十年72例嚴重眼外傷回顧性分析

A retrospective analysis of 72 cases with severe ocular trauma during past 10 years

目的回顧過去10年在本院須住院手術的嚴重眼外傷患者,分析其致傷原因、臨床特徵及預後情況。方法研究對象為2005年1月~2014年7月在本院診治的開放性眼外傷患者61例(61眼);嚴重的閉合性眼外傷患者11例(11眼),合共72例(72眼)。主要觀察指標:患者的基本資料、手術前後最佳矯正視力、致傷原因、受傷類型及部位、預後情況。結果本院每年平均收治嚴重眼外傷患者7例,男女比例9:1,兒童青少年患者有5例(6.9%)。病因以工業意外傷佔首位(49例68.1%),其中最多是金屬碎片傷(39例54.2%)。眼前節Ⅰ區或/和Ⅱ區是主要受傷部位(71例/98.6%),合併有Ⅲ區受累者術後視力預後差。有4例開放性眼外傷發生眼內炎,其中3例就診時間超過24小時。術後最佳矯正視力≥0.3的有47例(65.3%),而屬1級盲即最佳矯正視力<0.02~NLP者有16例(22.2%),有9例(12.5%)患者最終眼球萎縮或裝置義眼。結論過去10年本院嚴重眼外傷的主要原因是工業意外傷,以青壯年男性多見。視力預後與外傷部位有關。就診時間越長,發生眼內炎機會越大。

Objective A retrospective study of patients with severe ocular trauma treated with surgery in Macao Kiang Wu Hospital during past 10 years,analyzing the cause of injury,clinical feature and prognosis.Methods The data were collected from Kiang Wu Hospital from January 2005 to July 2014,which includes 72cases(72 eyes),in which 61 cases(61 eyes)were open-globe injury and 11 cases(11 eyes)were severe closed-globe injury.The data including patient’s basic profile,preoperative and postoperative best corrected visual acuity,cause of injury,type of injury,location of injury and prognosis of patient were studied.Results Average 7 patients with serious ocular trauma admitted to our hospital each year,the ratio of male vs female was 9:1,5 cases(6.9%)of children and adolescent patients.the most common reason was metal fragment injury(39 cases/54.2%)in industrial accident(49 cases/68.1%).Anterior segment in I area and/or II area were the main site of injury(71 cases/98.6%),injury associated with III area patient’s had poor visual aquity prognosis.Endophthalmitis occurred in 4 cases of open-globe injury,including 3 cases with delay in medical consultation time for more than 24 hours.47 cases(65.3%)had postoperative best corrected visual acuity≥0.3,and 16 cases(22.2%)had best corrected visual acuity<0.02~NLP,in 9 patients(12.5%)eyeball atrophy occurred or prosthetic eye device eventually placed.Conclusion Over the past 10 years,severe ocular trauma were mainly due to industrial accident injuries in our hospital,it is more common in young men.postoperative visual acuity was related to the location of injury.Delay in medical consultation can lead to occurrence of endophthalmitis.