The Department of Ophthalmology, Manavgat State Hospital, Antalya, Turkey.
The Department of Ophthalmology, Akdeniz University Faculty of Medicine, Antalya, Turkey.
J Fr Ophtalmol. 2024 Oct;47(8):104259. doi: 10.1016/j.jfo.2024.104259. Epub 2024 Aug 1.
The aim of this study was to investigate the predictive factors for evisceration or enucleation surgery after open globe injury (OGI) and to investigate the effectiveness of the ocular trauma score (OTS) in predicting the outcome.
Data from 380 patients who underwent OGI repair were retrospectively analyzed. The eyes of 31 patients who underwent evisceration or enucleation after OGI repair and who were followed up for at least 6 months were included in the study. Demographic characteristics, presence of rupture, penetrating injury, endophthalmitis, retinal detachment and afferent pupillary defect were evaluated and OTS was calculated. The etiology of OGI, the interval between OGI repair and evisceration, the presence of eyelid and canalicular laceration, orbital fractures, prolapsed choroidal tissue, and the presence of foreign bodies were also analyzed. The size of the sphere after evisceration/enucleation, the need for revision surgery and the time to revision surgery were evaluated.
Of the 380 patients, 31 (8.15%) underwent evisceration or enucleation after OGI. 19 of 31 patients underwent evisceration after primary repair of OGI, 10 patients underwent evisceration without OGI repair; 1 patient underwent enucleation after OGI repair and 1 patient underwent enucleation without OGI repair. The mean OTS was 37.95 in the group with evisceration/enucleation after OGI repair and 29.55 in the group without repair. The mean interval between OGI and evisceration was 2.4±5.9 (0-13) months. The etiology of 10 (32.2%) OGIs were traffic accidents, 9 (29%) were penetrating trauma with cutting or penetrating instruments, 8 (25.8%) were blunt trauma, and 4 (12.9%) were gunshot wounds. The mean follow-up time was 38.9±23.59 (6-72) months. There was no significant difference in OTS according to age, gender, affected side and etiology. Although OTS was lower in patients with additional injuries than in those without, the difference not statistically significant. There was a statistically significant decrease in OTS from zone 1 (cornea and limbus) to zone 3 (posterior to 5mm from the limbus) (P=0.015, r=-0.433).
The decision and consent for evisceration/enucleation after an open globe injury is very difficult for both patients and physicians. We believe that the presence of the injury in zone 3 and the presence of rupture are poor prognostic factors and that an OTS below 49 could be a risk factor for evisceration/enucleation. In conclusion, the OTS could be an objective parameter that provides an objective idea of visual rehabilitation and prognosis and helps in decision making for further surgery.
本研究旨在探讨开放性眼球损伤（OGI）后眼球摘除或眼内容剜除手术的预测因素，并探讨眼外伤评分（OTS）在预测结局方面的有效性。
回顾性分析了 380 例接受 OGI 修复的患者的数据。纳入了 31 例接受 OGI 修复后行眼球摘除或眼内容剜除术且至少随访 6 个月的患者。评估了患者的人口统计学特征、破裂、穿透伤、眼内炎、视网膜脱离和瞳孔传入缺陷的存在情况，并计算了 OTS。分析了 OGI 的病因、OGI 修复与眼球摘除或眼内容剜除之间的间隔、眼睑和泪小管裂伤、眼眶骨折、脉络膜脱垂组织、以及异物的存在情况。评估了眼球摘除或眼内容剜除后的眼球大小、是否需要再次手术以及再次手术的时间。
在 380 例患者中，31 例（8.15%）在 OGI 后行眼球摘除或眼内容剜除术。31 例患者中，19 例在 OGI 初次修复后行眼球摘除术，10 例未行 OGI 修复而行眼球摘除术；1 例在 OGI 修复后行眼球摘除术，1 例未行 OGI 修复而行眼球摘除术。行眼球摘除或眼内容剜除术的患者 OTS 平均为 37.95，未行修复术的患者 OTS 平均为 29.55。OGI 与眼球摘除或眼内容剜除之间的平均间隔为 2.4±5.9（0-13）个月。10 例（32.2%）OGI 的病因是交通事故，9 例（29%）是切割或穿透性器械所致的穿透伤，8 例（25.8%）是钝挫伤，4 例（12.9%）是枪伤。平均随访时间为 38.9±23.59（6-72）个月。OTS 与年龄、性别、受累侧和病因无关。尽管合并损伤的患者 OTS 较低，但差异无统计学意义。从区 1（角膜和角巩膜缘）到区 3（角巩膜缘后 5mm 处），OTS 显著降低（P=0.015，r=-0.433）。
对于患者和医生来说，决定并同意开放性眼球损伤后行眼球摘除或眼内容剜除术非常困难。我们认为，区 3 的损伤和破裂的存在是预后不良的因素，OTS 低于 49 分可能是眼球摘除或眼内容剜除的危险因素。总之，OTS 可以作为一个客观参数，为视觉康复和预后提供客观的思路，并有助于对进一步手术做出决策。
