玻璃体切割术治疗复杂眼外伤的疗效及预后影响因素分析
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摘要
目的:探讨玻璃体切割术治疗复杂眼外伤的临床疗效、安全性及其预后影响因素。方法:选取我院收治的80例眼外伤患者,均行玻璃体切割术治疗,观察并记录患者的术前、术后6个月的最佳矫正视力(BCVA),术前、术后3个月、6个月的汉密尔顿焦虑量表(HAMA)评分,分析影响患者预后的危险因素及随访6个月期间并发症的发生情况。结果:患者术后BCVA比例较术前显著提高,差异具有统计学意义(P<0.05)。术前视力、眼内异物、受伤类型、手术时机均是影响患者预后的危险因素。患者术后3个月、6个月的HAMA评分明显低于术前(P<0.05)。随访6个月期间,共有71例患者眼内炎症反应,17例术后继发青光眼,6例角膜水肿。结论:玻璃体切割术治疗复杂眼外伤能明显改善患者视力,缓解患者焦虑情绪,患者术前视力情况及手术时机的选择是患者预后重要的影响因素。
Objective: To investigate the efficacy, safety, prognostic influencing factors of vitrectomy in the treatment of the complicated ocular trauma. Methods: 80 patients with complicated ocular trauma were selected and given vitrectomy. The efficacy of vitrectomy in the treatment of the complicated ocular trauma was analyzed by best corrected visual acuity(BCVA) before operation, at 6months after operation, hamilton anxiety scale(HAMA) value before operation, at 3 and 6 months after operation, the risk factors influencing the prognosis and complications during 6 months follow-up. Results: The BCVA was significantly improved after operation(P<0.05). The preoperative visual acuity, intraocular foreign body, type of injury and operative time were the risk factor of prognosis. The preoperative HAMA score was 19.6±4.1, the HAMA score was 11.3±2.5 at 3 months after operation and 7.6 ±1.1 at 6 months after operation. The HAMA score at 3 and 6 months after operation were higher(P<0.05). During 6 months' follow-up, 71 cases of intraocular inflammation, 17 cases of secondary glaucoma and 6 cases of corneal edema were observed. Conclusion: Vitrectomy was effective in the treatment of complicated ocular trauma, which could improve the patients' vision, relieve the anxiety of patients. Preoperative visual acuity and operation opportunity were important prognostic factors for the patients with complicated ocular trauma.
Objective: To investigate the efficacy, safety, prognostic influencing factors of vitrectomy in the treatment of the complicated ocular trauma. Methods: 80 patients with complicated ocular trauma were selected and given vitrectomy. The efficacy of vitrectomy in the treatment of the complicated ocular trauma was analyzed by best corrected visual acuity(BCVA) before operation, at 6months after operation, hamilton anxiety scale(HAMA) value before operation, at 3 and 6 months after operation, the risk factors influencing the prognosis and complications during 6 months follow-up. Results: The BCVA was significantly improved after operation(P<0.05). The preoperative visual acuity, intraocular foreign body, type of injury and operative time were the risk factor of prognosis. The preoperative HAMA score was 19.6±4.1, the HAMA score was 11.3±2.5 at 3 months after operation and 7.6 ±1.1 at 6 months after operation. The HAMA score at 3 and 6 months after operation were higher(P<0.05). During 6 months' follow-up, 71 cases of intraocular inflammation, 17 cases of secondary glaucoma and 6 cases of corneal edema were observed. Conclusion: Vitrectomy was effective in the treatment of complicated ocular trauma, which could improve the patients' vision, relieve the anxiety of patients. Preoperative visual acuity and operation opportunity were important prognostic factors for the patients with complicated ocular trauma.
