开放性眼外伤患者行Ⅱ期玻璃体切除手术的时机选择

Timing of stage Ⅱ vitrectomy in patients with open ocular trauma

摘要:

目的： 观察开放性眼外伤不同时间点行玻璃体切除手术的临床疗效，以探讨Ⅱ期玻璃体手术的时机选择。

方法：回顾性系列病例研究。纳入2022-06/2023-02就诊于我院眼科的开放性眼外伤患者60例60眼，按Ⅰ期规范化急诊救治手术时间与Ⅱ期玻璃体视网膜手术的不同间隔时间分为治疗组A(间隔时间≤14 d，32例32眼)和治疗组B(间隔时间>14 d，28例28眼)。治疗组A中眼球破裂伤16眼(50%)，穿通伤13眼(41%)，贯通伤3眼(9%)； 治疗组B中眼球破裂伤15眼(54%)，穿通伤12眼(43%)，贯通伤1眼(4%)。术后随访6 mo，对比观察两组患者的治疗效果。

结果：玻璃体切除手术前两组患者间视力无差异(P>0.05)。术后6 mo，治疗组A中10眼(31%)视力显著提高，21眼(66%)视力有效提高，1眼(3%)视力无改善； 治疗组B中，5眼(18%)视力显著提高，16眼(57%)视力有效提高，7眼(25%)视力无变化，两组比较有差异(U=322.5，P=0.032)。治疗组A中继发性青光眼、硅油依赖、玻璃体再积血、眼球萎缩与治疗组B比较无显著差异(均P>0.05)； 治疗组A术后随访未见外伤性增生性玻璃体视网膜病变(TPVR)，显著低于治疗组B(P<0.05)。

结论：开放性眼外伤Ⅱ期玻璃体视网膜手术在Ⅰ期救治手术后2 wk内完成预后相对较好。

Abstract:

AIM:To observe the clinical efficacy of vitrectomy at different times for open ocular trauma and explore the timing of stage Ⅱ vitrectomy.

METHODS: Retrospective case series study. A total of 60 cases(60 eyes)with open ocular trauma who visited our ophthalmology department from June 2022 to February 2023 were included. They were divided into treatment group A(interval ≤14 d)and treatment group B(interval >14 d)based on the interval between the stage Ⅰ emergency treatment surgery and the stage Ⅱ vitreoretinal surgery. Among the 32 cases(32 eyes)in the treatment group A, 16 eyes(50%)had eyeball rupture, 13 eyes(41%)had penetrating injury, and 3 eyes(9%)had perforating injury. Among the 28 cases(28 eyes)in the treatment group B, 15 eyes(54%)had eyeball rupture, 12 eyes(43%)had penetrating injury, and one eye(4%)had perforating injury. The two groups of patients were followed-up for 6 mo after surgery, and the treatment effects were compared.

RESULTS:There was no statistically significant difference in visual acuity between the two groups of patients before vitrectomy(P>0.05). In the treatment group A, 10 eyes(31%)had significantly improved visual acuity, 21 eyes(66%)had effectively enhanced visual acuity, and 1 eye(3%)had no improvement in visual acuity at 6 mo after surgery. Among the 28 eyes in the treatment group B, 5 eyes(18%)had significantly improved vision, 16 eyes(57%)had effectively enhanced vision, and 7 eyes(25%)had no change in vision, with statistically significant difference between the two groups(U=322.5, P=0.032). There was no significant difference between the treatment group A and the treatment group B in complications such as secondary glaucoma, silicone oil dependence, vitreous hemorrhage, and eyeball atrophy(P>0.05). There was no evidence of traumatic proliferative vitreoretinopathy(TPVR)in the treatment group A during postoperative follow-up, which was significantly lower than that of the treatment group B(P<0.05).

CONCLUSION:The prognosis of the stage Ⅱ vitrectomy for open ocular injury is relatively good after completing the stage Ⅰ surgery within 2 wk.