Department of Ophthalmology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA.
Department of Ophthalmology and Visual Sciences, Case Western Reserve/University Hospitals Eye Institute, Cleveland, OH, USA.
Eye (Lond). 2023 Apr;37(6):1249-1253. doi: 10.1038/s41433-022-02098-z. Epub 2022 May 23.
BACKGROUND/OBJECTIVES: Our goal was to compare the characteristics and surgical outcomes of patients who underwent primary eye removal surgery after open globe injury with those who underwent secondary eye removal surgery after open globe repair.
SUBJECTS/METHODS: This was a retrospective review of subjects who underwent evisceration or enucleation within 3 months of an open globe injury, at three Level I trauma centres in three U.S. cities between July 2014 and July 2020.
19 patients underwent primary eye removal and 20 underwent secondary eye removal. The most common mechanism of trauma in patients who underwent primary eye removal was gunshot. Compared to the secondary eye removal group, patients who underwent primary eye removal were significantly more likely to be male; have longer hospital stays; be discharged to another care facility rather than home; have facial fractures; suffer intracranial injury; and be unable to consent themselves for surgery. Both groups had a low surgical complication rate with one case of socket contracture in each group.
The standard of care for an open globe injury is prompt repair, but there are occasions when the globe is so damaged that it is deemed unrepairable. We found that globes that required primary eye removal were more often due to gunshot wounds, and that there was greater morbidity associated with these injuries. The authors' preferred surgical approach was evisceration with placement of a silicone sphere; patient outcomes demonstrate that this method was found to be safe, with a low complication and infection rate.
背景/目的：我们的目标是比较初次眼球摘除术和二次眼球修复术后眼球摘除术患者的特征和手术结果。
受试者/方法：这是一项回顾性研究，纳入了 2014 年 7 月至 2020 年 7 月期间，美国三个城市的三个一级创伤中心的 3 个月内开放性眼球损伤后行眼内容剜除或眼球摘除术的患者。
19 例患者行初次眼球摘除，20 例患者行二次眼球摘除。初次眼球摘除患者最常见的创伤机制是枪伤。与二次眼球摘除组相比，初次眼球摘除组患者更可能为男性；住院时间更长；出院后被送往其他护理机构而非家中；有面部骨折；合并颅内损伤；且无法自行同意手术。两组的手术并发症发生率均较低，每组各有 1 例发生眼窝挛缩。
开放性眼球损伤的标准治疗方法是及时修复，但有时眼球损伤严重，无法修复。我们发现需要初次眼球摘除的眼球更常因枪伤所致，这些损伤的发病率更高。作者首选的手术方法是眼内容剜除联合硅酮球植入；患者的预后表明，这种方法是安全的，并发症和感染率均较低。
