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。

METHODS: Continuous observation and analysis from July 1, 2014 to June 1, 2016, hospitalized in our hospital caused by metallic perforating ocular trauma for 23G vitrectomy in 38 cases(38 eyes). A prospective collection of patient included age, gender, eye, place of occurance of trauma, foreign body size, wound length, foreign body position, initial visual acuity and final visual acuity, macular etc.. The ocular trauma score(OTS)system was used to assess the effectiveness and prognosis of the patients. The follow-up time was over 6mo.

RESULTS: There were 38 eyes in 38 patients, including 37 males and 1 females, aged 16y-56y. Ocular trauma mainly occurred in the workplace, 33 cases accounted for 87%, followed by sports venues, 3 cases accounting for 8%. Corrected visual acuity more than 0.1 in eyes with intraocular foreign bodies underwent 23G vitrectomy were 21 cases, accounting for 55%. Preoperative retinal detachment, large foreign body(more than 5.0mm), damage of lens were important factors of poor prognosis. Foreign bodies were located in the vitreous body in 23 cases, accounting for 61%, located in the retina in 15 cases, accounting for 39%. When admitted to hospital, the patients suffered from retinal detachment in 21 cases(55%), endophthalmitis in 7 cases(18%), the size of intraocular foreign bodies(IFOB)was larger than 5.0mm in 7 cases(18%), severe postoperative proliferative vitreoretinopathy(PVR)was in 6 cases(16%), epiretinal membrance of macula in 5 cases(13%). Of the same OTS scores, visual acuity in 6mo was significantly better than preoperative; no matter preoperative vision or postoperative vision in 6mo, the higher the OTS scores, the better the visual acuity.

CONCLUSION: The ocular perforation caused by metallic foreign body mostly occurs in young men under 40y, and the main reason is injury in the workplace. No protective measures are adopted. The main factors affecting the final visual acuity are retinal detachment, foreign body greater than 5.0mm and postoperative PVR appearance after the injury, vitrectomy time has little effect. The 23G vitrectomy is safe, reliable and effective in the treatment of ocular penetrating injuries due to metallic foreign bodies. OTS score can be used effectively in patients with ocular perforation caused by metallic foreign bodies and make reasonable and useful postoperative visual acuity prediction.