Hyun Lee Seung, Ahn Jae Kyoun
Department of Ophthalmology, Chonnam National University Medical School, Hakdong, Donggu, Gwangju 501-757, Korea.
J Trauma. 2010 Jul;69(1):195-8. doi: 10.1097/TA.0b013e3181bbd23b.
The objective of this study was to evaluate risk factors associated with eyeball loss and ambulatory vision loss on emergent examination of patients with ocular trauma.
We reviewed the medical records of 1,875 patients hospitalized in a single tertiary referral center between January 2003 and December 2007. Emergent examinations included a history of trauma, elapsed time between injury and hospital arrival, visible intraocular tissues, and initial visual acuity (VA) using a penlight. The main outcome measures were ocular survival and ambulatory vision survival (>20/200) at 1 year after trauma using univariate and multivariate regression analysis.
The ocular trauma scores were significantly higher in open globe injuries than in closed globe injuries (p < 0.01). In open globe injuries, initial VA less than light perception (LP) and a history of golf ball injury were the significant risk factors associated with eyeball loss. Elapsed time more than 12 hours and visible intraocular tissues were the significant risk factors associated with ambulatory vision loss. The most powerful predictor of eyeball loss and ambulatory vision loss was eyeball rupture. In closed globe injuries, there were no significant risk factors of eyeball loss, whereas initial vision less than LP and the presence of relative afferent pupillary defect were the significant risk factors associated with ambulatory vision loss.
An initial VA less than LP using a penlight, a history of golf ball injury, and elapsed time more than 12 hours between ocular trauma and hospital arrival were associated with eyeball loss and ambulatory vision loss. Physicians should bear these factors in mind so that they can more effectively counsel patients with such injuries.
本研究的目的是评估眼外伤患者急诊检查时与眼球丧失和非卧床视力丧失相关的危险因素。
我们回顾了2003年1月至2007年12月在一家单一的三级转诊中心住院的1875例患者的病历。急诊检查包括外伤史、受伤至入院的时间、可见的眼内组织以及使用手电筒检查的初始视力（VA）。主要结局指标是外伤后1年时的眼球存活率和非卧床视力存活率（>20/200），采用单因素和多因素回归分析。
开放性眼球损伤的眼外伤评分显著高于闭合性眼球损伤（p<0.01）。在开放性眼球损伤中，初始视力低于光感（LP）和高尔夫球伤史是与眼球丧失相关的显著危险因素。受伤至入院时间超过12小时和可见的眼内组织是与非卧床视力丧失相关的显著危险因素。眼球丧失和非卧床视力丧失的最强预测因素是眼球破裂。在闭合性眼球损伤中，没有与眼球丧失相关的显著危险因素，而初始视力低于LP和存在相对传入性瞳孔障碍是与非卧床视力丧失相关的显著危险因素。
使用手电筒检查时初始视力低于LP、高尔夫球伤史以及眼外伤与入院之间的时间超过12小时与眼球丧失和非卧床视力丧失相关。医生应牢记这些因素，以便能更有效地为此类受伤患者提供咨询。
