Kong George Y X, Henderson Robert H, Sandhu Sukhpal S, Essex Rohan W, Allen Penelope J, Campbell William G
Vitreoretinal Unit, The Royal Victorian Eye and Ear Hospital, Melbourne, Victoria.
Clinical Research Department, Centre for Eye Research Australia, Melbourne, Victoria.
Clin Exp Ophthalmol. 2015 Aug;43(6):508-13. doi: 10.1111/ceo.12511. Epub 2015 Jun 19.
Careful surgical management of traumatic wounds is important in open globe injury repair. This study examines the clinical outcomes following repair of open globe injuries with particular focus on wound-related issues.
Retrospective, cohort study of consecutive open globe injuries presenting to a tertiary referral eye hospital from 1 January 2009 to 31 December 2011.
A total of 267 eyes of 263 patients, mainly male (82.5%) with a mean age of 44.8 (range: 4-97) years. Average follow up was 6.9 months.
All cases classified according to Ocular Trauma Classification Group.
Visual outcomes, risk factors for and rates of postoperative complications and endophthalmitis.
There were 83 globe ruptures, 182 penetrating and 2 perforating eye injuries, of which 43 cases had intraocular foreign body. Factors contributing to final visual acuity (VA) <6/60 were poor presenting VA (odds ratio [OR] = 16.0, 95% confidence interval [CI]: 4.81-53.1), globe rupture (OR = 4.64, [1.99-10.8]), retinal detachment (OR = 3.40, [1.19-9.74]) and age ≥50 (OR = 2.45, [1.05-5.74]). Wound leak occurred in 44 eyes (16%). Of these, 18 (41%) proceeded to re-suturing. Factors contributing to wound leak were stellate-shaped wound (OR = 3.28, [1.39-7.73]) and delayed presentation (OR = 2.80, [1.02-7.71]). Ten eyes (3.7%) developed endophthalmitis. Factors associated with endophthalmitis were delayed presentation (OR = 8.91, [1.71-46.6]), microbial keratitis (OR = 12.5, [1.85-85.0]) and lens capsule breach (OR = 12.4, [1.85-83.1]).
Wound leak is an important postoperative complication of open globe injury repair. Delayed presentation is an important risk factor for postoperative wound leak and endophthalmitis. Prompt and meticulous wound management of open globe injury may reduce these complications.
在开放性眼球损伤修复中，对外伤性伤口进行仔细的手术处理很重要。本研究探讨开放性眼球损伤修复后的临床结局，特别关注与伤口相关的问题。
对2009年1月1日至2011年12月31日在一家三级转诊眼科医院就诊的连续性开放性眼球损伤进行回顾性队列研究。
共263例患者的267只眼，主要为男性（82.5%），平均年龄44.8岁（范围：4 - 97岁）。平均随访时间为6.9个月。
所有病例根据眼外伤分类组进行分类。
视力结局、术后并发症和眼内炎的危险因素及发生率。
有83例眼球破裂、182例穿通伤和2例眼球穿孔伤，其中43例有眼内异物。导致最终视力（VA）<6/60的因素有初始视力差（优势比[OR]=16.0，95%置信区间[CI]：4.81 - 53.1）、眼球破裂（OR = 4.64，[1.99 - 10.8]）、视网膜脱离（OR = 3.40，[1.19 - 9.74]）和年龄≥50岁（OR = 2.45，[1.05 - 5.74]）。44只眼（16%）发生伤口渗漏。其中，18只眼（41%）进行了再次缝合。导致伤口渗漏的因素有星芒状伤口（OR = 3.28，[1.39 - 7.73]）和就诊延迟（OR = 2.80，[1.02 - 7.71]）。10只眼（3.7%）发生了眼内炎。与眼内炎相关的因素有就诊延迟（OR = 8.91，[1.71 - 46.6]）、微生物性角膜炎（OR = 12.5，[1.85 - 85.0]）和晶状体囊膜破裂（OR = 12.4，[1.85 - 83.1]）。
伤口渗漏是开放性眼球损伤修复术后的重要并发症。就诊延迟是术后伤口渗漏和眼内炎的重要危险因素。对开放性眼球损伤进行及时、细致的伤口处理可能会减少这些并发症。
