玻璃体切割手术时机选择对眼外伤预后的影响

The influnce of vitrectomy surgery timing on the prognosis of ocular trauma

目的 分析玻璃体切割手术时机选择对眼外伤预后的影响。方法 选取我院就诊的150例单眼外伤并行玻璃体切割手术患者作为研究对象,对所有患者行玻璃体切割手术的时机和预后进行分析。结果 本研究150例患眼中,手术后视力较手术前提高者124眼（82.67%）,视力不变23眼（15.33%）,视力下降3眼（2.00%）。150例患眼术后共治愈117例,治愈率为78.00%。患者在外伤后7 d内行玻璃体手术者有39例,治愈率为69.23%;7-14 d内行玻璃体手术者有48例,治愈率为93.75%;15-21 d内行玻璃体手术者有36例,治愈率为75.00%;〉30 d行玻璃体手术者有27例,治愈率为66.67%。与其他治疗时间比较,7-14 d内行玻璃体手术患者的治愈率较高（P〈0.05）。外伤后7-14 d内1次手术视网膜复位成功率明显高于其他时间段（P〈0.05）;外伤后〉30 d 2次/多次手术复位成功率明显高于其他时间段（P〈0.05）。外伤后7 d内39眼中34眼（87.18%）眼球保留,7-14 d 48眼中47眼（97.92%）眼球保留,15-21 d 36眼中33眼（91.67%）眼球保留,〉30 d 27眼中19眼（70.37%）眼球保留,外伤后7-14 d内的眼球保留率明显高于其他时间段（P〈0.05）。结论 眼外伤后7-14 d是玻璃体切割手术的最好时机,尽早行玻璃体切割手术,可以最大程度提高手术视网膜复位率和眼球保存率。

Objective To analyze the effect of the vitrectomy surgery timing on the prognosis of ocular trauma. Methods One hundred and fifty patients who were monocular trauma in this hospital were selected and treated with vitrectomy. The timing and prognosis of vitrectomy for all patients were analyzed. Results Of 150 cases with ocular trauma, in this study, patients whose visual acuity improved were 124 eyes （82.67%）, unchanged were 23 eyes （15.33%）, and decreased were 3 cases （2.00%） compared with that before the operation. In 150 patients with eye surgery, 117 cases were cured, the cure rate was 78.00%. Thirty-nine patients underwent vitreoretinal surgery within 7 day after the trauma, the cure rate was 69.23%; 48 cases underwent vitrectomy within 7-14 d after the trauma, the cure rate was 93.75%; 36 cases underwent vitrectomy within 15-21 d after the trauma, the cure rate was 75.00%; the other 27 patients underwent vitrectomy more than 30 days after the trauma, the cure rate was 66.67%. Compared with other treatment time, the cure rate was higher within 7-14 d （P〈0.05）. Retinal reattachment success rate of single operation within 7-14 d after the trauma was significantly higher than that of other treatment time （P〈0.05）; retinal reattachment success rate of twice/multiple operations within 30 days after trauma was significantly higher than that of other treatment time （P〈0.05）. There were 34 of 39 eyes （87.18%） retained eyeball for patients received the surgery within 7 days after the trauma, 47 of 48 eyes （97.92%） retained eyeball for patients received the surgery within 7-14 d after the trauma, 33 of 36 eyes （91.67%） retained eyeball for patients received the surgery within 15-21 d after the trauma, 19 of 27 eyes （70.37%） retained eyeball for patients received the surgery within 30 days after trauma. The retention rate of ocular trauma within 7-14 d was significantly higher than that of other treatment time （P〈0.05）. Conclusion After ocular trauma, 7-14 d is the best time to implement vitrectomy, vitreous body cutting operation can greatly improve the operation rate of retinal reattachment and eyeball preservation rate.