保留晶状体的玻璃体切除术治疗婴儿摇荡综合征（英文）

Lens-sparing vitrectomy for shaken baby syndrome

目的:分析婴儿摇荡综合征(SBS)患者黄斑前及玻璃体出血遮挡黄斑的眼部特征及视力。患者均接受保留晶状体的玻璃体切除术(LSV)。方法:回顾性研究。选取2010年至2012年确诊为黄斑前及玻璃体出血遮挡黄斑的SBS并接受LSV的患者,对其眼部特征和人口统计学数据进行分析。均数的比较采用配对t检验,分析分类数据采用Fisher精确检验和Pearson卡方检验。P<0.05有统计学意义。结果:共32例患者纳入本研究,平均年龄为5.09±1.96mo。在本研究中,21例(65.6%)患者视力为无光感。患者瞳孔较大者初始视力较差(P=0.021),且大部分接受过神经外科手术(P=0.027)。行LSV的平均间隔为28.56±20.83d。我院玻璃体切除术的并发症发生率为4.26%。术后26例(80%)患者视力为光感或更好,术后等效球镜大多为近视(P=0.001)。结论:SBS患者的眼科评估对于最佳视觉预后非常重要。对于未清除眼内出血致黄斑模糊的SBS患者,LSV的并发症发生率较低,不失为早期手术治疗中的好选择。

AIM：To document the ophthalmological findings and visual outcomes for shaken baby syndrome（SBS）patients who had lens-sparing vitrectomy（LSV） for nonresolving premacular and vitreous hemorrhages obscuring the macula.METHODS：A retrospective review and statistical analysis of ophthalmological and demographic data of patients admitted with SBS from 2010 to 2012 was done.Patients with premacular and vitreous hemorrhage obscuring the macula who underwent LSV were included as subjects.Paired samples t-test was used to compare means,categorical data was analysed using Fisher＇s exact test and Pearson Chi-squared test.P value of less than0.05 was considered as statistically significant.RESULTS：Thirty two subjects were recruited with a mean age of 5.09±1.96 mo.Twenty one（65.6%） subjects had visual acuity of no light perception at presentation.Subjects with poorer initial visual acuity had larger pupil sizes（P = 0.021） and most of them had neurosurgical intervention（P= 0.027）.The mean duration to perform LSV was 28.56±20.83 d.Our vitrectomy complication rate was 4.26%.Post- operatively,26（80%） subjects had vision of light perception or better,the spherical equivalent was significantly more myopic（P= 0.001）.CONCLUSION：Prompt ophthalmological assessment is vital to ensure optimum visual rehabilitation in SBS patients.With low complication rates,early surgical intervention with LSV represents a promising option for non- resolving intraocular hemorrhages obscuring the macula in SBS.