Layton Christopher J
Gallipoli Medical Research Institute, University of Queensland, Greenslopes Private Hospital, Greenslopes, QLD 4120, Australia.
J Ophthalmol. 2014;2014:412397. doi: 10.1155/2014/412397. Epub 2014 Dec 16.
Purpose. To determine factors associated with the presence of significant ocular injury in subjects with orbital fractures. Subjects. A consecutive prospective cohort of 161 patients presenting to a general tertiary referral hospital with orbital fractures and undergoing initial conservative treatment was identified. Subjects were assessed at time of injury for the need for emergency surgery, and those initially treated conservatively were subsequently followed up by the Ophthalmology Department to assess for ocular injury requiring ophthalmic management at 1-7 days after injury. Associations between ocular injury and age, sex, visual acuity, presence of blowout fracture, extent of orbital involvement, and presence of distant facial fractures were assessed. Results. 142 male (average age of 32 [95% CI 30-35]) and 19 female (average age of 49 [95% CI 39-59]) subjects were identified. 17 subjects were diagnosed with significant ocular injury. Ocular injury was significantly associated with LogMAR VA worse than 0.2 (OR 49 [95% CI 11-217, P < 0.0001]), but no relationship was noted for age, sex, presence of blowout fracture, extent of fractures, or presence of distal facial fractures. LogMAR visual acuity worse than or equal to 0.2 had a 98% negative predictive value for ocular injury in the setting of orbital fractures. Conclusions. Demographic and nonophthalmic fracture characteristics were not useful predictors of ocular injury in orbital fractures. LogMAR visual acuity worse than or equal to 0.2 is a highly sensitive and useful guide of the need for ophthalmic referral in subjects with orbital fractures.
目的。确定眼眶骨折患者中存在严重眼外伤的相关因素。对象。确定了161例因眼眶骨折到一家大型三级转诊医院就诊并接受初始保守治疗的连续前瞻性队列患者。在受伤时评估患者是否需要急诊手术，最初接受保守治疗的患者随后由眼科在受伤后1 - 7天进行随访，以评估是否存在需要眼科处理的眼外伤。评估眼外伤与年龄、性别、视力、爆裂性骨折的存在、眼眶受累程度以及远处面部骨折的存在之间的关联。结果。确定了142名男性（平均年龄32岁[95%置信区间30 - 35]）和19名女性（平均年龄49岁[95%置信区间39 - 59]）。17名患者被诊断为严重眼外伤。眼外伤与LogMAR视力差于0.2显著相关（比值比49 [95%置信区间11 - 217，P < 0.0001]），但在年龄、性别、爆裂性骨折的存在、骨折程度或远处面部骨折的存在方面未发现相关性。在眼眶骨折情况下，LogMAR视力差于或等于0.2对眼外伤的阴性预测值为98%。结论。人口统计学和非眼科骨折特征不是眼眶骨折患者眼外伤的有用预测指标。LogMAR视力差于或等于0.2是眼眶骨折患者需要眼科转诊的高度敏感且有用的指导指标。
