儿童外伤性青光眼的临床分析

Analysis of traumatic glaucoma in children

目的:分析儿童外伤性青光眼的临床特征。方法:回顾性分析郑州大学第一附属医院2014年1月至2018年12月收治的1~14岁425例儿童眼外伤中继发性青光眼共67例(67只眼)的临床资料。其中闭合性眼外伤继发青光眼组52例(52只眼),开放性眼外伤继发青光眼组15例(15只眼)。分析两组患儿临床特征、治疗方法及其效果。随访时间1个月~2年。结果:425例儿童眼外伤中有251例闭合性眼外伤和174例开放性眼外伤。闭合性眼外伤继发青光眼的发生率(20.72%,52/251),高于开放性眼外伤继发青光眼的发生率(8.62%,15/174),差异有统计学意义(χ^2=11.323,P=0.001)。闭合性眼外伤继发青光眼的发病时间早于开放性眼外伤继发青光眼。前房积血是闭合性眼外伤青光眼的主要病因(40.38%,21/52),混合型机制是开放性眼外伤青光眼的主要病因(73.33%,11/15)。患者均经常规药物治疗,眼压不能控制者闭合性眼外伤青光眼组有22例行手术治疗(42.31%,22/52),开放性眼外伤继发青光眼组有3例(20.00%,3/15),两组对比无统计学意义(χ^2=2.477,P=0.116)。末次随访闭合性眼外伤青光眼组患者的平均眼压高于开放性眼外伤青光眼组(t=2.828,P=0.006)。两组患者末次随访BCVA差异无统计学意义(t=-1.244,P=0.218)。结论:闭合性眼外伤继发青光眼较开放性眼外伤继发青光眼常见。前房积血和混合型机制分别是闭合性眼外伤继发青光眼和开放性眼外伤继发青光眼的常见发病原因。药物治疗仍是首选,但滤过手术是控制闭合性眼外伤继发青光眼的有效途径。

Objective To analyze the clinical characteristics of traumatic glaucoma in children.Methods This is a retrospective study.The data of 67 eyes of 67 cases with secondary glaucoma in 425 children with ocular trauma,aged 1 to 14 years,from Jan.2014 to Dec.2018 in First Affiliated Hospital of Zhengzhou University were analysed retrospectively.There were 52 eyes of 52 cases with secondary glaucoma caused by closed ocular trauma in closed ocular trauma group,and 15 eyes of 15 cases with secondary glaucoma caused by open ocular trauma in open ocular trauma group.The clinical characteristics,treatment methods and efficacy of treatment of the two groups were analyzed.The follow-up time was 1 month-2 years.Results There were 251 cases of closed ocular trauma and 174 cases of open ocular trauma in children.The incidence of secondary glaucoma caused by closed ocular trauma(20.72%,52/251)was higher than that of open ocular trauma(8.62%,15/174),and the difference was statistically significant(χ^2=11.323,P=0.001).The onset time of secondary glaucoma caused by closed ocular trauma was earlier than that of open ocular trauma.Hyphema(40.38%,21/52)was the main cause of secondary glaucoma due to closed ocular trauma,and the mixed mechanism was the main cause of secondary glaucoma due to open ocular trauma(73.33%,11/15).The two groups received conventional medicine first,and 22 cases(42.31%,22/52)of closed ocular trauma group and 3 cases(20.00%,3/15)in open ocular trauma group were converted to surgery because of lose control of IOP.The difference in surgery rate was not statistically significant between the two groups(χ^2=2.477,P=0.116).At the last follow-up,the mean IOP of closed ocular trauma group was higher than that of open ocular trauma group(t=2.828,P=0.006).There was no statistical significance in BCVA between the two groups at the last follow-up(t=-1.244,P=0.218).Conclusion Secondary glaucoma caused by closed ocular trauma is more common than open ocular trauma.Treatment with medicine is still the first choice,but filtering surgery is an effective way to control secondary glaucoma with closed ocular trauma.