Ryan S J, Allen A W
Am J Ophthalmol. 1979 Sep;88(3 Pt 1):483-91. doi: 10.1016/0002-9394(79)90651-2.
Visual improvement was achieved in 62% of 100 consecutive patients with ocular trauma treated by pars plana vitrectomy. Anterior segment injuries had a better prognosis than posterior segment injuries, and retinal detachment was a poor prognostic sign. Patients undergoing vitrectomy during the two weeks after injury had a better visual prognosis than those who had delayed vitrectomy. Pars plana vitrectomy has increased the recovery rate in traumatized eyes which previously were deemed inoperable and frequently were enucleated. Most such eyes have intraocular fibrocellular proliferations, resulting in traction retinal detachments, cyclitic membranes, and phthisis, as documented in clinicopathological and experimentally produced specimens of penetrating ocular trauma. Vitrectomy can interrupt this sequence, if performed one to 14 days after injury, by removing the vitreous scaffold onto which proliferation occurs, together with the elements of hemorrhage, damaged lens, vitreous, and foreign material which may incite proliferation. We believe four to ten days after injury to be the optimal time for vitrectomy to avoid the hazards of immediate intervention, while removing damaged tissue before serious sequenlae occur.
在连续接受玻璃体切除术治疗的100例眼外伤患者中，62%的患者视力得到改善。前段损伤的预后优于后段损伤，视网膜脱离是预后不良的体征。伤后两周内接受玻璃体切除术的患者视力预后优于延迟进行玻璃体切除术的患者。玻璃体切除术提高了以前被认为无法手术且常被摘除眼球的外伤眼的恢复率。大多数此类眼球存在眼内纤维细胞增殖，导致牵拉性视网膜脱离、睫状体膜和眼球痨，这在穿透性眼外伤的临床病理和实验标本中得到证实。如果在伤后1至14天进行玻璃体切除术，通过去除发生增殖的玻璃体支架以及可能引发增殖的出血成分、受损晶状体、玻璃体和异物，可以中断这一过程。我们认为伤后4至10天是进行玻璃体切除术的最佳时间，既能避免立即干预的风险，又能在严重后遗症发生前清除受损组织。
