Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK.
Research and Clinical Innovation, Royal Centre for Defence Medicine, Birmingham, UK.
Eye (Lond). 2024 Nov;38(16):3047-3051. doi: 10.1038/s41433-024-03246-3. Epub 2024 Jul 31.
Open globe injuries are a significant global cause of visual loss, including unilateral and bilateral blindness. Prognosis is predicted by injury severity, with lower presenting visual acuity and more posterior injuries associated with poor visual outcomes, although even the most severely injured eyes with no perception of light vision may regain some visual function. In addition to severity of the primary injury, the secondary injuries and complications causing poor outcomes include proliferative vitreoretinopathy (PVR) and endophthalmitis. Endophthalmitis is common after open globe injury, affecting up to 16.5% of patients. Systemic antibiotic prophylaxis is commonly used, with a limited evidence base, while intraocular antibiotics are less commonly used but have stronger supporting evidence of efficacy. Endophthalmitis rates are also reduced by prompt primary repair, which may also support recovery of visual acuity. PVR is not prevented or treated by any pharmacologic interventions in current clinical practice, but the incidence of post-traumatic PVR may be reduced by early vitrectomy within the first 4-7 days after injury. Ocular trauma training is often limited in Western ophthalmic surgical training programmes, and patients with ocular trauma often require the input of multiple subspecialists. In this context, it is important that patients have an overview and coordination of the different aspects of their care, with ownership by one lead clinician.
开放性眼球损伤是全球范围内导致视力丧失的一个重要原因，包括单侧和双侧失明。预后取决于损伤的严重程度，表现出较低的视力和更靠后的损伤与较差的视力结果相关，尽管即使是受伤最严重、无光感的眼睛也可能恢复一些视力。除了原发性损伤的严重程度外，导致不良预后的继发性损伤和并发症包括增生性玻璃体视网膜病变（PVR）和眼内炎。开放性眼球损伤后眼内炎很常见，影响多达 16.5%的患者。通常使用全身抗生素预防，但基于有限的证据，而眼内抗生素的使用较少，但有更强的疗效证据支持。及时进行初次修复也可以降低眼内炎的发生率，这也可能有助于恢复视力。在目前的临床实践中，任何药物干预都不能预防或治疗 PVR，但在受伤后 4-7 天内早期玻璃体切除可能会降低创伤后 PVR 的发生率。西方眼科手术培训项目中眼球创伤培训通常受到限制，而眼球创伤患者通常需要多个亚专科医生的参与。在这种情况下，重要的是让患者对其治疗的不同方面有一个全面的了解和协调，并由一位主要临床医生负责。
