Papp Alexandra M, Justin Grant A, Vernau Christian T, Aden James K, Fitzgerald Brian M, Kraus Gregory P, Legault Gary L
McChord Airman's Clinic, Madigan Army Medical Center, Joint Base Lewis McChord, Tacoma, WA.
Department of Ophthalmology, Brooke Army Medical Center, San Antonio, TX.
Cornea. 2019 Jul;38(7):927-932. doi: 10.1097/ICO.0000000000001972.
To perform a systematic review of the international literature evaluating the risk factors, preventative steps, and treatments for perioperative corneal injuries for nonocular surgery.
PubMed, Embase, and Evidence-Based Medicine Reviews databases were searched on April 13, 2018. Two hundred four articles were identified with 16 meeting the inclusion criteria. All studies were evaluated for quality and level of evidence. Two types of studies were included. The first were primary epidemiological studies that looked at the rates of perioperative corneal injuries after nonocular surgery and the second were trials that either studied preventative steps or treatments.
A statistical analysis was completed to reveal trends in perioperative corneal abrasions. Rates ranged from 0.01% to 59% with a cumulative rate of 0.64% (95% confidence interval 0.36%-1.35%). Primary risk factors were identified as longer procedures, general anesthesia, and advanced age. The most commonly associated ocular injuries were found to include chemical injury, conjunctivitis, blurred vision, and conjunctival congestion. Treatment strategies for corneal abrasion in the literature recommended erythromycin ointment and ample ocular lubrication for the fastest recovery. Education interventions alone, as studied in 2 of the 16 articles, demonstrated a significant decrease in the rate of corneal abrasions.
Standardized ocular protection, reporting, and education initiatives were found to maximally decrease rates of perioperative corneal abrasions after nonocular surgery. However, no gold standard currently exists for intraoperative ocular protection. More research needs to be conducted on specific prevention strategies and content of educational initiatives in hopes of standard development across facilities nationwide.
对评估非眼科手术围手术期角膜损伤的危险因素、预防措施及治疗方法的国际文献进行系统综述。
于2018年4月13日检索了PubMed、Embase和循证医学评价数据库。共识别出204篇文章，其中16篇符合纳入标准。对所有研究进行质量和证据水平评估。纳入了两种类型的研究。第一种是原发性流行病学研究，观察非眼科手术后围手术期角膜损伤的发生率；第二种是试验研究，研究预防措施或治疗方法。
完成了一项统计分析以揭示围手术期角膜擦伤的趋势。发生率范围为0.01%至59%，累积发生率为0.64%（95%置信区间0.36%-1.35%）。主要危险因素被确定为手术时间较长、全身麻醉和高龄。最常见的相关眼部损伤包括化学伤、结膜炎、视力模糊和结膜充血。文献中推荐使用红霉素眼膏和充分的眼部润滑以促进角膜擦伤最快恢复。在16篇文章中的2篇所研究的单纯教育干预措施显示角膜擦伤发生率显著降低。
发现标准化的眼部保护、报告和教育举措可最大程度降低非眼科手术后围手术期角膜擦伤的发生率。然而，目前术中眼部保护尚无金标准。需要对具体的预防策略和教育举措内容进行更多研究，以期在全国各医疗机构制定标准。
