开放性眼外伤患者行Ⅱ期玻璃体切除手术的时机选择

Timing of stageⅡvitrectomy in patients with open ocular trauma

目的:观察开放性眼外伤不同时间点行玻璃体切除手术的临床疗效,以探讨Ⅱ期玻璃体手术的时机选择。方法:回顾性系列病例研究。纳入2022-06/2023-02就诊于我院眼科的开放性眼外伤患者60例60眼,按Ⅰ期规范化急诊救治手术时间与Ⅱ期玻璃体视网膜手术的不同间隔时间分为治疗组A(间隔时间≤14 d, 32例32眼)和治疗组B(间隔时间>14 d, 28例28眼)。治疗组A中眼球破裂伤16眼(50%),穿通伤13眼(41%),贯通伤3眼(9%);治疗组B中眼球破裂伤15眼(54%),穿通伤12眼(43%),贯通伤1眼(4%)。术后随访6 mo,对比观察两组患者的治疗效果。结果:玻璃体切除手术前两组患者间视力无差异(P>0.05)。术后6 mo,治疗组A中10眼(31%)视力显著提高,21眼(66%)视力有效提高,1眼(3%)视力无改善;治疗组B中,5眼(18%)视力显著提高,16眼(57%)视力有效提高,7眼(25%)视力无变化,两组比较有差异(U=322.5,P=0.032)。治疗组A中继发性青光眼、硅油依赖、玻璃体再积血、眼球萎缩与治疗组B比较无显著差异(均P>0.05);治疗组A术后随访未见外伤性增生性玻璃体视网膜病变(TPVR),显著低于治疗组B(P<0.05)。结论:开放性眼外伤Ⅱ期玻璃体视网膜手术在Ⅰ期救治手术后2 wk内完成预后相对较好。

AIM:To observe the clinical efficacy of vitrectomy at different times for open ocular trauma and explore the timing of stageⅡvitrectomy.METHODS:Retrospective case series study.A total of 60 cases(60 eyes)with open ocular trauma who visited our ophthalmology department from June 2022 to February 2023 were included.They were divided into treatment group A(interval≤14 d)and treatment group B(interval>14 d)based on the interval between the stageⅠemergency treatment surgery and the stageⅡvitreoretinal surgery.Among the 32 cases(32 eyes)in the treatment group A,16 eyes(50%)had eyeball rupture,13 eyes(41%)had penetrating injury,and 3 eyes(9%)had perforating injury.Among the 28 cases(28 eyes)in the treatment group B,15 eyes(54%)had eyeball rupture,12 eyes(43%)had penetrating injury,and one eye(4%)had perforating injury.The two groups of patients were followed-up for 6 mo after surgery,and the treatment effects were compared.RESULTS:There was no statistically significant difference in visual acuity between the two groups of patients before vitrectomy(P>0.05).In the treatment group A,10 eyes(31%)had significantly improved visual acuity,21 eyes(66%)had effectively enhanced visual acuity,and 1 eye(3%)had no improvement in visual acuity at 6 mo after surgery.Among the 28 eyes in the treatment group B,5 eyes(18%)had significantly improved vision,16 eyes(57%)had effectively enhanced vision,and 7 eyes(25%)had no change in vision,with statistically significant difference between the two groups(U=322.5,P=0.032).There was no significant difference between the treatment group A and the treatment group B in complications such as secondary glaucoma,silicone oil dependence,vitreous hemorrhage,and eyeball atrophy(P>0.05).There was no evidence of traumatic proliferative vitreoretinopathy(TPVR)in the treatment group A during postoperative follow-up,which was significantly lower than that of the treatment group B(P<0.05).CONCLUSION:The prognosis of the stageⅡvitrectomy for open ocular injury is relatively good after completing the stageⅠsurgery within 2 wk.