Baillif S, Paoli V
Service d'ophtalmologie, hôpital Saint-Roch, CHU de Nice, 5, rue Pierre-Dévoluy, 06000 Nice, France.
J Fr Ophtalmol. 2012 Feb;35(2):136-45. doi: 10.1016/j.jfo.2011.08.003. Epub 2012 Jan 9.
Open globe injuries involving the posterior segment remain a major cause of visual loss in young adults. They occur more frequently in male than in female populations. The majority is due to domestic accidents, since work-related injuries have been decreasing due to proper education and use of safety equipment. However, leisure-related open globe injuries are on the increase. Prompt recognition and treatment of open globe injuries are essential. At presentation, it is necessary to collect etiological data such as cause, nature, time and place of injury. Anti-tetanus immunization must be confirmed. The presenting visual acuity and clinical examination data must be recorded. The lesion type is classified in accordance with the Birmingham Eye Trauma Terminology. Ocular ultrasound or computed tomography is performed for patients suspected of having an intra- or periocular foreign body. Functional prognosis is negatively influenced by a posterior or large rupture, the presence of an intraocular foreign body, the presence of retinal lacerations or retinal detachment, or the occurrence of posttraumatic infectious endophthalmitis. Recent advances in microsurgical techniques such as pars plana vitrectomy and new visualization techniques may improve the anatomical and functional prognosis for these patients. However, postoperative proliferative vitreoretinopathy remains a major concern: it is responsible for a significant rate of secondary retinal detachment with negative consequences for visual prognosis.
累及眼后段的开放性眼球损伤仍是年轻成年人视力丧失的主要原因。此类损伤在男性人群中的发生率高于女性。大多数损伤是由家庭事故导致的,由于安全教育和安全设备的使用,与工作相关的损伤一直在减少。然而,与休闲活动相关的开放性眼球损伤却在增加。及时识别和治疗开放性眼球损伤至关重要。就诊时,有必要收集病因数据,如损伤的原因、性质、时间和地点。必须确认破伤风免疫接种情况。必须记录就诊时的视力和临床检查数据。根据伯明翰眼外伤术语对损伤类型进行分类。对于怀疑有眼内或眼球周围异物的患者,需进行眼部超声或计算机断层扫描。后极部或大的破裂、眼内异物的存在、视网膜裂伤或视网膜脱离的存在,或创伤后感染性眼内炎的发生,均会对功能预后产生负面影响。诸如玻璃体切除术等显微外科技术和新的可视化技术的最新进展可能会改善这些患者的解剖和功能预后。然而,术后增殖性玻璃体视网膜病变仍然是一个主要问题:它是导致继发性视网膜脱离的主要原因,对视力预后产生负面影响。