Feng Kang, Wang Chang-guan, Hu Yun-tao, Yao Yi, Jiang Yan-rong, Shen Li-jun, Pang Xiu-qin, Nie Hong-ping, Ma Zhi-zhong
Department of Ophthalmology, Ministry of Education's Key Laboratory of Vision Loss and Restoration, Peking University Third Hospital, Beijing, China.
Department of Ophthalmology, Chinese PLA General Hospital, Beijing, China.
Clin Exp Ophthalmol. 2015 Sep-Oct;43(7):629-36. doi: 10.1111/ceo.12534. Epub 2015 Jun 19.
The objective of the study was to delineate clinical characteristics, surgical interventions, anatomic and visual outcomes of ruptured eye balls after trauma, and establish the prognostic indicators, which can assist clinicians in making correct surgical decisions during globe exploration for ruptured eyes.
The study design used was a multicentre prospective cohort study, including six university-affiliated tertiary hospitals.
We selected 242 cases of ruptured globe from the Eye Injury Vitrectomy Study database, until 31 December 2012.
All selected cases underwent vitreoretinal surgery, enucleation or evisceration, and were followed up for at least 6 months. Age, visual acuity (VA) after injury, ocular trauma zone, time to surgery, corneal laceration, scleral wound, extrusion of iris or lens, ciliary body damage, intraocular haemorrhage, retinal detachment or defect, proliferative vitreoretinopathy (PVR) and choroidal damage were the predisposing factors evaluated by logistic regression models.
We compared the pre-surgical indicators between cases of anatomically restored eyes with VA of 4/200 or better, or eyes with initial no light perception restored light perception or better, and cases of VA worse than 4/200, silicone oil-sustained eyes, phthisis or enucleation.
Nearly 40% of cases with ruptured globe were anatomically restored through vitreoretinal surgery. The closed-funnel retinal detachment or extensive retinal loss (odds ratio [OR] = 3.38, P = 0.026), PVR-C (OR = 3.45, P = 0.008), and choroidal damage (OR = 4.20, P = 0.004) were correlated with poor outcomes.
The closed-funnel retinal detachment or extensive retinal loss, PVR-C, and choroidal damage are the risk factors for unfavourable outcomes in globe ruptures.
本研究的目的是描述眼球外伤后破裂的临床特征、手术干预、解剖和视觉结果，并建立预后指标，以协助临床医生在探查破裂眼球时做出正确的手术决策。
本研究采用多中心前瞻性队列研究，包括六家大学附属医院。
我们从眼外伤玻璃体切除术研究数据库中选取了242例眼球破裂病例，截至2012年12月31日。
所有入选病例均接受了玻璃体视网膜手术、眼球摘除术或眼内容剜出术，并随访至少6个月。通过逻辑回归模型评估的易感因素包括年龄、伤后视力（VA）、眼外伤区域、手术时间、角膜裂伤、巩膜伤口、虹膜或晶状体脱出、睫状体损伤、眼内出血、视网膜脱离或缺损、增殖性玻璃体视网膜病变（PVR）和脉络膜损伤。
我们比较了解剖结构恢复且视力达到4/200或更好的病例、初始无光感但恢复了光感或更好的病例，与视力低于4/200的病例、硅油填充眼、眼球痨或眼球摘除术病例之间的术前指标。
近40%的眼球破裂病例通过玻璃体视网膜手术实现了解剖结构恢复。闭合性漏斗状视网膜脱离或广泛视网膜缺失（比值比[OR]=3.38，P=0.026）、PVR-C（OR=3.45，P=0.008）和脉络膜损伤（OR=4.20，P=0.004）与不良预后相关。
闭合性漏斗状视网膜脱离或广泛视网膜缺失、PVR-C和脉络膜损伤是眼球破裂预后不良的危险因素。
