Rahman I, Maino A, Devadason D, Leatherbarrow B
Manchester Royal Eye Hospital, Lister Centre, Manchester, UK. imran1973@ tiscali.co.uk
Eye (Lond). 2006 Dec;20(12):1336-41. doi: 10.1038/sj.eye.6702099. Epub 2005 Sep 23.
Despite advances in ocular and orbital imaging, instrumentation, materials, and surgical procedures, the management of open globe injuries continues to pose difficult management dilemmas. In this retrospective study, we identify clinical characteristics and outcome of a series of open globe injuries presenting to a major UK centre.
Operating department records were reviewed to identify all patients who had undergone repair of an open globe injury from 1 January 1998 to 1 January 2003 at the Manchester Royal Eye Hospital. Case notes were examined to determine demographic data, mechanisms of injury, influence of alcohol/drugs, and location of injury. The Snellen visual acuity on presentation and initial clinical signs were recorded.
In total, 115 cases of open globe injury were identified of which 107 cases notes were available for review. Injury to the eye with a sharp object accounted for 71/107 (66%) cases and blunt mechanisms for 30/107 (28%) cases. In six (6%) cases the cause of injury was unknown. The rate of secondary enucleation in our series of 107 open globe injuries was 13/107 (12%). Significant risk factors on presentation associated with eventual enucleation included relative afferent pupillary defect (P<0.001), absence of a red reflex (P<0.001), presence of a lid laceration (P<0.02), a blunt mechanism of injury (P<0.02), and an initial VA worse than 6/60 (P=0.03).
From this retrospective study, we have identified several factors that may aid the clinician in deciding on the prognostic value of primary repair. Blunt injuries associated with adnexal trauma, with poor initial visual acuity, the presence of an RAPD or retinal detachment, and the absence of a red reflex are associated with a significantly higher rate of subsequent enucleation.
尽管在眼部和眼眶成像、器械、材料及手术操作方面取得了进展，但开放性眼球损伤的处理仍面临诸多棘手的管理难题。在这项回顾性研究中，我们确定了一系列在英国一家主要中心就诊的开放性眼球损伤的临床特征及预后。
回顾手术科室记录，以确定1998年1月1日至2003年1月1日在曼彻斯特皇家眼科医院接受开放性眼球损伤修复手术的所有患者。检查病历以确定人口统计学数据、损伤机制、酒精/药物的影响及损伤部位。记录就诊时的斯内伦视力及初始临床体征。
共确定115例开放性眼球损伤病例，其中107例病历可供审查。锐器致眼损伤占107例中的71例（66%），钝性损伤机制占30例（28%）。6例（6%）损伤原因不明。在我们这组107例开放性眼球损伤中，二期眼球摘除率为13/107（12%）。就诊时与最终眼球摘除相关的显著危险因素包括相对传入性瞳孔障碍（P<0.001）、无红光反射（P<0.001）、存在眼睑裂伤（P<0.02）、钝性损伤机制（P<0.02）及初始视力差于6/60（P=0.03）。
通过这项回顾性研究，我们确定了几个有助于临床医生判断一期修复预后价值的因素。与附属器创伤相关的钝性损伤、初始视力差、存在相对传入性瞳孔障碍或视网膜脱离以及无红光反射与随后眼球摘除率显著较高相关。
