Acuna Olga M, Yen Kimberly G
Cullen Eye Institute, Baylor College of Medicine, Texas Children Hospital, Houston, Texas, USA.
J Pediatr Ophthalmol Strabismus. 2009 Jul-Aug;46(4):202-7; quiz 208-9. doi: 10.3928/01913913-20090706-04. Epub 2009 Mar 20.
Open-globe injuries in children can present in a delayed fashion, potentially increasing the risk of endophthalmitis and delaying surgical intervention. This article presents the outcome of pediatric patients with delayed diagnosis of open-globe injuries for 24 hours or more.
The study was a retrospective observational case series of patients who presented with open-globe injuries diagnosed 24 hours or more after the injury between July 2002 and March 2007.
Thirteen patients were included in the study. The average age at presentation was 5.8 +/- 2.8 years; average follow-up was 11.5 +/- 14.5 months. Mean time of presentation after injury was 9.2 +/- 16.0 days. The most common chief complaints were chronic red eye (7 of 13 patients), eye pain (5 of 13 patients), and decreased vision (4 of 13 patients). All patients had self-sealing corneal wounds; 8 of 13 patients had a visually significant traumatic cataract. One patient had sympathetic ophthalmia. Initial visual acuity was 20/200 or worse in 10 patients, and final visual acuity was 20/40 or better in 6 patients. No patient had endophthalmitis.
Open-globe injuries, especially self-sealing corneal wounds, can present in a delayed fashion in children or may be missed if obvious findings, such as subconjunctival hemorrhage or prolapsed iris tissue, are not present. Pediatricians should be educated that they should maintain a high level of suspicion in the setting of chronic unilateral red eye, decreased visual acuity, or abnormal red reflex.
儿童开放性眼球损伤可能以延迟的方式出现，这有可能增加眼内炎的风险并延迟手术干预。本文介绍了开放性眼球损伤延迟诊断24小时或更长时间的儿科患者的治疗结果。
本研究是一项回顾性观察性病例系列研究，研究对象为2002年7月至2007年3月期间受伤后24小时或更长时间被诊断为开放性眼球损伤的患者。
13例患者纳入本研究。就诊时的平均年龄为5.8±2.8岁；平均随访时间为11.5±14.5个月。受伤后就诊的平均时间为9.2±16.0天。最常见的主要症状是慢性眼红（13例患者中的7例）、眼痛（13例患者中的5例）和视力下降（13例患者中的4例）。所有患者均有角膜伤口自行闭合；13例患者中有8例患有具有视觉意义的外伤性白内障。1例患者发生交感性眼炎。10例患者的初始视力为20/200或更差，6例患者的最终视力为20/40或更好。没有患者发生眼内炎。
开放性眼球损伤，尤其是角膜伤口自行闭合的情况，在儿童中可能以延迟的方式出现，或者如果没有明显的表现，如结膜下出血或虹膜组织脱垂，则可能被漏诊。应教育儿科医生，在出现慢性单侧眼红、视力下降或红色反射异常的情况下，应保持高度怀疑。
