Senior Department of Ophthalmology, the Third Medical Center of Chinese PLA General Hospital, Beijing, 100039, China.
Department of Ophthalmology, the First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China.
Mil Med Res. 2023 Jan 12;10(1):3. doi: 10.1186/s40779-022-00438-4.
Explosions can produce blast waves, high-speed medium, thermal radiation, and chemical spatter, leading to complex and compound eye injuries. However, few studies have comprehensively investigated the clinical features of different eye injury types or possible risk factors for poor prognosis.
We retrospectively reviewed all consecutive records of explosive eye injuries (1449 eyes in 1115 inpatients) in 14 tertiary referral hospitals in China over 12 years (between January 2008 and December 2019). Data on demographics, eye injury types, ocular findings, treatments, and factors affecting visual prognosis were extracted from a standardized database of eye injuries and statistically analyzed.
Mechanical ocular trauma accounted for 94.00% of explosion-related eye injuries, among which intraocular foreign bodies (IOFBs) resulted in 55.17% of open globe injuries (OGIs) and contusion caused 60.22% of close globe injuries (CGIs). Proliferative vitreous retinopathy (PVR) was more common in perforating (47.06%) and IOFB (26.84%) than in penetrating (8.79%) injuries, and more common with laceration (24.25%) than rupture (9.22%, P < 0.01). However, no difference was observed between rupture and contusion. Ultimately, 9.59% of eyes were removed and the final vision was ≤ 4/200 in 45.82% of patients. Poor presenting vision [odds ratio (OR) = 5.789], full-thickness laceration of the eyeball ≥ 5 mm (OR = 3.665), vitreous hemorrhage (OR = 3.474), IOFB (OR = 3.510), non-mechanical eye injury (NMEI, OR = 2.622, P < 0.001), rupture (OR = 2.362), traumatic optic neuropathy (OR = 2.102), retinal detachment (RD, OR = 2.033), endophthalmitis (OR = 3.281, P < 0.01), contusion (OR = 1.679), ciliary body detachment (OR = 6.592), zone III OGI (OR = 1.940), and PVR (OR = 1.615, P < 0.05) were significant negative predictors for poor visual outcomes.
Explosion ocular trauma has complex mechanisms, with multiple eyes involved and poor prognosis. In lethal level I explosion injuries, eyeball rupture is a serious condition, whereas contusion is more likely to improve. In level II injuries, IOFBs are more harmful than penetrating injuries, and level IV represents burn-related eye injuries. PVR is more associated with penetrating mechanisms than with OGI. Identifying the risk predictors for visual prognosis can guide clinicians in the evaluation and treatment of ocular blast injuries.
爆炸可产生冲击波、高速介质、热辐射和化学喷溅，导致复杂和复合性眼损伤。然而，很少有研究全面调查不同眼损伤类型的临床特征或可能导致预后不良的危险因素。
我们回顾性分析了中国 14 家三级转诊医院在 12 年间（2008 年 1 月至 2019 年 12 月）连续记录的 1115 例爆炸伤眼患者（1449 只眼）的所有连续记录。从眼伤标准化数据库中提取人口统计学、眼损伤类型、眼部发现、治疗以及影响视觉预后的因素，并进行统计学分析。
机械性眼外伤占爆炸相关性眼外伤的 94.00%，其中眼内异物（IOFB）导致开放性眼球损伤（OGI）的 55.17%，挫伤导致闭合性眼球损伤（CGI）的 60.22%。增殖性玻璃体视网膜病变（PVR）在穿透性（8.79%）和 IOFB（26.84%）损伤中比穿孔性（47.06%）更常见，在裂伤（24.25%）中比破裂（9.22%，P<0.01）更常见。然而，破裂与挫伤之间无差异。最终，9.59%的眼球被切除，45.82%的患者最终视力≤4/200。就诊时视力差[比值比（OR）=5.789]、全层球结膜裂伤≥5mm（OR=3.665）、玻璃体积血（OR=3.474）、眼内异物（OR=3.510）、非机械性眼损伤（NMEI，OR=2.622，P<0.001）、破裂（OR=2.362）、外伤性视神经病变（OR=2.102）、视网膜脱离（OR=2.033）、眼内炎（OR=3.281，P<0.01）、挫伤（OR=1.679）、睫状体脱离（OR=6.592）、Ⅲ区 OGⅠ（OR=1.940）和 PVR（OR=1.615，P<0.05）是视力预后不良的显著负预测因素。
爆炸性眼外伤机制复杂，多眼受累，预后差。在致命性 I 级爆炸伤中，眼球破裂是一种严重情况，而挫伤更有可能改善。在 II 级损伤中，IOFB 比穿透性损伤更有害，而 IV 级代表与烧伤相关的眼损伤。PVR 与穿透性机制的相关性高于 OGⅠ。确定视觉预后的风险预测因素可以指导临床医生对眼爆炸伤的评估和治疗。
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