儿童角膜穿孔伤术后视力恢复的相关因素

Relevant factors for the recovery of visual acuity in children after surgery for corneal perforating wound

目的 分析儿童角膜穿孔伤手术后视力恢复的相关因素.方法 以2006年8月至2014年8月,年龄不超过14岁,因角膜穿孔伤来本院行手术治疗的91例91眼为样本,记录性别、年龄、受伤原因、伤后就诊时间、手术前后视力、术后并发症,并分析各相关因素对视力恢复的影响程度.比较近8年来患儿角膜穿孔致伤原因、就诊及时程度、年龄与性别差异及主要并发症的变化.结果 术后平均视力（LogMar）由术前-1.96±1.87提高到-1.12±1.37（t=-4.50,P＜0.05）.锐器伤比例最高,其中剪刀、铅笔引起的视力损害程度无差异（F=0.84,P＞0.05）.6岁以上患儿较3～6岁患儿视力恢复显著（F=0.22,P＜0.05）.就诊时间超过24h者视力恢复较差（F=0.57,P＜0.05）.并发症中外伤性白内障较虹膜嵌顿的患儿视力恢复得好（F=0.10,P＜0.05）.对比在2006至2010年期间和2010至2014年期间入院的患儿铅笔伤从10.8％升至22.2％,摔伤碰伤下降82.9％.24h内就诊率提高41.3％.6岁以上儿童比例由28.2％升至40.0％.术后裸眼视力维持或改善例数提高2倍多.并发症下降15.8％,其中葡萄膜嵌顿占14.9％,差异有统计学意义.结论 促进角膜穿孔伤儿童视力恢复的相关因素有年龄大于6岁,24 h内就诊,积极进行手术治疗,减少并发症,特别是葡萄膜嵌顿的发生.近8年来儿童角膜穿孔伤有好发年龄增大,铅笔伤增多,就诊及时率提高,手术效果更显著以及并发症减少的变化趋势。

Objective To assess the characteristics of hospitalized children with corneal perforating wound in the past 8 years and to evaluate the factors that affect their vision recovery.Methods Ninety-one patients aged 14 or younger who were admitted between August 2006 and August 2014 for corneal injury were included in this study.Data on sex,age,injury cause,time between injury and admission,vision before and after surgery,post-surgery complications,and other factors were recorded and analyzed to detect whether there was any changes in injury cause,timeliness of treatment,age or sex distribution,or post-surgery complication incidence in the past 8 years.Results Between 2006 and 2014,mean post-surgery vision （108 Man） improved from-1.96 （SD 0.95） to-1.12 （SD 0.70） （t =-4.50,P 〈 0.05）,and sharp objects （e.g.,scissor,pencil） were still the most common cause and there was no statistically significant difference in vision damage caused by scissor and pencil （F =0.84,P 〉 0.05）.Older children over 6 years had significantly better vision outcomes compared to children in the 3-6 age group （F =0.22,P 〈 0.05）.The visiting time which was more than 24 hours after injury was associated with a worse vision outcome （F =0.57,P 〈 0.05）.Among patients with post-surgery complications,children with traumatic cataract had better vision outcomes than those with iris prolapsed （F =0.10,P 〈 0.05）.Comparing the patients that were admitted from 2006 to 2010 with those from 2010 to 2014,the proportion of pencil-induced injury increased from 10.8% to 22.2%,the proportion of falling-induced injury decreased to 82.9%,the proportion of timely treatment within 24 hours after the injury increased to 41.3%,the proportion of older children （〉6 years） increased from 28.2% to 40.0%,the proportion of patients with equal or improved vision after surgery increased twice,and the incidence of post-surgery complication decreased by 15.8%,of which iris prolapsed accounted for 14.9%.Conclusion Older age （〉 6 years） and timely treatment （〈 24 hours） are associated with better vision recovery,fewer post-surgery complications,and lower incidence of iris prolapsed.Children with corneal injury in recent 8 years tend to be older,more likely to have pencil-induced injury,more likely to be treated within 24 hours after the injury,and have better postsurgery outcomes with fewer complications.