大型眼内异物的临床特点及预后因素分析

Analysis on the clinical characterization and prognostic factors of ocular trauma with giant intraocular foreign body

目的分析大型眼内异物的临床特点及预后因素.方法回顾性分析郑州大学第一附属医院2016年1月至2017年12月眼内异物580例(580只眼)中大型异物62例(62只眼)的临床资料.随访6个月~2年.观察大型眼内异物的临床特征,分析预后因素.结果本研究中大型异物(长≥10 mm或宽≥4 mm或厚≥3 mm)占同期眼内异物的10.69%(62/580).男58例,女4例.年龄范围1~62岁,平均(39.7±11.7)岁.其中磁性异物41例(66.13%).在工作场所受伤者最多,共45例(72.58%).一期行眼内容摘除术者2例,其余60例均行二期眼内异物摘出联合玻璃体切除、晶状体摘出及硅油填充等手术.术后最终取出硅油并保存眼球者37例(59.68%),未取出硅油者20例(32.26%),三期行眼内容摘除术者3例(4.84%).最终视力:无光感者8例,光感~手动者19例,数指~0.04者11例,0.05~0.25者22例,≥0.3者2例,总体视力(logMAR)优于术前(t=7.703,P=0.000).最终视力与术前视力有相关性(r=0.516,P=0.000).异物长度与最终视力无相关性(r=-0.227,P=0.096),异物宽度和伤口长度均与最终视力有相关性(r=0.375,0.453;P=0.003,0.000).按有无虹膜脱出/嵌顿、晶状体脱出、后极部视网膜伤口、视网膜坏死及视网膜脱出分别分组,具有相应伤情组的最终视力较无相应伤情组差(P<0.05).结论大型眼内异物的预后与术前视力、异物宽度、伤口长度及视网膜损伤程度有关.

Objective To analyze the clinical characterization and the prognostic factors of ocular trauma with giant intraocular foreign bodies.Methods The clinical data of 62 eyes of 62 cases of giant intraocular foreign bodies(IOFBs)from 580 eyes of 580 cases of IOFBs from Jan.2016 to Dec.2017 in the Affiliated Hospital of Zhengzhou University were selected and analyzed retrospectively.The follow-up time was from 6 months to 2 years.Results The sizes of giant IOFBs were no less than 10 mm in length,or no less than 4 mm in width,or no less than 3 mm in thickness.The rate of giant IOFB was 10.69%(62/580)in all the IOFBs during the period.There were 58 males and 4 females.Their ages ranged from 1-62 years,with an average of(39.7±11.7)years.Magnetic IOFBs occupied 66.13%(41/62)of all.The working place was the most common injury environment,which occupied 72.58%(45/62).Two cases with serious damage received evisceration during debridement and suturing surgery.The other 60 cases underwent a secondary combined surgery of IOFB extraction,vitrectomy,lens surgery and silicone oil tamponade.Amongst the above,37 cases(59.68%,37/62)had reserved the eyeball after a secondary surgery of silicone oil extraction,and 20 cases(32.26%,20/62)had not accepted silicone oil extraction and another 3 cases(4.84%,3/62)had undergone evisceration because of postoperative complications.The final BCVA was no light perception in 8 eyes,from light perception to hand movement in 19 cases,from counting finger to 0.04 in 11 cases,from 0.05 to 0.25 in 22 cases and no less than 0.3 in 2 cases.The final BCVA(logMAR)were better than the preoperative BCVA.The difference was statistically significant(t=7.703,P=0.000).There was positive relationship between the preoperative BCVA and the final BCVA(r=0.516,P=0.000).The final BCVA was also positively related to the width of IOFB(r=0.375,P=0.003)and the length of the wound(r=0.453,P<0.001).But there was no relationship between the final BCVA and the length of IOFB(r=-0.227,P=0.096).When the patients were divided into two groups on the tissue injuries of the eyeball,such as iris prolapse/incarceration,lens dislocation/prolapse,posterior polar wound,retinal necrosis and retinal prolapse,the statistical results of the final BCVA showed significant difference between each paired groups(P<0.05).Conclusion The prognosis of giant IOFB is related to the preoperative BCVA after injury,width of the IOFB,length of wound and the severity of retinal injuries.The accurate judgement of those items can be beneficial for the treatment and the prognosis.