眼外伤患者不同时机行人工晶状体悬吊术的临床特征及预后比较  

Clinical features and prognosis in patients with ocular trauma undergoing intraocular lens suspension at different time points

作　　者：刘思佳 李景兰 叶子[2] 罗昱 马天驹[2] 陈文倩[2] 李朝辉[2] LIU Sijia;LI Jinglan;YE Zi;LUO Yu;MA Tianju;CHEN Wenqian;LI Zhaohui(Chinese PLA Medical School,Beijing 100853,China;Senior Department of Ophthalmology,the Third Medical Center,Chinese PLA General Hospital,Beijing 100039,China)

机构地区：[1]解放军医学院,北京100853 [2]解放军总医院第三医学中心眼科医学部,北京100039

出　　处：《解放军医学院学报》2024年第12期1252-1258,共7页Academic Journal of Chinese PLA Medical School

摘　　要：背景眼外伤患者不同时机行人工晶状体悬吊植入手术的临床疗效和长期预后,目前研究较少。目的分析比较眼外伤患者的临床特征以及不同时机行人工晶状体悬吊术的临床疗效及长期并发症。方法回顾性分析2009年5月—2023年6月解放军总医院第一医学中心收治的因眼外伤致外伤性白内障或晶状体脱位,行人工晶状体悬吊术患者的病例资料。根据手术时机和方式,分为Ⅰ期人工晶状体悬吊和Ⅱ期人工晶状体悬吊。对两组患者基本信息、眼外伤情况、手术情况、手术预后等进行分析。结果共纳入患者142例,男性126例,女性16例,中位年龄48(IQR:37~61)岁。闭合性眼外伤的患病率略高于开放性眼外伤的患病率(56.34%vs 43.66%,P<0.001),开放性眼外伤的损伤部位以角膜穿透伤多见(62.90%)。截至2023年12月,Ⅰ期植入组平均随访时间为(72.1±45.6)个月,Ⅱ期植入组平均随访时间为(81.8±44.2)个月。Ⅰ期植入组术后最佳矫正视力(best corrected visual acuity,BCVA)较术前提高(logMAR)[M(IQR):0.4(0.2~0.7)vs0.8(0.5~1.8),P<0.001],Ⅱ期植入组术后较术前BCVA略改善或保持不变(logMAR)[M(IQR):0.5(0.3~1.05)vs 0.4(0.2~1.7),P=0.877],两组术后BCVA差异无统计学意义(logMAR)[M(IQR):0.4(0.2~0.7)vs 0.5(0.3~1.05),P=0.093]。Ⅰ期植入组术前(16.9±7.6 vs 13.5±4.6,P=0.026)和术后(14.7±4.6 vs 12.9±3.7,P=0.026)眼压均高于Ⅱ期植入组。Ⅰ期与Ⅱ期植入组在视力预后及悬吊型人工晶状体脱位[6例(10.53%)vs 14例(16.47%)]、继发性青光眼等并发症[5例(8.77%)vs 3例(3.53%)]方面的差异无统计学意义(P>0.05)。结论眼外伤后,Ⅰ期和Ⅱ期人工晶状体悬吊植术均可有效改善患者的屈光状态,两组术后最佳矫正视力无显著差异。Ⅰ期人工晶状体悬吊植入术相比Ⅱ期人工晶状体悬吊植术在术前和术后可能具有更高的高眼压风险。两种时机行人工晶状体悬吊植入的长期视力预后和术后常�Background There is currently limited research on the clinical efficacy and long-term prognosis of artificial intraocular lens suspension implantation surgery in patients with eye trauma at different time points.Objective To analyze and compare the clinical characteristics of patients with ocular trauma and the clinical efficacy and long-term complications of intraocular lens suspension at different time points.Methods Clinical data about patients with traumatic cataracts or lens dislocation due to ocular trauma admitted to the First Medical Center of Chinese PLA General Hospital from May 2009 to June 2023 were retrospectively analyzed.According to different operation time and methods,patients were divided into stage I intraocular lens suspension(stage I group)and stage II intraocular lens suspension(stage II group).The basic information,ocular trauma,operation,and prognosis of the two groups were collected and analyzed.Results This study included 142 patients,126 males and 16 females,with a median age of 48(IQR:37-61)years.The incidence of closed-eye trauma was slightly higher than that of open-eye trauma(56.34%vs 43.66%,P<0.001),and the most common injury site in open-eye trauma was corneal penetration(62.90%).As of December 2023,the average follow-up time of the stage I group was(72.1±45.6)months,and it was(81.8±44.2)months in the stage II group.The best-corrected visual acuity in the stage I group improved postoperatively compared to preoperatively(0.4[0.2-0.7]vs 0.8[0.5-1.8],P<0.001).In the stage II group,the BCVA improved slightly or remained unchanged postoperatively compared to preoperatively(0.5[0.3-1.05]vs 0.4[0.2-1.7],P=0.877).There was no statistically significant difference in postoperative BCVA between the two groups(0.4[0.2-0.7]vs 0.5[0.3-1.05],P=0.093).The intraocular pressure in the stage I group was higher than that in the stage II group both preoperatively(16.9±7.6 vs 13.5±4.6,P=0.026)and postoperatively(14.7±4.6 vs 12.9±3.7,P=0.026).There were no statistically significant differences in

关 键 词：眼外伤 外伤性白内障 外伤性晶状体脱位 人工晶状体悬吊术 手术时机 

分 类 号：R779.6[医药卫生—眼科]