目的 探讨累及后节的眼球穿通伤患者的临床特征及手术预后。方法 回顾性分析2013-01至2022-12在武警四川总队医院、乐山市眼科中心、成都中医药大学附属眼科医院诊治的累及后节的眼球穿通伤行玻璃体切割手术(PPV)的患者175例(175眼),记录术前临床特征、受伤至入院时间及受伤至PPV时间。PPV术后随访1～6月,每次随访记录视力、眼压、屈光介质情况,视网膜复位情况,眼球摘除及并发症情况。根据末次随访结果评判手术预后为解剖痊愈、功能痊愈、未愈。结果 所有患者均为单眼受累,男女比例为12.5:1,平均年龄(46.6±13.8)岁,高速金属物为最常见的致伤物(占51.4%),56.0%患眼有眼内异物,其中金属异物占84.7%,一区为最常见受伤区域占68.6%,术前视力主要分布在LP-0.02(占76.0%),通常伴有晶状体损伤(77.1%)、前房玻璃体积血(53.7%)和视网膜脱离(38.9%)等,多数患者在24 h内入院(占58.9%),PPV主要在伤后两周内进行(占84.6%),硅油填充占33.1%。49.1%患眼解剖痊愈,45.7%功能痊愈,总治愈94.9%,5.1%未愈,1.1%眼球摘除,术后总体并发症发生率为17.1%。结论 累及后节的眼球穿通伤患者主要临床特征为中年男性,单眼受累,多为高速金属物致伤、一区受伤,通常伴有眼内金属异物、眼内出血、晶状体损伤及视网膜脱离等,视力损害严重。PPV主要在伤后两周内进行,手术疗效确切,预后良好。

Objective To study the clinical features and surgical prognosis of patients with ocular penetrating injury involving posterior segment. Methods A multicenter retrospective study was conducted. A total of 175 patients (175 eyes) with ocular penetrating injury involving posterior segment who underwent pars plana vitrectomy (PPV) in three hospitals of Sichuan province from January 2013 to December 2022 were collected, and the clinical features, the time from injury to hospitalization, and the time from injury to PPV were recorded. The patients were followed up 1 to 6 months after PPV, Visual acuity, intraocular pressure, refractive media, retinal reattachment, enucleation of eyeballs and complications were recorded at each follow-up. According to the final follow-up results, the surgical prognosis was evaluated as anatomical recovery, functional recovery, and non-recovery. Results All patients were monocular affected, the ratio of male to female was 12.5:1, and the average age was 46.6±13.8 years old. Metal objects with high speed were the most common cause of injury (51.4%), and 56.0% of the affected eyes had intraocular foreign bodies, of which metallic foreign bodies accounted for 84.7%. Zone 1 was the most common injury area (68.6%), and preoperative visual acuity were mainly distributed in LP-0.02 (76.0%), usually accompanied by lens injury (77.1%), anterior chamber vitreous hemorrhage (53.7%) and retinal detachment (38.9%). Most patients were admitted within 24 hours (58.9%), PPV were mainly performed within two weeks after injury (84.6%), and silicone oil filling accounted for 33.1%. A total of 49.1% of the affected eyes were anatomically cured, 45.7% were functionally cured, and the total cure rate was 94.9%, 5.1% were not cured, and 1.1% were enucleated. The overall incidence of postoperative complications was 17.1%. Conclusions The main clinical features of patients with ocular penetrating injury involving the posterior segment are middle-aged males with single eye involvement, mostly caused by high-speed metal objects and in Zone 1, usually accompanied by intraocular metal foreign bodies, intraocular bleeding, lens damage and retinal detachment, with serious visual impairment. PPV is mainly performed within two weeks after injury, with good surgical effect and prognosis.