Tirakunwichcha Suppapong, Pongsachareonnont Pear
Ophthalmic Plastic and Reconstructive Surgery Unit, Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.
Vitreoretinal Research Unit, Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.
Clin Ophthalmol. 2021 Mar 23;15:1173-1181. doi: 10.2147/OPTH.S300753. eCollection 2021.
To assess factors associated with visual outcome after open-globe injury (OGI) repair by trainees.
In this observational study, charts of OGIs repaired by trainees at King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok were retrospectively reviewed. Preoperative, intraoperative, and postoperative outcomes (day 1, month 1, and month 6 postoperation) were analyzed.
A total of 78 OGIs presented in a 10-year period. A biphasic pattern was found among the young and the elderly. Approximately 73.6% of the cases had had surgical repair outside office hours. A majority of cases had been caused by machinery and hammers, and had visual acuity (VA) <20/200. Three cases were reported as having been unsuccessful intraoperatively for globe repair. A fifth of the cases required evisceration/enucleation within 2 weeks of presentation. Presenting VA worse than hand motion was associated with the risk of evisceration/enucleation (OR 14.5, =0.013). VA improved at 6 months postoperation to the range of counting fingers and 20/200 (OR 15.6, <0.01). High ocular trauma scores (OTSs) was associated with lower risk of evisceration/enucleation, and 12% retinal detachment (RD) was discovered, of which 90% occurred within 1 month after OGI repair.
Most OGIs were efficiently managed by the trainees, seldomly requiring assistance from subspecialists. Poor initial VA was associated with high risk of visual loss, whereas higher OTSs were inversely related to lower risk of evisceration or enucleation. There was a higher percentage of participants with final VA of 20/100-20/20 than the preoperative period. Precaution and careful evaluation of RD in the early postoperative period is recommended.
评估实习医生对开放性眼球损伤（OGI）修复术后视觉预后的相关因素。
在这项观察性研究中，回顾性分析了曼谷朱拉隆功大学朱拉隆功纪念医院实习医生修复的OGI病例。分析术前、术中和术后（术后第1天、1个月和6个月）的结果。
在10年期间共出现78例OGI。在年轻人和老年人中发现了一种双相模式。约73.6%的病例在非办公时间进行了手术修复。大多数病例由机械和锤子导致，视力（VA）<20/200。有3例报告术中眼球修复未成功。五分之一的病例在就诊后2周内需要进行眼内容剜除术/眼球摘除术。就诊时视力差于手动与眼内容剜除术/眼球摘除术的风险相关（比值比14.5，P=0.013）。术后6个月时视力提高到指数和20/200范围（比值比15.6，P<0.01）。高眼外伤评分（OTSs）与较低的眼内容剜除术/眼球摘除术风险相关，发现12%的视网膜脱离（RD），其中90%发生在OGI修复后1个月内。
大多数OGI由实习医生有效处理，很少需要专科医生的协助。初始视力差与高视力丧失风险相关，而较高的OTSs与较低的眼内容剜除术或眼球摘除术风险呈负相关。最终视力为20/100 - 20/20的参与者比例高于术前。建议术后早期对RD进行预防和仔细评估。
