Chuang Lan-Hsin, Lai Chi-Chun
Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung, Taiwan, ROC.
Can J Ophthalmol. 2005 Aug;40(4):454-9. doi: 10.1016/S0008-4182(05)80005-5.
The purpose of this study was to determine the visual outcome and accuracy of biometry in traumatic cataract in open-globe injury.
A clinical retrospective study of 30 consecutive patients treated for ocular penetrating trauma was conducted. Patient demographics, causes of injury, wound categories, timing and procedures of the primary repair, interval of subsequent intraocular lens (IOL) implantation, follow-up, and postoperative complications were recorded. Additionally, binocular biometry was documented. Twenty-six eyes (86.7%) were open-globe injuries occurring in the workplace. All patients received cataract extraction with primary repair of the penetrating wound, 18 eyes (60%) underwent trans pars plana vitrectomy with lensectomy and 12 eyes (40%) underwent lens aspiration or extracapsular cataract extraction. Simultaneously, 16 eyes (53.3%) underwent intraocular foreign body removal.
The mean visual improvement after secondary IOL implantation was statistically significant (p = 0.002). Seventeen eyes (56.7%) achieved final best-corrected visual acuity of 20/40 or better. The mean deviation of final refraction and target refraction was -0.69 +/- 0.56 diopter, and 23 eyes (76.7%) were within 1 diopter based on biometry of the traumatic eye. In 18 eyes (60%), the difference was within 1 diopter according to biometry of the fellow eye. In 5 cases (16.7%), there was no improvement of vision because of central corneal scar, secondary glaucoma, macular pucker, or recurrent retinal detachment.
The vision of patients with traumatic cataract in open-globe injury was improved after prompt surgical intervention and subsequent IOL implantation. A minority of patients experienced no change in vision or a deterioration of vision due to irregular astigmatism caused by a corneal wound or variable damage to the posterior segment. Using biometry of the injured eye after primary repair was more accurate than using biometry of the fellow eye to determine the power of the lens for IOL implantation in variable open-globe injury.
本研究的目的是确定开放性眼球损伤所致外伤性白内障的视觉预后及生物测量的准确性。
对连续30例接受眼穿透伤治疗的患者进行临床回顾性研究。记录患者的人口统计学资料、损伤原因、伤口类别、一期修复的时间和手术方式、后续人工晶状体（IOL）植入的间隔时间、随访情况及术后并发症。此外，记录双眼生物测量数据。26只眼（86.7%）为 workplace 发生的开放性眼球损伤。所有患者均接受白内障摘除联合穿透伤口一期修复，18只眼（60%）行经平坦部玻璃体切除术联合晶状体切除术，12只眼（40%）行晶状体抽吸或囊外白内障摘除术。同时，16只眼（53.3%）行眼内异物取出术。
二期IOL植入术后平均视力改善具有统计学意义（p = 0.002）。17只眼（56.7%）最终最佳矫正视力达到20/40或更好。最终验光与目标验光的平均偏差为-0.69±0.56屈光度，根据伤眼生物测量，23只眼（76.7%）在1屈光度以内。根据健眼生物测量，18只眼（60%）的差异在1屈光度以内。5例（16.7%）因中央角膜瘢痕、继发性青光眼、黄斑皱襞或视网膜脱离复发而视力无改善。
开放性眼球损伤所致外伤性白内障患者在及时手术干预及后续IOL植入后视力得到改善。少数患者因角膜伤口导致的不规则散光或后段的可变损伤而视力无变化或视力恶化。在可变的开放性眼球损伤中，一期修复后使用伤眼生物测量来确定IOL植入的晶状体度数比使用健眼生物测量更准确。
