Kim Tae Hun, Kim Junghoon
Department of Ophthalmology, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, Korea.
Korean J Ophthalmol. 2025 Feb;39(1):57-63. doi: 10.3341/kjo.2024.0084. Epub 2025 Jan 9.
To analyze the frequency and clinical characteristics of ocular injuries in patients with prior blowout fractures who experience new blunt trauma, and to assess whether old orbital fractures provide a protective effect against subsequent ocular trauma.
The medical records of 1,315 ocular trauma patients were reviewed. A total of 927 patients who had orbital or facial computed tomography scans and ophthalmologist evaluations were considered. After applying exclusion criteria, 568 patients with 581 affected eyes were included in the final analysis. The patients were divided into two groups based on the presence of old blowout fractures, identified on computed tomography scan. The clinical characteristics and the frequency of ocular injuries were compared between the two groups. The risk of ocular injury according to the presence of old blowout fracture ware studied using multiple logistic regression after controlling age and sex.
Among the 581 eyes examined, 140 (24.1%) had old blowout fractures. The incidence of intraocular complications was significantly higher in the no orbital fracture group compared to the old blowout fracture group (20.4% vs. 2.1%, p < 0.001). Specifically, the incidence of complications such as gross hyphema (p = 0.001), globe rupture (p = 0.006), and vitreous hemorrhage (p = 0.027) was significantly greater in the group without old blowout fractures than in those with them. Multiple logistic regression showed that the presence of old blowout fractures was significantly associated with reduced risk of ocular injury (p < 0.001).
The patients with old blowout fractures had a lower risk of ocular injuries following subsequent blunt trauma. The findings suggest that old fractures may provide protective effect. These results may have important implications for the clinical management of patients at risk of recurrent orbital trauma.
分析既往有爆裂性骨折的患者遭受新的钝性外伤后眼外伤的发生频率及临床特征，并评估陈旧性眼眶骨折是否对后续眼外伤具有保护作用。
回顾了1315例眼外伤患者的病历。共有927例进行了眼眶或面部计算机断层扫描及眼科医生评估的患者被纳入研究。应用排除标准后，568例患者的581只患眼被纳入最终分析。根据计算机断层扫描确定的陈旧性爆裂性骨折情况将患者分为两组。比较两组的临床特征及眼外伤发生频率。在控制年龄和性别后，采用多因素logistic回归分析研究陈旧性爆裂性骨折与眼外伤风险的关系。
在检查的581只眼中，140只（24.1%）有陈旧性爆裂性骨折。无眼眶骨折组的眼内并发症发生率显著高于陈旧性爆裂性骨折组（20.4%对2.1%，p<0.001）。具体而言，无陈旧性爆裂性骨折组的严重前房积血（p=0.001）、眼球破裂（p=0.006）和玻璃体积血（p=0.027）等并发症发生率显著高于有陈旧性爆裂性骨折组。多因素logistic回归分析显示，陈旧性爆裂性骨折的存在与眼外伤风险降低显著相关（p<0.001）。
有陈旧性爆裂性骨折的患者在后续钝性外伤后发生眼外伤的风险较低。研究结果表明陈旧性骨折可能具有保护作用。这些结果可能对复发性眼眶外伤风险患者的临床管理具有重要意义。
