Colyer Marcus H, Chun Dal W, Bower Kraig S, Dick John S B, Weichel Eric D
Ophthalmology Service, Walter Reed Army Medical Center, Washington, DC, USA.
Ophthalmology. 2008 Nov;115(11):2087-93. doi: 10.1016/j.ophtha.2008.05.013. Epub 2008 Jul 31.
To report the injury patterns associated with perforating (through-and-through) injuries of the globe and the visual impact of these injuries on patients with combat ocular trauma (COT) seen at Walter Reed Army Medical Center (WRAMC) from March 2003 through October 2006.
Retrospective, noncomparative, interventional case series.
Sixty-five eyes of 61 United States military soldiers deployed during Operation Iraqi Freedom sustaining perforating globe injuries and treated subsequently at WRAMC.
Principal procedures included enucleation and 20-gauge 3-port pars plana vitrectomy with or without intraocular foreign body removal.
Final visual acuity and rates of proliferative vitreoretinopathy, enucleation, and endophthalmitis.
Average patient age was 29 years, with an average of 200 days of postinjury follow-up (median, 97 days; range, 4-1023 days). Nineteen patients confirmed the use of eye protection at the time of injury, whereas 25 patients did not use eye protection. The median presenting visual acuity at WRAMC was no light perception (range, no light perception to hand movements). Twenty-five patients underwent primary enucleation, 1 was eviscerated, and 12 patients underwent secondary enucleation within 2 weeks of surgery. Of 19 patients undergoing pars plana vitrectomy, median visual acuity at presentation was light perception and the median final visual acuity was counting fingers, whereas 4 eyes (21%) achieved final visual acuity of better than 20/200, and in 11 (61%) of 17, proliferative vitreoretinopathy developed over a follow-up of at least 6 months. There were no cases of endophthalmitis or sympathetic ophthalmia. Neither mechanism of injury nor timing of surgery correlated with favorable outcomes. However, entry and exit wounds localized to the anterior half of the globe were associated with favorable anatomic outcome (P<0.005, Fisher exact test, 2-tailed) and visual outcome (P = 0.041, Fisher exact test, 2-tailed).
Perforating globe injuries associated with COT generally result in poor visual and anatomic outcomes despite surgical intervention. Prophylactic measures, such as eye protection, are helpful in reducing the likelihood of perforating injuries; however, novel surgical and pharmacologic therapies will be required to improve the functional and anatomic outcomes of these devastating injuries.
报告2003年3月至2006年10月在沃尔特里德陆军医疗中心（WRAMC）就诊的战斗性眼外伤（COT）患者眼球穿通伤（贯通伤）的损伤模式及其对视力的影响。
回顾性、非对照、干预性病例系列研究。
61名在伊拉克自由行动期间部署的美国军人的65只眼，这些眼睛遭受了眼球穿通伤，随后在WRAMC接受治疗。
主要手术包括眼球摘除术和20G三通道平坦部玻璃体切除术，术中可选择取出或不取出眼内异物。
最终视力、增殖性玻璃体视网膜病变、眼球摘除术及眼内炎的发生率。
患者平均年龄29岁，伤后平均随访200天（中位数97天；范围4 - 1023天）。19名患者证实受伤时使用了眼部防护，而25名患者未使用。WRAMC的初始视力中位数为无光感（范围：无光感至手动）。25例患者接受了一期眼球摘除术，1例接受了眼内容剜除术，12例患者在术后2周内接受了二期眼球摘除术。在19例行平坦部玻璃体切除术的患者中，初始视力中位数为光感，最终视力中位数为数指，4只眼（21%）最终视力优于20/200，17只眼中11只眼（61%）在至少6个月的随访中发生了增殖性玻璃体视网膜病变。未发生眼内炎或交感性眼炎病例。损伤机制和手术时机均与良好预后无关。然而，位于眼球前半部分的入口和出口伤口与良好的解剖学预后（P<0.005，Fisher确切概率检验，双侧）和视力预后（P = 0.041，Fisher确切概率检验，双侧）相关。
尽管进行了手术干预，但与COT相关的眼球穿通伤通常导致较差的视力和解剖学预后。眼部防护等预防措施有助于降低眼球穿通伤的发生可能性；然而，需要新的手术和药物治疗方法来改善这些严重损伤的功能和解剖学预后。
