170例儿童眼内异物患者的致病原因、临床特征及预后分析

Pathogenic causes,clinical features and prognosis of intraocular foreign bodies in children——170 case analysis

目的研究儿童眼内异物患者的致病原因、临床特征及预防策略。设计回顾性病例系列。研究对象北京同仁医院2004年1月至2016年12月因眼内异物住院的14岁及以下儿童患者170例。年龄1~14岁,平均(8.73±3.12)岁。其中男性157例(92.4%)。方法收集及分析患者的基本信息、致伤原因、致伤物、眼部并发症、眼内异物特征、手术治疗情况及预后。主要指标致病原因、致伤物种类、并发症和致盲率。结果致伤原因中爆炸伤占首位(59.4%,n=101),其次是锐器扎伤(20.6%,n=35)。常见的致伤物是烟花爆竹(41.2%,n=70)及雷管(8.8%,n=15)。并发眼内炎35例(25.0%),视网膜裂孔或脱离96例(56.5%)。140例(82.4%)患者的异物位于眼后节。148例(87.1%)施行玻璃体切除术。105例(61.8%)术后患眼矫正视力低于0.05。爆炸伤患者术后患眼盲的比例高于其他类致伤原因的患者(72.3%及46.4%,P<0.01)。结论儿童眼内异物伤的首要致伤原因是爆炸伤,烟花爆竹是首要致伤物。多数患者视力预后不佳。

Objective To study the etiological,clinical characteristics and prevention strategies of children with intraocular foreign body（ IOFB）. Design Retrospective case series. Participants One hundred and seventy inpatients of Beijing Tongren Hospital with IOFB during January 1 2004 to December 312016 with age of 1 to 14 years old（ mean 8. 73 ± 3. 12 years）,among whom 157 were boys（ 92. 4%）.Method The basic information of patients,causes of injury,wounds,eye complications,IOFB characteristics,surgical treatment and prognosis were collected and analyzed using SPSS. Main Outcome Measures Cause of the injury,type of foreign body,complications and blindness rate. Results Among the causes of the injury,explosive injuries was the most common（ 59. 4%,n = 101）,followed by sharp stick injuries（ 20. 6%,n = 35）. Fireworks were the most damaging items（ 41. 2%,n = 70）,followed by detonators（ 8. 8%,n = 15）. Endophthalmitis occurred in 35 cases（ 25. 0%）. Retinal tears or detachment occurred in96 cases（ 56. 5%）. 140 cases（ 82. 4%） of foreign bodies located in the posterior segment. 148 cases（ 87. 1%） underwent vitrectomy. 105 patients（ 61. 8%） were blind（ best corrected visual acuity 0. 05）after operation. Blast injury patients had higher blinding rates than other causes of injury（ 72. 3% vs46. 4%,P〈0. 01）. Conclusions The most common cause of injury in children with IOFB is explosion.Fireworks are the most damaging items. The vision prognosis is poor in children with IOFB.