25G玻璃体切除手术治疗眼外伤后无光感眼的临床观察

Clinical observation of 25-gauge vitrectomy in the treatment of traumatized eyes with nonlight perception

目的:探讨25G微创玻璃体切除手术在治疗眼外伤后无光感眼的临床价值。方法:收集2013-07-01/2017-06-01以无光感首诊于我院的眼外伤并行25G微创玻璃体切除手术治疗的患者46例46眼,对其性别、年龄、户口地域、外伤性质、致伤原因、受伤时间、伤口位置及大小、视力和预后等情况进行回顾性研究并做统计学分析。结果:患者46例中男38例,女8例(男∶女=4.75∶1);年龄7~77(平均37.96±18.99)岁,其中青年组(<45岁)26例(57%),中年组(45~60岁)14例(30%),老年组(>60岁)6例(13%);致伤原因钝器伤18眼(39%),锐器伤8眼(17%),植物伤6眼(13%),爆炸伤6眼(13%),撞击伤4眼(9%),肢体击伤2眼(4%),车祸伤2眼(4%)。眼球破裂伤33眼(72%),眼球穿通伤12眼(26%),眼球挫伤1眼(2%)。合并玻璃体积血44眼(96%),视网膜脱离30眼(65%),球内异物18眼(39%),睫状体脉络膜脱离22眼(48%),眼内炎18眼(39%),视网膜下出血12眼(26%)。术后最终最佳矫正视力提高至光感及以上者30眼(65%),仍无光感者16眼(35%)。结论:眼外伤后无光感患者以农村地区中青年多见,影响无光感眼术后恢复的因素主要包括受伤类型、伤口的大小和位置、视网膜脱离、睫状体脉络膜脱离、受伤时间、是否合并球内异物及眼内炎等,25G微创玻璃体切除手术可以使大部分眼外伤后无光感眼恢复至光感及光感以上的视力。

AIM： To explore the clinical value of 25-gauge vitrectomy in the treatment of traumatized eyes with non-light perception. METHODS： Forty-six patients（46 eyes）who diagnosed as traumatized eyes with non-light perception treated with 25-gauge vitrectomy, which collected in our hospital from July 1, 2013 to June 1, 2017. Their sex, age, residence area, traumatic nature, causes of injury, duration from the injury to intervention, location and size of the wound, visual acuity and prognosis was retrospectively studied and analyzed statistically in this study.RESULTS： In the 46 patients, 38 were males, 8 were females（M：F=4.75：1）. The age of the patients was between 7 and 77 years（mean 37.96±18.99 years）. Among them, there were 26 case（57%）in the young group（〈45 years）, 14 case（30%）in the middle age group（45-60 years）, 6 cases（13%）in the older age group（〉60 years）. The cause of injury included blunt trauma（18 cases, 39%）, sharp instrument injury（8 cases, 17%）, plant injury（6 cases, 13%）, explosion injury（6 cases, 13%）, impact injury（4 cases, 9%）, limb impact injury（2 cases, 4%）, traffic accident injury（2 cases, 4%）. There were 33 cases（72%）with ocular rupture, 12 cases（26%）with perforating injury of eyeball and 1 case（2%）with ocular contusion. There were 44 cases（96%）with vitreous hemorrhage, 30 cases（65%）with retinal detachment, 18 cases（39%）with intraocular foreign body（IOFB）, 22 cases（48%）with cilio-choroidal detachment, 18 cases（39%）with endophthalmitis and 12 cases（26%）with retinal hemorrhage. The postoperative best-corrected visual acuity improved to light perception or better than light perception in 30 cases（65%）, and 16 cases（35%）still had no light perception.CONCLUSION： The patients who had no light perception after ocular trauma were almost young and middle-aged people in rural areas. The factors that affected the visual acuity of the postoperative included the type of injury, the location and size of the wound, the retinal detachment, the cilio-choroidal detachment, the duration from the injury to intervention, the endophthalmitis and whether the merger of intraocular foreign body or not. The 25-gauge vitrectomy could make most of the visual acuity from no light perception to light perception or over the light perception, which had a high clinical value in curing traumatized eyes with no light perception.