Ho Trung Q, Jupiter Daniel, Tsai Jonathan H, Czerwinski Marcin
From the *Division of Plastic and Reconstructive Surgery, Department of Surgery, Baylor Scott and White Health, Temple; †The University of Texas Medical Branch at Galveston, Galveston; ‡Department of Ophthalmology, and §Division of Plastic and Reconstructive Surgery, Department of Surgery, Baylor Scott and White Health, Temple, TX.
Ann Plast Surg. 2017 Jan;78(1):59-61. doi: 10.1097/SAP.0000000000000748.
Prompt identification of significant ocular injuries in patients who sustain an orbital fracture is important to prevent any potential long-term visual sequelae. The true incidence of these injuries has not been determined, however. As a consequence, most surgeons choose to have all patients evaluated by an ophthalmologist. The objective of this study was to conclusively identify the incidence of significant ocular injuries in patients with isolated orbital fractures and to determine their predictors to guide more efficient patient care.
A prospective cohort study powered to detect a 15% incidence of ocular injuries was designed. All patients presenting to our center with computed tomography findings of an isolated orbital fracture were included and evaluated by plastic surgery and ophthalmology services. Patients were followed up for a minimum of 1 week to identify any delayed injuries.
Eighty patients were enrolled from 2012 to 2014. There were 46 men and 34 women with a mean age of 42.8 years. Assault was the most common mechanism of injury. There were 8 ocular injuries (10%): ruptured globe (1), uveal prolapse (1), retrobulbar hemorrhage (2), hyphema (2), hemorrhagic glaucoma with hyphema (1), and scleral tear (1). Predictors for significant ocular injuries were grossly abnormal visual acuity and abnormal pupillary reactivity of the affected eye.
The incidence of significant ocular injuries in isolated orbital fractures is lower than previously reported. Patients presenting with grossly abnormal visual acuity or abnormal pupillary reactivity are at high risk and should receive prompt ophthalmology service evaluation.
对于眼眶骨折患者，及时识别严重眼外伤对于预防任何潜在的长期视觉后遗症至关重要。然而，这些损伤的真实发生率尚未确定。因此，大多数外科医生选择让所有患者接受眼科医生的评估。本研究的目的是最终确定孤立性眼眶骨折患者中严重眼外伤的发生率，并确定其预测因素，以指导更有效的患者护理。
设计了一项前瞻性队列研究，旨在检测眼外伤发生率为15%的情况。所有因计算机断层扫描结果显示为孤立性眼眶骨折而就诊于我们中心的患者均被纳入，并由整形外科和眼科服务部门进行评估。对患者进行至少1周的随访，以确定是否有任何延迟性损伤。
2012年至2014年共纳入80例患者。其中男性46例，女性34例，平均年龄42.8岁。袭击是最常见的受伤机制。共有8例眼外伤（10%）：眼球破裂（1例）、葡萄膜脱垂（1例）、球后出血（2例）、前房积血（2例）、伴有前房积血的出血性青光眼（1例）和巩膜撕裂（1例）。严重眼外伤的预测因素是患眼视力严重异常和瞳孔反应异常。
孤立性眼眶骨折中严重眼外伤的发生率低于先前报道。视力严重异常或瞳孔反应异常的患者风险较高，应立即接受眼科服务评估。