引文
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[17]Mazinani B,Baumgarten S,Schiller P,et al.Vitrectomy with or without encircling band for pseudophakic retinal detachment:a multi-centre,three-arm,randomised clinical trial.VIPER Study Report No.1--design and enrolment[J].Br J Ophthalmol,2016,100(3):405-410
[18]譒ín M,Chrapek O,KarhanováM,et al.The effect of pars plana vitrectomy and nuclear cataract on oxygen saturation in retinal vessels,diabetic and non-diabetic patients compared[J].Acta Ophthalmol,2016,94(1):41-47
[19]Fassbender JM,Ozkok A,Canter H,et al.A Comparison of Immediate and Delayed Vitrectomy for the Management of Vitre ous Hemorrhage due to Proliferative Diabetic Retinopathy[J].Ophthalmic Surg Lasers Imaging Retina,2016,47(1):35-41
[20]高旭辉,刘铁城,代艾艾,等.玻璃体切割治疗复杂眼外伤的临床疗效分析[J].解放军医学院学报,2016,37(2):133-136Gao Xu-hui,Liu Tie-cheng,Dai Ai-ai,et al.Clinical efficacy of vitrectomy for treatment of patients with complex ocular trauma[J].Acad J Chin PLA Med Sch,2016,37(2):133-136
[2]黄红艳,马效工,牛建军.玻璃体切除手术治疗复杂眼外伤[J].国际眼科杂志,2010,10(6):1177-1178Huang Hong-yan,Ma Xiao-gong,Niu Jian-jun.Vitrectomy for severe ocular trauma[J].International Journal of Ophthalmology,2010,10(6):1177-1178
[3]Clark A,Morlet N,Ng JQ,et al.Long-term trends and outcomes of anterior vitrectomy in Western Australia[J].Acta Ophthalmol,2015,93(1):27-32
[4]Septa D,Newaskar VP,Agrawal D,et al.Etiology,incidence and patterns of mid-face fractures and associated ocular injuries[J].J Maxillofac Oral Surg,2014,13(2):115-119
[5]蒋红文.复杂眼外伤并眼内异物的玻璃体手术临床分析[J].中华眼外伤职业眼病杂志,2014,36(12):918-920Jiang Hong-wen.Clinical analysis of vitreous surgery for complicated ocular trauma with intraocular foreign bodies[J].Chinese Journal of ocular trauma and occupational eye disease,2014,36(12):918-920
[6]霍银平,王文战,周利晓.玻璃体切除术治疗复杂眼外伤的效果观察[J].中华眼外伤职业眼病杂志,2014,36(4):270-272Huo Yin-ping,Wang Wen-zhan,Zhou Li-xiao.The efficacy of vitrectomy for complex ocular trauma[J].Chinese Journal of ocular trauma and occupational eye disease,2014,36(4):270-272
[7]Magarakis M,Mundinger GS,Kelamis JA,et al.Ocular injury,visual impairment,and blindness associated with facial fractures:a systematic literature review[J].Plast Reconstr Surg,2012,129(1):227-233
[8]Carifi G,Miller MH,Pitsas C,et al.Complications and outcomes of phacoemulsification cataract surgery complicated by anterior capsule tear[J].Am J Ophthalmol,2015,159(3):463-469
[9]Pacheco Shah BK,Tothy AS.Severe facial and ocular injuries from a potato gun[J].Pediatr Emerg Care,2013,29(3):366-367
[10]Chae JJ,Mulreany DG,Guo Q,et al.Application of a collagen-based membrane and chondroitin sulfate-based hydrogel adhesive for the potential repair of severe ocular surface injuries[J].Mil Med,2014,179(6):686-694
[11]Choi JH,Greene WA,Johnson AJ,et al.Pathophysiology of blastinduced ocular trauma in rats after repeated exposure to low-level blast overpressure[J].Clin Exp Ophthalmol,2015,43(3):239-246
[12]Zhou J,Wang FH,Lu H,et al.Ocular Trauma in a Rural Population of North China:The Handan Eye Study[J].Biomed Environ Sci,2015,28(7):495-501
[13]Kalwerisky K,Davies B,Mihora L,et al.Use of the Boston Ocular Surface Prosthesis in the management of severe periorbital thermal injuries:a case series of 10 patients[J].Ophthalmology,2012,119(3):516-521
[14]Kim J,Kang SW,Shin DH,et al.Macular ischemia and outcome of vitrectomy for diabetic macular edema[J].Jpn J Ophthalmol,2015,59(5):295-304
[15]Gu R,Zhou M,Jiang C,et al.Elevated concentration of cytokines in aqueous in post-vitrectomy eyes[J].Clin Exp Ophthalmol,2016,44(2):128-134
[16]侯颖,刘平,吕勇,等.复杂性眼外伤患者玻璃体切割围手术期护理体会[J].现代生物医学进展,2015,15(5):926-928Hou Ying,Liu Ping,Lv Yong,et al.Nursing Experience of Vitrectomy on Patients with Complicated Ocular Trauma in Preoperative Period[J].Progress in Modern Biomedicine[J].Progress in Modern Biomedicine,2015,15(5):926-928
[17]Mazinani B,Baumgarten S,Schiller P,et al.Vitrectomy with or without encircling band for pseudophakic retinal detachment:a multi-centre,three-arm,randomised clinical trial.VIPER Study Report No.1--design and enrolment[J].Br J Ophthalmol,2016,100(3):405-410
[18]譒ín M,Chrapek O,KarhanováM,et al.The effect of pars plana vitrectomy and nuclear cataract on oxygen saturation in retinal vessels,diabetic and non-diabetic patients compared[J].Acta Ophthalmol,2016,94(1):41-47
[19]Fassbender JM,Ozkok A,Canter H,et al.A Comparison of Immediate and Delayed Vitrectomy for the Management of Vitre ous Hemorrhage due to Proliferative Diabetic Retinopathy[J].Ophthalmic Surg Lasers Imaging Retina,2016,47(1):35-41
[20]高旭辉,刘铁城,代艾艾,等.玻璃体切割治疗复杂眼外伤的临床疗效分析[J].解放军医学院学报,2016,37(2):133-136Gao Xu-hui,Liu Tie-cheng,Dai Ai-ai,et al.Clinical efficacy of vitrectomy for treatment of patients with complex ocular trauma[J].Acad J Chin PLA Med Sch,2016,37(2):133-136