目的 探讨开放性眼外伤行玻璃体切割手术(PPV)治疗的预后情况,并对其相关影响因素进行分析。方法 回顾性研究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行PPV治疗的开放性眼外伤患者241例(241眼)的临床资料。记录术前临床特征,包括性别、年龄、外伤类型、外伤分区、眼内异物、视力、眼压、相对性传入性瞳孔障碍、受伤至PPV时间(受伤～手术时间)、感染性眼内炎和组织受累情况。根据患者情况制定相应的PPV方案,术后随访6个月,每次随访记录视力、眼压、屈光介质情况,视网膜复位情况,眼球保留和摘除情况。根据末次随访结果评判手术预后情况。采用多因素回归分析术前临床特征与手术预后的相关性。结果 241眼中,解剖痊愈113眼(46.9%),功能痊愈93眼(38.6%),总治愈206眼(85.5%),未愈35眼(14.5%),眼球摘除17眼(7.1%)。多因素回归分析显示总治愈率与外伤类型、外伤分区、受伤～手术时间相关,眼球摘除率与外伤类型、术前视力、受伤～手术时间相关。结论 PPV治疗开放性眼外伤疗效显著,外伤类型、外伤分区、术前视力和受伤～手术时间是影响手术预后的相关因素。
Abstract
Objective To study the prognosis of pars plana vitrectomy (PPV)for open globe injury and explore the relevant factors. Methods The clinical data of 241 patients (241 eyes) with open globe injury who received PPV treatment in Department of Ophthalmology of Sichuan Provincial Corps Hospital of Chinese People’s Armed Police Force, Leshan Ophthalmic Center and Ophthalmic Hospital Affiliated to Chengdu University of Traditional Chinese Medicine from January 2013 to December 2022 were retrospectively studied. Preoperative clinical features were recorded, including gender, age, type of injury, zone of trauma, intraocular foreign bodies, visual acuity, intraocular pressure, relative afferent pupillary defect, time between trauma and pars plana vitrectomy, infectious endophthalmitis, and tissue involvement. Individualized surgery was performed based on each patient’s condition and followed up for 6 months after surgery. Visual acuity, intraocular pressure, refractive media, retinal reattachment, and eyeball retention and removal were recorded at each follow-up. According to the final follow-up results, the surgical prognosis was evaluated. Multivariate regression analysis was used to investigate the correlation between preoperative clinical features and surgical prognosis. Results In 241 eyes, 113 eyes (46.9%) had anatomical cure, 93 eyes (38.6%) had functional cure, 206 eyes (85.5%) were cured altogether, 35 eyes (14.5%) were not cured, and 17 eyes (7.1%) underwent enucleation. Multivariate regression analysis showed that the total cure rate was correlated with the type of injury, the area of injury, and the time between injury and operation, and the enucleation rate was correlated with the type of injury, preoperative visual acuity, and the time from injury to operation. Conclusions PPV is effective in the treatment of open globe injury. The type of injury, area of injury, preoperative visual acuity, and time between injury to pars plana vitrectomy are the related factors that affect the surgical prognosis.
关键词
开放性眼外伤 /
玻璃体切割手术 /
预后 /
多因素分析 /
危险因素 /
手术时机
Key words
open globe injury /
pars plana vitrectomy /
prognosis /
multifactor analysis /
risk factor /
surgical timing
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基金
武警部队某课题资助;乐山“嘉州英才培育计划”项目(乐人才办2021-5号)
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