Amro Murad Y
Faculty of Health Professions, Al-Quds University, Abu-Dis, occupied Palestine territory.
Lancet. 2021 Jul;398 Suppl 1:S14. doi: 10.1016/S0140-6736(21)01500-2.
Open globe eye injuries have poor visual outcomes. In Palestine, no studies have completely described the impact of time delays to surgery on visual outcomes. This study examines the causal factors for open globe eye injuries, time to presentation, and the effects of delays to surgery on visual outcomes.
A retrospective review was carried out of 413 patients with monocular open globe eye injuries attending St John Eye Hospital, Jerusalem, occupied Palestine territory, from Jan 1, 2000, to Dec 31, 2005. Injury cause, time to presentation, visual acuity on arrival, and the final corrected visual outcomes were assessed.
Open globe eye injuries were caused by traumatic injury during the Intifada in 2002 (13%) and military actions throughout the study period (14%), but most injuries (38%) occurred in workplace or were related to domestic eye injuries (20%). The median time from open globe eye injury to arrival at hospital was 4 hours (IQR 11-3); 290 (70%) of 413 patients arrived within 8 h of injury. Visual acuity on arrival was normal only in five eyes (1·2%), functionally accepted vision in 42 eyes (10%), visually impaired in 77 eyes (18.6%), blindness in 229 (55%), and difficult to measure in 60 (15%). Surgical repair was performed in 366 eyes (89%) and 47 (11%) eyes were removed. After surgery, visual status was classified as visual acuity impaired in 85 (20·6%) of 336 repaired eyes, blindness in 87 (21%), normal vision restored in 58 eyes (14%), functionally acceptable vision restored in 116 eyes (28%), difficult to measure in 20 (4·8%). Among the 290 patients who presented within 8 h of injury, the final visual outcomes were impaired visual acuity in 72 (25%), blindness in 71 (24%), eye removed in 38 (13%), and visual acuity difficult to measure due to very young age or devastating injury remaining after surgery in 14 (4.8%) and vision was restored in 95 (33%).
Despite the devastating nature of open globe eye injury, minimum time from trauma to surgical intervention could save the injured eyes. Further studies should investigate whether delay in surgery affects outcomes in relation to the severity of injuries, as this study is cross-sectional and longitudinal epidemiological studies might yield better interpretations.
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开放性眼球损伤的视觉预后较差。在巴勒斯坦，尚无研究全面描述手术时间延迟对视觉预后的影响。本研究探讨开放性眼球损伤的病因、就诊时间以及手术延迟对视觉预后的影响。
对2000年1月1日至2005年12月31日期间在被占领巴勒斯坦领土耶路撒冷的圣约翰眼科医院就诊的413名单眼开放性眼球损伤患者进行回顾性研究。评估损伤原因、就诊时间、入院时的视力以及最终矫正后的视觉预后。
开放性眼球损伤在2002年起义期间由外伤引起（13%），在整个研究期间由军事行动导致（14%），但大多数损伤（38%）发生在工作场所或与家庭眼部损伤有关（20%）。从开放性眼球损伤到入院的中位时间为4小时（四分位间距11 - 3）；413例患者中有290例（70%）在受伤后8小时内就诊。入院时视力正常的仅5只眼（1.2%），功能可接受视力的42只眼（10%），视力受损的77只眼（18.6%），失明的229只眼（55%），难以测量的60只眼（15%）。366只眼（89%）进行了手术修复，47只眼（11%）被摘除。手术后，336只修复眼中有85只（20.6%）视力受损，87只（21%）失明，58只眼（14%）恢复正常视力，116只眼（28%）恢复功能可接受视力，20只眼（4.8%）难以测量。在受伤后8小时内就诊的290例患者中，最终视觉预后为视力受损的72例（25%），失明的71例（24%），眼球摘除的38例（13%），因年龄过小或手术后仍有严重损伤而视力难以测量的14例（4.8%），视力恢复的95例（33%）。
尽管开放性眼球损伤具有毁灭性，但从创伤到手术干预的最短时间可挽救受伤的眼睛。由于本研究为横断面研究，进一步的研究应调查手术延迟是否根据损伤严重程度影响预后，纵向流行病学研究可能会得出更好的解读。
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