开放性眼外伤早期行玻璃体切除术的可行性及意义

Feasibility and significance of early vitrectomy for open ocular trauma

目的:探究开放性眼外伤患者早期行玻璃体切除术的可行性及意义。方法:回顾性分析2018-03/2019-03在本院眼外科治疗的开放性眼外伤合并视网膜脱离患者82例82眼,根据眼外伤发生后行玻璃体切除术的时间分为早期组(7d内)和常规组(7~14d),术后随访3mo,比较两组患者的总体疗效、视力变化、视网膜剥离复位率、外伤性增殖性玻璃体视网膜病变(TPVR)和并发症情况。结果:早期组总治愈率、视力提高率分别为93%、95%,常规组分别为71%、76%,早期组均显著高于常规组(χ2=5.222、4.783,P<0.05)。早期组硅油依赖、玻璃体再出血、继发性青光眼发生率分别为5%、10%、5%,常规组分别为27%、39%、29%,早期组均显著低于常规组(P<0.05);两组患者视网膜剥离复位率无差异(P>0.05),而早期组TPVR发生率为5%,常规组为20%,早期组低于常规组,但是差异无统计学意义(P>0.05)。结论:对于开放性眼外伤合并视网膜脱离患者,早期行玻璃体切除术的预后效果更佳,可提高视网膜复位率并降低TPVR的发生率。

·AIM:To explore the feasibility and significance of early vitrectomy for open ocular trauma.·METHODS:Eighty-two cases(82 eyes)of open ocular trauma complicated with retinal detachment in Department of Ophthalmic Surgery in our hospital from March,2018 to 2019 were reviewed,and the patients were divided into early group(<7d)and routine group(7-14d)according to the time of vitrectomy.All patients were followed up for 3mo.The overall efficacy,visual acuity changes,retinal detachment reduction rate,dysfunctional vitreous diseases(TPVR)and complications were compared between the two groups.·RESULTS:The total cure rate and visual acuity improvement rate of the early group were 93%and 95%,and those of the conventional group were 71%and 76%.The early group was significantly higher than the conventional group,and the difference was statistically significant(χ2=5.222,4.783,P<0.05).The complication rates of silicone oil dependence,vitreous hemorrhage and secondary glaucoma were 5%,10%and 5%in the early group which were significantly lower than in the conventional group(27%,39%,29%,P<0.05).There was no difference in the reduction rate of retinal detachment between two groups(P>0.05).The incidence of TPVR was 5%in the early group,which lower than in the conventional group,but had no difference(P>0.05).·CONCLUSION:For patients with open ocular trauma and retinal detachment,early vitrectomy may be more effective,which is more significant in improving the rate of retinal reduction and reducing the incidence of TPVR.