眼球裂伤患者健侧眼视野缺损情况及治疗效果

Visual field defect and effect of treatment on contralateral uninjured eye of patients with incised injury of eyeball

目的观察药物治疗眼球裂伤患者对侧健眼视野缺损的效果。方法单眼眼球裂伤（包括眼球穿孔及眼球破裂）124例（124眼），给予糖皮质激素等药物治疗，检测治疗前及治疗5d后健侧眼视功能的变化。结果本组124例单眼眼球裂伤后健侧眼出现视野缺损117例，占94．35％，视野平均缺损绝对值为（12．8±1．2）dB，模式标准差为（18．4±3．1）dB；视野缺损计分显示中度78眼，轻度39眼，无缺损7眼，未见终末期或重度缺损者。随访6个月，健侧眼视野缺损者44眼，占35．48％，视野平均缺损绝对值为（4．7±1．4）dB，模式标准差为（5．8±2．1）dB；视野缺损计分显示中度8眼，轻度36眼，无缺损80眼。治疗前后各指标差异均有统计学意义（P〈0．05）。治疗前健侧眼视力下降15眼（12．1％），随访6个月，其中视力改善9例，而视力不提高6例（4．8％）。结论糖皮质激素和营养神经药物有助于改善健侧眼的视野缺损和视力。

Objective To observe the variation of visual field and therapeutic effects of treatment on contralateral uninjured eye after incised injury of eyeball. Methods Total of 124 eyes of 124 cases with incised injury of eyeball were selected and treated with glucocorticoid and neurotrophic agents. The defect of visual field and visual acuity of the uninjured side eye were observed before and after treatment. Results The uninjured side eye of patient was found to have different degrees of visual field damage. The mean defect （MD） was （12.8 ± 1.2） dB, pattern standard deviation（PSD） was （18.4 ± 3.1 ） dB. The visual field defect score showed moderate defect in 78 eyes, mild defect in 39 eyes. No end-stage or severe defect was observed, and no defect in 7 eyes. After followed up for 6 months, the absolute value of MD was （4.7 ± 1.4 ） dB, PSD was （5.8 ± 2.1 ） dB. And the visual field defect score showed moderate defect in 8 eyes, mild defect in 36 eyes, no patient with end stage and severe defect, and no defect in 80 eyes. The differences were statistically significant between before and after treatment （ P 〈 0.05 ）. After treatment, the visual acuities of uninjured side eyes were not changed in 6 eyes, improved in 17 eyes. The rest of the patients had no significant change. The visual acuity of the contralateral eye decreased in 15 eyes after the injury （12.1%）. Followed up for 6 months, the visual acuity was improved in 9 patients, and still reduced in 6 cases （4.8%）. Conclusion The damage of visual field and visual acuity of uninjured side eye for patients with incised injury of eyeball may be improved after glucocorticoid and neurotrophic agents therapy.