Sheard R M, Mireskandari K, Ezra E, Sullivan P M
Moorfields Eye Hospital, City Road, London, UK.
Eye (Lond). 2007 Jun;21(6):793-8. doi: 10.1038/sj.eye.6702332. Epub 2006 Apr 7.
In adults modern vitreoretinal surgery allows many traumatised eyes to be salvaged. However, one third of serious eye injuries occur in the paediatric age group and trauma is a leading cause of monocular blindness in childhood. This study aims to report the indications, complications and outcomes for vitreoretinal surgical intervention after childhood ocular trauma.
Retrospective case note review of 61 children (age 16 years or less) undergoing vitreoretinal surgical procedures following ocular trauma at a tertiary referral centre.
Twenty-eight children (45.9%) had open globe injuries (OGI) and 33 closed globe injuries (CGI, 54.1%). The mean age of children with OGI was 9.5 years and with CGI 12.3 years (P=0.0068). Forty-seven children had traumatic retinal detachments (77.1%), which in 17 cases were treated with conventional scleral buckling surgery and in 30 by vitrectomy. Retinal re-attachment was achieved after one procedure in 70.6% with scleral buckling and 46.7% with vitrectomy. Fourteen children (22.9%) had attached retinas but required vitrectomy for other reasons. After a mean follow-up of 19.6 months, the median visual acuity (VA) of the children improved from counting fingers at presentation to 6/36 at final review (P=0.0031). Traumatic retinal detachment requiring vitrectomy was associated with poor visual outcome (P=0.0003).
Vitreoretinal intervention resulted in an improvement in vision in 32 children (57.1%) and stabilised 11 at their presenting acuity (19.6%). Two thirds of the children attained a final VA of 6/60 or better. Proliferative vitreoretinopathy was the cause of redetachment in 68.2% of cases and was significantly associated with a poor outcome (P<0.0001).
在成人中，现代玻璃体视网膜手术能挽救许多受创伤的眼睛。然而，三分之一的严重眼外伤发生在儿童年龄组，且外伤是儿童单眼失明的主要原因。本研究旨在报告儿童眼外伤后玻璃体视网膜手术干预的适应证、并发症及结果。
对一家三级转诊中心61例（年龄16岁及以下）眼外伤后接受玻璃体视网膜手术的儿童进行回顾性病例记录审查。
28例儿童（45.9%）为开放性眼球损伤（OGI），33例为闭合性眼球损伤（CGI，54.1%）。OGI儿童的平均年龄为9.5岁，CGI儿童为12.3岁（P = 0.0068）。47例儿童发生外伤性视网膜脱离（77.1%），其中17例采用传统巩膜扣带手术治疗，30例采用玻璃体切除术治疗。巩膜扣带手术一次手术后视网膜复位率为70.6%，玻璃体切除术为46.7%。14例儿童（22.9%）视网膜已附着，但因其他原因需要进行玻璃体切除术。平均随访19.6个月后，儿童的中位视力（VA）从就诊时的数指提高到最终复查时的6/36（P = 0.0031）。需要玻璃体切除术的外伤性视网膜脱离与不良视力结果相关（P = 0.0003）。
玻璃体视网膜干预使32例儿童（57.1%）视力提高，11例视力稳定在就诊时的水平（19.6%）。三分之二的儿童最终视力达到6/60或更好。增殖性玻璃体视网膜病变是68.2%病例再次脱离的原因，且与不良结果显著相关（P < 0.0001）。
