Academic Unit of Ophthalmology, Birmingham and Midland Eye Centre, City Hospital, Birmingham, UK
Neuroscience and Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK.
Br J Ophthalmol. 2019 Oct;103(10):1491-1494. doi: 10.1136/bjophthalmol-2017-311559. Epub 2019 Jan 12.
BACKGROUND/AIM: Historic data suggest that open globe injuries should be repaired within 12-24 hours to reduce the risk of endophthalmitis. However, endophthalmitis is uncommon when systemic antibiotic prophylaxis is given. It is not clear whether delayed primary repair impacts visual outcomes in other ways or what is the optimum time to repair. We aimed to examine the effect of time to primary repair on visual outcomes.
This is a retrospective comparative case series including all open globe injuries presenting to the Birmingham Midland Eye Centre between 1 January 2014 and 15 March 2016. Presenting features, mechanism of injury, visual acuity at 6-12 months and demographic data were examined.
56 open globe injuries were repaired, of which sufficient data for analysis were available on 52 cases. The mean time to primary repair was 1 day after injury (range 5 hours to 7 days). Final visual acuity at 6-12 months was related to the presenting visual acuity and the Ocular Trauma Score and to the time between injury and primary repair, with a reduction in predicted visual acuity of logarithm of the minimum angle of resolution of 0.37 for every 24 hours of delay (95% CI 0.14 to 0.6).
Open globe injuries should be repaired promptly. Presenting visual acuity remains the strongest predictor of outcome; however, delay to primary repair also reduced final visual acuity, and any significant delay from injury to repair is likely to negatively impact final visual outcome.
背景/目的：历史数据表明，开放性眼球损伤应在 12-24 小时内修复，以降低眼内炎的风险。然而，在给予全身抗生素预防的情况下，眼内炎并不常见。目前尚不清楚延迟初次修复是否会以其他方式影响视力结果，以及最佳修复时间是什么时候。我们旨在研究初次修复时间对视力结果的影响。
这是一项回顾性比较病例系列研究，纳入了 2014 年 1 月 1 日至 2016 年 3 月 15 日期间在伯明翰米德兰眼科中心就诊的所有开放性眼球损伤患者。检查了患者的就诊特征、损伤机制、6-12 个月时的视力和人口统计学数据。
共修复了 56 例开放性眼球损伤，其中 52 例有足够的数据分析资料。初次修复的平均时间为受伤后 1 天（范围为 5 小时至 7 天）。6-12 个月时的最终视力与就诊时的视力、眼外伤评分以及损伤与初次修复之间的时间有关，每延迟 24 小时，预测视力对数最小角分辨率下降 0.37（95%CI 0.14 至 0.6）。
开放性眼球损伤应尽快修复。就诊时的视力仍然是结果的最强预测因素；然而，初次修复的延迟也降低了最终视力，任何从损伤到修复的明显延迟都可能对最终视力结果产生负面影响。
