眼外伤评分与眼球结构参数在眼外伤愈后视力评估中的价值  

Value of ocular trauma score and ocular structural parameters in the assessment of healing visual acuity from ocular trauma

作　　者：周智露 王杰[1] 夏文涛 陈捷敏 郝虹霞 Zhi-Lu Zhou;Jie Wang;Wen-Tao Xia;Jie-Min Chen;Hong-Xia Hao(School of Forensic Medicine,Guizhou Medical University,Guiyang 550009,Guizhou Province,China;Academy ofForensic Science,Institute of Forensic Science,Ministry of Justice,Shanghai Key Laboratory of Forensic Medicine,Shanghai Forensic ServicePlatform,Shanghai 200063,China;Basic Medical College,Jiamusi University,Jiamusi 154007,Heilongjiang Province,China)

机构地区：[1]贵州医科大学法医学院,贵州省贵阳市550009 [2]司法鉴定科学研究院,司法部司法鉴定重点实验室,上海市法医学重点实验室,上海市司法鉴定专业技术服务平台,上海市200063 [3]佳木斯大学基础医学院,黑龙江省佳木斯市154007

出　　处：《国际眼科杂志》2023年第2期261-266,共6页International Eye Science

基　　金：国家重点研发计划项目(No.2022YFC3302001);推荐性国家标准计划项目(No.20214464-T-315,20214528-T-315)。

摘　　要：目的:探讨眼外伤评分(OTS)、初诊视力与眼球结构参数在眼外伤愈后视力评估中的价值。方法:选取司法鉴定科学研究院2015-06/2021-06受理并出具明确鉴定意见的眼外伤者302例302眼,根据眼外伤愈后最佳矫正视力(BCVA)进行分组,Ⅰ组63例63眼,BCVA<3.7;Ⅱ组70例70眼3.7≤BCVA<4.5;Ⅲ组78例78眼,4.5≤BCVA<4.9;Ⅳ组91例91眼,BCVA≥4.9。另选取纳入的眼外伤者健眼77例77眼作为对照组即Ⅴ组。分析纳入研究对象的眼外伤愈后BCVA和眼球结构参数及其相关性,并使用IBM SPSS Modeler 18.0软件建立预测眼外伤愈后视力的随机森林(RF)和支持向量机(SVM)模型。结果:纳入眼外伤者初诊视力、OTS评分、眼外伤愈后角膜分级、晶状体分级、眼底分级、视神经周围神经纤维层厚度与眼外伤愈后BCVA均存在相关性(P<0.01)。除中央视网膜厚度外,各组眼球结构参数均有差异(P<0.001)。SVM模型较RF模型预测眼外伤愈后视力的准确率高,误差在0.15以内者准确率达80%以上。结论:OTS评分与眼球结构检查可为眼外伤后视觉功能障碍的法医临床鉴定提供有效信息,在鉴别伪装视觉功能障碍中具有价值。AIM:To explore the value of ocular trauma score(OTS),initial visual acuity,and ocular structural parameters in the assessment of healing visual acuity from ocular trauma.METHOD:A total of 302 cases(302 eyes)of ocular trauma were selected as subjects,which were accepted and issued clear appraisal opinions by the Academy of Forensic Science from June 2015 to June 2021.The subjects were grouped according to the healing best corrected visual acuity(BCVA)from ocular trauma.GroupⅠincluded 63 cases(63 eyes)with BCVA<3.7;GroupⅡincluded 70 cases(70 eyes)with 3.7≤BCVA<4.5;GroupⅢincluded 78 cases(78 eyes)with 4.5≤BCVA<4.9;GroupⅣincluded 91 cases(91 eyes)with BCVA≥4.9.In addition,77 cases(77 healthy eyes)of ocular trauma were selected as the control group,namely GroupⅤ.The healing BCVA and ocular structural parameters from ocular trauma and theirs correlation were analyzed,and the random forest(RF)and support vector machine(SVM)model of healing visual acuity was established by the IBM SPSS Modeler 18.0.RESULTS:The initial visual acuity,OTS,the grading of corneas,lenses,and fundus,and the thickness of the retinal never fiber layer of ocular trauma patients were correlated with the healing BCVA(P<0.01).There were significant differences in ocular structural parameters among groups,except the central subfield thickness(P<0.001).The SVM model had higher accuracy of predicting healing visual acuity than the RF model,and the accuracy rate was over 80%when the error was within 0.15.CONCLUSION:OTS and ocular structural examination can provide effective information for the clinical forensic medicine appraisal of visual dysfunction after ocular trauma,and they are valuable in discriminating camouflage of visual dysfunction.

关 键 词：眼损伤 眼外伤评分 眼球结构参数 视力预测 法医临床学 

分 类 号：R779.1[医药卫生—眼科] D919.4[医药卫生—临床医学]