玻璃体视网膜手术联合地塞米松玻璃体内植入剂治疗复杂眼外伤的短期效果

Short-term efficacy of vitreoretinal surgery combined with dexamethasone intravitreal implant in the treatment of open complex ocular trauma

目的观察玻璃体视网膜手术联合地塞米松玻璃体内植入剂(傲迪适)治疗复杂开放性眼外伤的短期效果。方法回顾性病例系列研究。收集西安市人民医院2020年8月至2021年8月复杂开放性眼外伤13例(13眼)的临床资料, 患者于眼外伤后3~61 d行玻璃体视网膜手术联合傲迪适玻璃体腔注射, 术后随访2个月, 观察患者眼压、视力及并发症。结果术前、术后1 d、1周、1个月及2个月的眼压依次为(9.77±2.83)mmHg、(12.89±3.13)mmHg、(16.58±7.39)mmHg、(17.64±10.63)mmHg及(11.85±3.79)mmHg(1 mmHg=0.133 kPa), 不同时间点的眼压差异有统计学意义(F=5.34, P=0.018)。术前视力(BCVA, logMAR)为2.51±0.25, 术后2个月视力提高至1.79±0.64(t=4.55, P=0.001)。术后高眼压(>21 mmHg)的发生率为30.8%(4/13), 给予局部降眼压药物后可控制眼压;所有患者的视网膜均平伏;3例(23.1%)出现傲迪适脱入前房。结论术后2个月玻璃体视网膜手术联合傲迪适可有效治疗复杂开放性眼外伤, 但应警惕引起眼压升高及药物脱至前房的风险。

Objective To observe the short-term efficacy of vitreoretinal surgery combined with dexamethasone intravitreal implant(ozurdex)for the treatment of complex open ocular trauma.Methods This was a retrospective case series study.The clinical data of 13 eyes of 13 patients with complex open ocular trauma from Aug.2020 to Aug.2021 in Xi’an People’s Hospital were collected.The patients received vitreoretinal surgery combined with intravitreal injection of Ozurdex at 3-61 days after ocular trauma.The follow-up duration was 2 months.The intraocular pressure,visual acuity and complication were observed.Results The intraocular pressure(IOP)at pre-operation,1 day,1 week,1 and 2 months postoperatively were(9.77±2.83)mmHg,(12.89±3.13)mmHg,(16.58±7.39)mmHg,(17.64±10.63)mmHg and(11.85±3.79)mmHg,respectively(1 mmHg=0.133 kPa),and the difference was statistically significant(F=5.34,P=0.018).The visual acuity(BCVA,logMAR)was 2.51±0.25 before operation,and improved to 1.79±0.64 at 2 months postoperatively(t=4.55,P=0.001).The incidence of high IOP(>21 mmHg)was 30.8%(4/13)after operation,and local anti-glaucoma drugs could control the IOP.The retina of all patients was flat after the operation.And the dexamethasone intravitreal implant prolapsed into the anterior chamber in 3 cases(23.1%).Conclusion At 2 months postoperatively,vitreoretinal surgery combined with Ozurdex is effective in the treatment of complex open ocular trauma,but the risk of elevated IOP and drug detachment to the anterior chamber should be looked into.