Department of Ophthalmology, San Antonio Military Medical Center, Fort Sam Houston, TX 78234, USA.
Mil Med. 2021 Jan 25;186(Suppl 1):491-495. doi: 10.1093/milmed/usaa286.
Penetrating and perforating ocular trauma are often devastating and may lead to complete visual loss in the traumatized eye and subsequent compromise of the fellow eye. A significant proportion of traumatic injuries are complex, often requiring vitreoretinal intervention to preserve vision. A retrospective analysis at a level 1 trauma center was performed to evaluate the time course, incidence, and outcomes following pars plana vitrectomy (PPV) after traumatic ocular injury and initial globe repair.
Eyes that underwent open globe repair following ocular trauma at Brooke Army Medical Center, between January 1, 2014 and December 30, 2016 were analyzed. Specific factors evaluated include mechanism of injury, defect size and complexity, ocular trauma score, zone of injury, associated orbital trauma, and time from injury to surgical intervention. A subset analysis was conducted specifically on eyes requiring subsequent PPV for vision preservation because of vitreoretinal disease. Surgical outcomes, time to secondary intervention, and complication rates were then assessed.
In total, 70 eyes requiring open globe repair were examined, with 43 having undergone PPV. Average and median time to vitrectomy were 18.8 and 8 days, respectively. Eyes that underwent PPV were more likely to have an afferent papillary defect, vitreous hemorrhage, intraocular foreign body, and retinal detachment at the time of initial injury (although the latter two factors were not statistically significant), and were more likely to receive penetrating keratoplasty. Proliferative vitreoretinopathy occurred in 37.2% of eyes that underwent PPV, versus 3.7% of those that did not (P = 0.0013). Timing of PPV (i.e., before or after 14 days) had no statistically significant effect on the rate of PVR (Table I). Eyes that underwent PPV showed an improvement of visual acuity from average 2.5 logMAR following initial injury to 1.5 logMAR 6 months after PPV, equivalent to 18.7 Early Treatment Diabetic Retinopathy Study (ETDRS) letters gained, versus 37.7 ETDRS letters gained in eyes without PPV. Among PPV eyes, early repair (<14 days) was associated with greater improvement in visual acuity.
Overall, patients requiring PPV following open globe repair generally had more severe injuries and worse 6-month postoperative visual acuity. Patients who underwent more expedited vitrectomy showed greater improvement in visual acuity as measured by ETDRS letters gained.
穿透性和穿孔性眼球外伤通常是破坏性的，可能导致受伤眼完全失明，并随后影响对侧眼。相当一部分创伤性损伤很复杂，通常需要玻璃体视网膜干预来保护视力。在一级创伤中心进行了回顾性分析，以评估创伤性眼外伤后行巩膜平坦部玻璃体切除术（PPV）以及初次眼球修复后的时间进程、发生率和结果。
分析了 2014 年 1 月 1 日至 2016 年 12 月 30 日在 Brooke 陆军医疗中心接受眼球外伤后行开放性眼球修复的眼。评估的具体因素包括损伤机制、缺损大小和复杂性、眼外伤评分、损伤区、伴发眼眶外伤和从损伤到手术干预的时间。对因玻璃体视网膜疾病需要后续 PPV 以保存视力的眼进行了亚组分析。然后评估手术结果、二次干预时间和并发症发生率。
共检查了 70 只需要开放性眼球修复的眼，其中 43 只眼行 PPV。平均和中位数玻璃体切除术时间分别为 18.8 和 8 天。行 PPV 的眼在初次损伤时更有可能出现视盘传入缺陷、玻璃体积血、眼内异物和视网膜脱离（尽管后两个因素无统计学意义），并且更有可能接受穿透性角膜移植术。行 PPV 的眼发生增生性玻璃体视网膜病变的比例为 37.2%，而未行 PPV 的眼为 3.7%（P=0.0013）。PPV 的时机（即 14 天之前或之后）对 PVR 发生率无统计学意义（表 I）。行 PPV 的眼视力从初次损伤后的平均 2.5 logMAR 提高到 6 个月后的 1.5 logMAR，相当于增加了 18.7 个早期治疗糖尿病视网膜病变研究（ETDRS）字母，而未行 PPV 的眼增加了 37.7 个 ETDRS 字母。在行 PPV 的眼中，早期修复（<14 天）与视力提高更明显相关。
总体而言，行开放性眼球修复后需要行 PPV 的患者通常有更严重的损伤和更差的 6 个月术后视力。行更快速玻璃体切除术的患者，视力提高更明显，以 ETDRS 字母增加衡量。
