手术时机对开放性眼球损伤玻璃体切除术预后的影响：一项前瞻性随机对照研究。
TIMING INFLUENCE ON OUTCOMES OF VITRECTOMY FOR OPEN-GLOBE INJURY: A Prospective Randomized Comparative Study.
作者信息
He Yan, Zhang Ling, Wang Fang, Zhu Meidong, Wang Yi, Liu Yong
机构信息
Department of Ophthalmology, Southwest Hospital, Southwest Eye Hospital, Army Medical University, Chongqing, China.
Key Lab of Visual Damage and Regeneration & Restoration of Chongqing, Chongqing, China.
出版信息
Retina. 2020 Apr;40(4):725-734. doi: 10.1097/IAE.0000000000002447.
PURPOSE
To compare the impact of surgical timing on anatomical and functional outcomes of vitrectomy for open-globe injury.
METHODS
Fifty-three patients were entered into this prospective open-label study, with 26 patients randomized into early surgery group (vitrectomy conducted within 4 days) and 27 into delayed surgery group (vitrectomy performed between 10-14 days after injury). Six-month data were available for 46 patients and 7 were lost to follow-up. The main outcome measures were incidence of traumatic proliferative vitreoretinopathy assessed intraoperatively and postoperatively, reattachment of retina, eye enucleation, improvement of the best-corrected visual acuity, and complications.
RESULTS
Patient demographics and surgical intervention were similar in both groups. Final analysis of 46 patients demonstrated higher rates of traumatic proliferative vitreoretinopathy assessed both intraoperatively and postoperatively in the delayed group (P = 0.000; P = 0.054). In the early surgery group, 18 of 21 patients had retinal detachment, of which 15 patients (83%) achieved retinal reattachment by the first vitreoretinal surgery, 2 patients (11%) by a second surgery, and 1 (6%) received enucleation. In the delayed surgery group, 22 of 25 patients had retinal detachment. Retinal reattachment was achieved in 7 (32%) and 8 (36%) with the first and the second surgery, respectively, and 7 patients (32%) received enucleation (P = 0.005). In the early surgery group, best-corrected visual acuity improved significantly, moderately, and decreased in 8 patients (38%), 11 eyes (52%) and 2 eyes (10%), respectively. In the delayed surgery group, best-corrected visual acuity improved significantly, moderately, and worsened in 3 eyes (12%), 12 eyes (48%), and 10 eyes (40%) (P = 0.041), respectively. No statistically significant difference was observed in the rate of postoperative complications between the two groups.
CONCLUSION
Early vitrectomy after open-globe injury leads to better anatomical and functional outcomes.
目的
比较手术时机对开放性眼球损伤玻璃体切除术的解剖和功能结局的影响。
方法
53例患者纳入这项前瞻性开放标签研究，26例患者随机分为早期手术组（伤后4天内进行玻璃体切除术），27例分为延迟手术组（伤后10 - 14天进行玻璃体切除术）。46例患者有6个月的数据，7例失访。主要结局指标为术中及术后评估的创伤性增殖性玻璃体视网膜病变的发生率、视网膜复位、眼球摘除、最佳矫正视力的改善情况及并发症。
结果
两组患者的人口统计学特征和手术干预情况相似。对46例患者的最终分析显示，延迟手术组术中及术后评估的创伤性增殖性玻璃体视网膜病变发生率更高（P = 0.000；P = 0.054）。早期手术组21例患者中有18例发生视网膜脱离，其中15例（83%）在首次玻璃体视网膜手术时实现视网膜复位，2例（11%）通过二次手术复位，1例（6%）接受眼球摘除。延迟手术组25例患者中有22例发生视网膜脱离。首次手术和二次手术分别有7例（32%）和8例（36%）实现视网膜复位，7例患者（32%）接受眼球摘除（P = 0.005）。早期手术组中，最佳矫正视力显著改善、中度改善及下降的分别有8例（38%）、11眼（52%）和2眼（10%）。延迟手术组中，最佳矫正视力显著改善、中度改善及恶化的分别有3眼（12%）、12眼（48%）和10眼（40%）（P = 0.041）。两组术后并发症发生率无统计学显著差异。
结论
开放性眼球损伤后早期玻璃体切除术可带来更好的解剖和功能结局。
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