IOFB was pushed towards opposite pars plana region to avoid injury to macula, optic nerve, lens and peripheral retina. The IOFB was then removed.The retinal tears were lasered. Three months following the surgery, he developed cataract, which needed surgery. His BCVA at the last follow up visit was 20/25 with attached retina.

HIGHLIGHTS

Limitation of movement in presence of linear IOFB shall raise a suspicion of IOFB being impacted in coats and possibility of its extraocular extension; 2.An oblique IOFB posterior to limbus, can have length more in transverse diameter of the eyeball. Though rarely used, an ab-externo approach can be a viable option in such a case to minimise injury to vital structure of the eye, particularly if the IOFB is severely impacted in sclera.

ONLINE VIDEO LINK

https://youtu.be/2bF3WLd812o.

摘要

背景

如果眼内异物（IOFB）较大且嵌入眼组织，那么其取出就变得棘手。当遇到这种情况时，玻璃体视网膜外科医生需要修改手术计划。这段手术视频描述了在取出嵌入眼组织的长木 IOFB 时遇到的一种情况。

目的

该视频描述了一种情况，即外科医生意识到由于 IOFB 的固有长度，对眼组织造成损伤是不可避免的。然而，仔细评估情况有助于外科医生确定如何将对眼睛的损伤最小化，同时不危及视力。

概要

一名年轻男孩因左眼疼痛性视力丧失 15 天就诊。检查发现最佳矫正视力为 20/32，上转运动受限。眼底显示混浊的眼部介质和上象限的 IOFB。注意到 IOFB随眼球运动而移动。怀疑 IOFB 嵌入巩膜并延伸至眼外。行玻璃体切割术后，观察到 IOFB 比扫描测量的长度更长，且嵌入眼组织。使用 IOFB 夹进一步将 IOFB 拉入玻璃体腔。创建一个矩形巩膜窗，将 IOFB 推向对侧的玻璃体平面区域，以避免对黄斑、视神经、晶状体和周边视网膜造成损伤。然后取出 IOFB。视网膜裂孔被激光治疗。术后 3 个月，他出现白内障，需要手术。他最后一次随访时的最佳矫正视力为 20/25，视网膜贴附。