Zhang Ying, Zhang Mao-Nian, Wang Xin, Chen Xiao-Fei
Department of Ophthalmology, Chinese People's Liberation Army General Hospital, Beijing 100853, China.
Int J Ophthalmol. 2015 Oct 18;8(5):1024-30. doi: 10.3980/j.issn.2222-3959.2015.05.31. eCollection 2015.
To investigate the original protopathy, direct indications, clinical characteristics, complications of orbit plants and visual conditions of eye enucleation/evisceration.
A retrospective study of 573 eyes removed (573 inpatients) at Ophthalmology Department in a tertiary care center of China from January 1993 to December 2012 was completed.
Cases underwent removal of the eye accounted for 2.15% of total ophthalmology inpatients, whose annual frequency declined from 3.80% to 0.52%. There were 167 eyes (29.14%) being enucleated and 406 (70.86%) eviscerated. Annual proportion of evisceration rose from 16.67% in 1993 to 90.48% in later years. Trauma was the top one (65.62%) in original protopathies followed by neoplasm (13.44%) and ocular infections (5.76%). Phthisis bulbi (45.20%) was the most common direct indication, succeeded by malignant tumor (12.57%), loss/unreconstructed of intraocular tissues due to trauma (11.00%), untreatable inflammation (9.60%), intractable glaucoma (8.55%) and sclerocorneal staphyloma (5.24%). Exenteration was underwent in 20 (25.97%) cases (40% for recurrent carcinoma). Following evisceration, secondary prosthesis implantation was more and earlier, implant exposure occurred in less but earlier and infection and extraction/exchange of implants were more than those following enucleation. Male, phthisis bulbi, evisceration and secondary implantation meant lower risk of implant exposure; eyes removed within 24h following trauma was an independent risk factor. There were 14.37% of eyes with vision of light perception at least as been removed. In the residual contralateral eyes, low vision accounted 5.58% and blindness 3.14%.
Ocular trauma, tumor and infections were great threats to eyeball preservation. Early and effective controlling of any original protopathies was vital. Generally evisceration presented more superior and safe outcomes than enucleation did. Visual conditions of the sufferers should be focused on.
探讨眼眶手术的原发病、直接指征、临床特征、并发症及眼球摘除/眼内容剜出术后的视力情况。
对1993年1月至2012年12月在中国某三级甲等医疗中心眼科摘除的573只眼（573例住院患者）进行回顾性研究。
眼球摘除病例占眼科住院患者总数的2.15%，其年发生率从3.80%降至0.52%。其中眼球摘除167只眼（29.14%），眼内容剜出406只眼（70.86%）。眼内容剜出的年比例从1993年的16.67%上升至后期的90.48%。原发病中创伤居首位（65.62%），其次是肿瘤（13.44%）和眼部感染（5.76%）。眼球痨（45.20%）是最常见的直接指征，其次是恶性肿瘤（12.57%）、外伤后眼内组织缺失/无法重建（11.00%）、无法治疗的炎症（9.60%）、难治性青光眼（8.55%）和巩膜角膜葡萄肿（5.24%）。20例（25.97%）患者接受了眶内容剜除术（复发性癌患者占40%）。眼内容剜出术后二期义眼植入更多且更早，义眼座暴露发生较少但较早，感染及义眼座取出/更换比眼球摘除术后更多。男性、眼球痨、眼内容剜出及二期植入意味着义眼座暴露风险较低；外伤后24小时内摘除眼球是独立危险因素。至少有14.37%的摘除眼有光感视力。在剩余的对侧眼中，低视力占5.58%，失明占3.14%。
眼外伤、肿瘤及感染对眼球保留构成巨大威胁。尽早有效控制任何原发病至关重要。总体而言，眼内容剜出术的效果比眼球摘除术更优且更安全。应关注患者的视力情况。
