玻璃体手术治疗眼外伤的预后因素分析

Prognostic factors of vitrectomy in treating ocular trauma

目的 探讨影响玻璃体手术治疗眼外伤的预后因素。方法 对 1998年 7月至 2 0 0 0年 8月 ,经玻璃体手术治疗的严重眼外伤病例随访资料齐全的 85例 ,85眼临床资料进行分析。结果 术后功能修复 63眼 (74 1% ) ,解剖修复 14眼 (16 4% ) ,失败 8眼 (9 4% )。术前视力与预后 :①术前视力≥ 0 0 2者的功能修复率 (10 0 0 % )较术前视力 <0 0 2者 (68 5 % )高 ,二者间差异非常显著(P <0 0 1)。②伤型与预后 :功能修复率分别为 :穿通伤 :73 3 % ;异物伤 :75 0 % ;钝挫伤 :75 9% ;破裂伤 66 7% ,相互比较无显著性差异 (P >0 0 5 )。③手术时机与预后 :功能修复率 14d内为 71 4% (10 14 ) ,15～ 3 0d为 69 6% (16 2 3 ) ,大于 3 0d为 77 1% (3 7 48) ,三者比较无明显差异 (P >0 0 5 ) ,但修复失败主要发生在外伤后超过 3 0d手术者 (6 8)。④术前外伤性增殖性玻璃体视网膜病变(TRVR)与预后 :合并有TPVR者的功能修复率 (64 3 % )较术前无TPVR者的手术后功能修复率 (83 7% )低 ,其差异有统计学意义 (P<0 0 5 )。⑤术前有玻璃体积血、外伤性白内障者功能修复率与不伴有玻璃体积血和无外伤性白内障者无显性差异 (P >0 0 5 )。结论 玻璃体手术是治疗眼外伤的有效手段。影响伤眼手术预后的因素是

Objective To evaluate prognostic factors influencing final results of patients undergoing vitreous surgery for ocular trauma. Methods The data of 85 patients (85 eyes) undergoing vitrectomy due to ocular trauma from 1998 to 2000 were reviewed. The analyses were performed to determine predictors of the final results. Results In these 85 eyes, 63 eyes (74.1%) were repaired successfully, 14 eyes (16.4%) were repaired anatomically and 8 eyes (9.4%) were failed. The rate of successful repair was very significantly higher in patients with pre operative visual acuity of 4/200 or better (100.0%) than in those with pre operative visual acuity of 4/200 or worse (68.5%)( P <0.01). The rates of successful repair were 66.7%, 73.3%, 75.9%, and 75.0% respectively in patients with globe rupture, penetrating injury, blunt injury and foreign bodies in the posterior segment. The rates of successful repair in patients receiving surgery within 14 d, during 15-30 d, and beyond 30 d after injury were 71.4%, 69.6% and 77.1% respectively. But the failure was mainly in patients operated in more than 30 d after injury. The rate of successful repair was significantly lower in patients with tramatic proliferative vitreoretinopathy (TPVR) (64.3%) than those without (83.7%) ( P < 0.05) . The rates between patients with and without vitreous hemorrhage was not significant, so was in patients with or without tramatic cataract. In these 85 eyes, 13 eyes (15.1%) were failed after first vitreous surgery because of PVR, and 7 eyes were repaired successfully through second vitreous surgery. Conclusion Vitrectomy is an effective method in treating patients with ocular trauma. Prognosis in ocular trauma depends on the preoperative visual acuity, the duration of eye injury to surgery, the occurrence of TPVR after eye injury, but is not associated with the types of eye injury, tramatic vitreous hemorrhage and tramatic cataract.