严重眼雷管爆炸伤特点及玻璃体切割手术疗效观察

Characteristics of severe ocular detonator explosive injury and the therapeutic effect of vitreoretinal surgery

目的观察眼球严重雷管爆炸伤的特点以及2期玻璃体切割手术治疗的效果。方法回顾分析37例雷管爆炸伤患者65只眼的临床资料。男性36例，女性1例；平均年龄28．6岁。双眼伤31例，占83．8％；单眼伤6例，占16．2％。48只眼为严重爆炸伤眼，视力无光感9只眼，其中3只眼明显萎缩；光感28只眼；眼前手动4只眼；数指／33cm7只眼。46只眼行玻璃体切割手术治疗，其中41只眼为严重爆炸伤眼。未行手术治疗的19眼中13只眼无玻璃体手术指征；6只眼因眼球萎缩或经济原因放弃手术治疗。就诊时间在伤后1周以内者7例，占18．9％；1周～1个月者13例，占35．2％；1个月以上者17例，占45．9％。手术后随访6个月～2年，平均随访时间8．6个月。结果65只跟中结膜异物占66．2％；角膜异物占46．2％；玻璃体积血占70．8％；球内异物占69．2％。视网膜震荡伤或视神经冲击伤占56．9％。视力提高33只眼；不变25只眼；下降7只眼。46只玻璃体切割手术眼中，眼球内异物伤35只眼，占76．1％。视力提高26只眼，占59．5％；未提高13只眼，占28．3％；未治愈7只眼，占15．2％，其中眼球摘除2只眼，眼球萎缩5只眼。就诊时间超过1个月的患者手术后视力提高率低。单眼盲51．4%；双眼盲8．1％。结论严重眼雷管爆炸伤大部为多发球内异物伤，就诊晚，伤情严重致盲率高，加强视网膜震荡和视神经冲击伤的诊治，尽早玻璃体切割手术可提高预后视功能。

Objective To observe the clinical characteristics of severe ocular detonator explosive injuries and to evaluate the therapeutic effects of vitrectomy on it. Methods Clinical data of 37 consecutive patients （65 eyes） with severe ocular detonator explosive injuries were retrospectively analyzed. The patients included 36 males and 1 female with the average age of 28.6 years. The biocular injuriy was in 31 cases （83.8 %）, and one-eyed injury was in 6 cases （16.2%）. A total of 48 eyes had severe explosive injury. The visual acuity was no light perception in 9 eyes in which 3 eyeballs were obviously atrophic, light perception in 28 eyes, hand moving in 4 eyes, and counting finger/33 cm in 7 eyes. Vitrectomy was performed on 46 eyes, in which 41 had severe ocular explosive injury. There were no vitreous surgery indications in 13 eyes of 19 eyes didn＇t undergo surgery; the other 6 eyes didn＇t undergo surgery due to the atrophic eyeballs or economic reasons. The treating time after trauma was within 1 week in 7 patients （18.9%）, 1 week to 1 month in 13 （35.2%）, and more than 1 month in 17 （45.9%）. The follow-up duration lasted 6 months to 2 years after operation with the average of 8. 6 months. Results In 65 eyes, the occupation ratio of conjunctival foreign bodies was 66. 2%; corneal foreign bodies was 46.2%; vitreous hemorrhage was 70.8 % ; intraocular foreign bodies （IOFB） was 69.2 % ; retinal shocking injury or optic nerve blasting injury was 56.9%. The visual acuity improved in 33 eyes, remained unchanged in 25 eyes, and decreased in 7 eyes. In 46 eyes which had undergone vitrectomy, IOFB injuries was in 35 eyes （76.1%） ; the visual acuity increased in 26 eyes （59.5%）, remained unchanged in 13 eyes （28.3%） , and didn＇t cure in 7 eyes （15.2%） in which 2 eyes underwent ocular enucleation and 5 eyes were atrophic. The increasing rate of visual acuity in the patients who accepted the treatment more than 1 month after injury was low. The occupation ratio of monocular blindness was 51.4% and biocular blind was 8.1%. Conclusions Most of severe ocular explosive injuries by detonator are with IOFB. The causes of the high blinding rate are late treatment and seriousinjury. Strengthening the diagnosis and treatment of retinal shock and optic nerve blast, and performing vitreetomy as soon as possible can improve prognositc visual function of injured eyes.