开放性眼外伤修复术中外伤性白内障的处理及疗效观察。
Management and Outcomes of Traumatic Cataract During Open Globe Repair.
机构信息
Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA.
Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA; Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA; Department of Ophthalmology, Keck School of Medicine, USC Roski Eye Institute, University of Southern California, Los Angeles, CA.
出版信息
Am J Ophthalmol. 2024 Oct;266:248-254. doi: 10.1016/j.ajo.2024.05.017. Epub 2024 May 25.
PURPOSE
To compare outcomes of primary lensectomy (PL) versus no lensectomy (NL) during repair of zone I (involving cornea and limbus) and II (up to 5mm posterior to the limbus) open globe injuries (OGIs) with lens involvement.
DESIGN
Retrospective clinical cohort study.
METHODS
107 patients with OGIs involving both blunt and penetrating injury to the lens who presented to Wills Eye Hospital between April 1, 2017 and August 31, 2022 were included. Data from presenting visit was collected including demographic information, time from injury to surgery, visual acuity (VA), intraocular pressure (IOP), injury characteristics, and years since residency graduation of surgeon. VA, IOP, retinal detachment (RD) rate, and endophthalmitis incidence were compared between PL and NL groups at postoperative week 1 (POW1) and postoperative month 1 (POM1). VA, peak IOP, need for further surgeries, and types of additional surgery were compared between the two groups at the final visit.
RESULTS
19 (17.8%) patients underwent PL. Age, sex, and initial VA were similar between groups (all p≥0.05). The PL group had surgery later from the time of injury (6.1±14.6 days vs. 1.3±1.9 days; p=0.010), higher IOP at presentation (12.9±11.6 mmHg vs. 7.7±11.3 mmHg; p=0.046), shorter wounds (2.3±1.4mm vs. 4.7±3.2mm; p=0.003), more frequent lens capsule violation (89.5% vs. 50%; p=0.010), increased likelihood of intraocular foreign bodies (52.6% vs. 17.0%; p=0.004), and were more likely to be operated on by surgeons with ≥ 5 years of experience post-residency (68.4% vs. 28.4%; p<0.001). At POW1, the PL group had significantly better logMAR VA (1.2±0.9 vs. 2.0±1.0; p=0.002), and this continued at POM1 (1.0±0.8 vs. 1.6±1.1; p=0.031) and the final visit (0.4±0.7 vs. 1.0±1.1; p=0.010). The PL group had lower IOP at POW1 (12.4±3.0 mmHg vs. 17.3±8.2 mmHg; p=0.005) than the NL group. There was no difference in RD or endophthalmitis rates between the two groups at POW1 or POM1 (p>0.05 for all). The NL group was more likely to require additional surgery by final follow-up (77.3% vs. 47.4%; p<0.001). In the multivariable analysis, PL had better final VA and decreased need for further surgery (both p<0.05).
CONCLUSIONS
In the appropriate circumstance, PL during lens-involving anterior OGI repair may lead to improved patient outcomes.
目的
比较在累及晶状体的 I 区（角膜和角巩膜缘）和 II 区（角巩膜缘后 5mm 以内）开放性眼球损伤（OGI）修复中进行晶状体切除术（PL）与不进行晶状体切除术（NL）的结果，这些损伤都累及晶状体。
设计
回顾性临床队列研究。
方法
纳入 2017 年 4 月 1 日至 2022 年 8 月 31 日期间在 Wills 眼科医院就诊的累及晶状体的钝挫伤和穿透伤的 107 例 OGIs 患者。收集就诊时的人口统计学信息、从受伤到手术的时间、视力（VA）、眼内压（IOP）、损伤特征和手术医生住院医师毕业后的年限。比较 PL 和 NL 组在术后第 1 周（POW1）和术后第 1 个月（POM1）的 VA、IOP、视网膜脱离（RD）发生率和眼内炎发生率。比较两组在最后一次就诊时的 VA、峰值 IOP、需要进一步手术和其他手术类型。
结果
19 例（17.8%）患者接受了 PL。两组的年龄、性别和初始 VA 相似（均 p≥0.05）。PL 组从受伤到手术的时间较晚（6.1±14.6 天比 1.3±1.9 天；p=0.010），就诊时 IOP 较高（12.9±11.6mmHg 比 7.7±11.3mmHg；p=0.046），伤口较短（2.3±1.4mm 比 4.7±3.2mm；p=0.003），晶状体囊破裂的频率更高（89.5%比 50%；p=0.010），眼内异物的可能性更大（52.6%比 17.0%；p=0.004），且更可能由住院医师毕业后有≥5 年经验的医生进行手术（68.4%比 28.4%；p<0.001）。在 POW1，PL 组的 logMAR VA 明显更好（1.2±0.9 比 2.0±1.0；p=0.002），这种情况一直持续到 POM1（1.0±0.8 比 1.6±1.1；p=0.031）和最后一次就诊（0.4±0.7 比 1.0±1.1；p=0.010）。PL 组的 IOP 在 POW1 时（12.4±3.0mmHg 比 17.3±8.2mmHg；p=0.005）低于 NL 组。两组在 POW1 或 POM1 时的 RD 或眼内炎发生率无差异（均 p>0.05）。NL 组在最后一次随访时更有可能需要进一步手术（77.3%比 47.4%；p<0.001）。在多变量分析中，PL 有更好的最终 VA 和减少进一步手术的需要（均 p<0.05）。
结论
在适当的情况下，晶状体受累的前 OGIs 修复中进行 PL 可能会改善患者的预后。
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