外伤性无光感眼玻璃体手术预后及其危险因素分析  

Prognosis of traumatic eyes with no light perception undergone vitrectomy and analysis of risk factors

作　　者：王叶楠[1] 沈丽君[2] 王常观[1] 冯学峰[1] 许艺民[1] 窦宏亮[1] 宋宗明[2] 马志中[1] 

机构地区：[1]北京大学第三医院北京大学眼科中心,100083 [2]温州医学院附属眼视光学医院

出　　处：《中华眼科杂志》2007年第4期340-345,共6页Chinese Journal of Ophthalmology

基　　金：北京大学211工程资助项目（03-9-02）

摘　　要：目的探讨外伤性无光感眼玻璃体手术预后及其危险因素。方法统计1999年2月至2004年8月由北京大学第三医院北京大学眼科中心和温州医学院附属眼视光学医院登记的机械性眼外伤接受玻璃体手术的577例（599只眼）患者临床资料。其中外伤性无光感38例（38只眼），包括开放性眼损伤32只眼（84．2％），闭合性眼损伤6只眼（15．8％）。一期行眼球摘除术者未进行随访，其他患者随访6个月以上，平均7．2个月。所有患者的临床资料均被填入预先设计的表格，每项参数的确定严格遵循协议规定的标准，并对外伤眼预后不良的危险因素及外伤性无光感的危险因素进行logistic统计分析。结果14只眼（36．8％）获得解剖及功能修复，3只眼（7．9％）获得解剖修复。9只眼（23．7％）行眼球摘除术。其余4只眼低眼压，7只眼为硅油支持眼，1只眼眼球萎缩。术后21只眼视力提高（55．3％），其中视力提高至0．2者3只眼，0．02者2只眼，数指、手动各3只眼，恢复光感10只眼。仍无光感8只眼（21．1％）。Logistic回归分析结果显示，外伤眼预后不良的危险因素是外伤性无光感、相对性传入瞳孔障碍（RAPD）、脉络膜上腔大出血（MSCH）、闭合漏斗状视网膜脱离、睫状体损害、早期眼球萎缩、虹膜脱出及无虹膜、晶状体逐出、巩膜伤口〉10mm和眼球破裂伤。以上诸因素（除外外伤性无光感、虹膜脱出及无虹膜）亦是外伤后造成无光感的危险因素。通常有2种以上危险因素共同存在于同一只外伤眼中。结论外伤性无光感眼预后较差，但是通过玻璃体手术有将近45％的外伤眼可获得解剖及功能修复或解剖修复。外伤性无光感归因于综合危险因素。MSCH、视网膜组织严重损害及睫状体的广泛损害是外伤眼预后不良的主要指征。Objective To evaluate the prognosis of traumatic eyes with no light perception post vitrectomy, and to analyze the risk factors influencing the final results. Methods Five hundred and ninety nine mechanically injured eyes in 577 patients undergone vitrectomy were registered from 1999-2004. Thirtyeight eyes in this group showed no light perception in initial visual examination. Thirty-two eyes （ 84. 2% ） had open-globe injury, the other 6 eyes （ 15.8% ） had closed-globe injury. Excluded the enucleated eyes, the others were followed up for at least 6 months, averaged 7. 2 months. All registered data were filled in predesigned forms. Each parameter was evaluated strictly according to the standards of the protocol. The risk factors of poor prognosis and traumatic no light perception were analyzed by logistic regression. Results Fourteen eyes （36. 8% ） achieved anatomic and functional success. Three eyes （7. 9% ） attained anatomic success. Nine eyes （23.7%） were enucleated. Hypotony occurred in 4 eyes. Seven eyes were maintained by silicone oil. Atrophy of eyeball occurred in 1 eye. Twenty-one eyes （55.3%） achieved a final visual acuity of light perception or better, including. 0. 2 in 3 eyes, 0. 02 in 2 eyes, count finger in 3 eyes, hand move in 3 eyes, light perception in 10 eyes. Eight eyes （21.1%） remained no light perception. The logistic regression analysis identified the significant risk factors predictive of poor prognosis, including traumatic no light perception, presence of a relative afferent pupillary defect （RAPD）, massive suprachoroid hemorrhage （MSCH）, panretinal detachment with closed-funnel, ciliary body injury, preoperative atrophy of eyeball, prolapse of iris and aniridia, extrusion of crystalline lens, length of scleral wound greater than 10 mm and ruptured injury. These factors were also the risk factors of traumatic no light perception, excluded traumatic no light perception, prolapse of iris and aniridia. More than one risk factor usually co-exists in each eye

关 键 词：眼损伤 脉络膜出血 玻璃体切除术 危险因素 预后 

分 类 号：R686[医药卫生—骨科学]