Zhu Lili, Shen Pingyu, Lu Hong, Du Chixin, Shen Jianqin, Gu Yangshun
From the Department of Ophthalmology, The First Affiliated Hospital, Medical College, Zhejiang University, Hangzhou (ZLL, LH, DCX, SJQ, GYS); and Department of Ophthalmology, The Second Shaoxing Hospital, Shaoxing, China (SPY).
Medicine (Baltimore). 2015 Sep;94(39):e1533. doi: 10.1097/MD.0000000000001533.
The purpose of this study was to investigate the clinical characteristic and visual outcome of siderosis bulbi with retained intraocular foreign body (IOFB) and to validate the predictive value of the Ocular Trauma Score (OTS) in siderosis bulbi. Certain numerical values rendered to the OTS variables at present were summated (Table 1) and converted into 5 OTS categories as performed in the OTS study. The prognostic value of OTS was first assessed in cases of siderosis bulbi resulting from a chemical reaction of retained IOFBs. Twenty-four eyes of 24 patients diagnosed with siderosis bulbi who underwent surgery between 2007 and 2013 at our medical centre were reviewed. Due to patients' ignorance in ocular injuries, delayed presentation by the patient (54.17%) and no history of trauma (16.67%) were the most common cause of siderosis bulbi with IOFB retention. The main symptom of all these patients was impaired vision. The most common complications were cataract (23/24, 95.83%), followed by retinal pigmentary degeneration (15/22, 68.18%), iris heterochromia (14/24, 58.33%), pupillary mydriasis (10/21, 47.62%), secondary glaucoma (6/24, 25.00%), relative afferent pupillary defect (6/24, 25.00%), and retinal detachment (3/24, 12.50%). IOFBs were removed in 22 eyes (91.67%), except 2 enucleated eyes with absolute glaucoma (8.33%). Among all the patients (24 eyes), the best-corrected visual acuity improved in 63.64%, unchanged in 18.18% and deteriorated in 18.18% after surgical intervention. No statistically significant difference was found between the categorical distributions of our patients and those in the OTS study group. Further promotion and education on eye protection are needed to minimize visual loss from siderosis bulbi. The OTS, which was designed to predict visual outcomes of general ocular trauma, may also provide reliable information about the prognosis of siderosis bulbi resulting from a chemical reaction of retained IOFBs.
本研究的目的是调查眼球铁锈症合并眼内异物（IOFB）残留的临床特征和视觉预后，并验证眼外伤评分（OTS）对眼球铁锈症的预测价值。将目前赋予OTS变量的某些数值进行汇总（表1），并按照OTS研究中的方法将其转换为5个OTS类别。首先在因残留IOFB发生化学反应导致的眼球铁锈症病例中评估OTS的预后价值。回顾了2007年至2013年期间在我们医疗中心接受手术的24例诊断为眼球铁锈症患者的24只眼。由于患者对眼外伤的忽视，患者延迟就诊（54.17%）和无外伤史（16.67%）是眼球铁锈症合并IOFB残留最常见的原因。所有这些患者的主要症状是视力受损。最常见的并发症是白内障（23/24，95.83%），其次是视网膜色素变性（15/22，68.18%）、虹膜异色症（14/24，58.33%）、瞳孔散大（10/21，47.62%）、继发性青光眼（6/24，25.00%）、相对性传入瞳孔障碍（6/24，25.00%）和视网膜脱离（3/24，12.50%）。22只眼（91.67%）取出了IOFB，除了2只因绝对期青光眼而摘除的眼（8.33%）。在所有患者（24只眼）中，手术干预后最佳矫正视力提高的占63.64%，不变的占18.18%，恶化的占18.18%。在我们的患者与OTS研究组的分类分布之间未发现统计学上的显著差异。需要进一步加强眼保护的宣传和教育，以尽量减少眼球铁锈症导致的视力丧失。OTS旨在预测一般眼外伤的视觉预后，它也可能为因残留IOFB发生化学反应导致的眼球铁锈症的预后提供可靠信息。
