开放性眼外伤Ⅲ区不同亚型患眼临床结局观察  

Observation of patient clinical outcomes based on the new subclassification of zoneⅢopen-globe injury

作　　者：顾鹏 李莎 蒋典君 刘勇 吴楠 Gu Peng;Li Sha;Jiang Dianjun;Liu Yong;Wu Nan(Department of Ophthalmology,The First Affiliated Hospital of Army Medical University,Chongqing 400038,China;Department of Ophthalmology,The Second Affiliated Hospital of Army Medical University,Chongqing 400037,China)

机构地区：[1]陆军军医大学第一附属医院眼科,重庆400038 [2]陆军军医大学第二附属医院眼科,重庆400037

出　　处：《中华眼底病杂志》2025年第4期271-276,共6页Chinese Journal of Ocular Fundus Diseases

摘　　要：目的对比观察开放性眼外伤(OGI)Ⅲ区不同亚型患眼视力、眼球结构解剖结局。方法单中心回顾性队列研究。2020年1月至2023年12月于陆军军医大学第一附属医院眼科住院治疗的OGI累及Ⅲ区患者187例187只眼纳入研究。按照2022年国际眼球和附属器创伤流行病学研究共识,Ⅲ区再分为Ⅲa(角膜缘后5~8 mm)、Ⅲb(角膜缘后>8 mm)区并据此分组,分别为58(31%,58/187)、129(69%,129/187)只眼。采用国际标准小数视力表进行最佳矫正视力(BCVA)检查,记录时换算为最小分辨角对数(logMAR)视力。记录患眼损伤区域、初始视力、最终视力以及视网膜脱离(RD)、葡萄膜脱出、增生性玻璃体视网膜病变(PVR)等发生情况。手术后随访时间≥6个月。观察两组患眼最终视力及眼球结构解剖结局。硅油依赖、眼球萎缩、眼球摘除定义为解剖结局不良。组间比较采用t检验或χ^(2)检验。多元线性回归分析OGIⅢb区对最终视力的影响。结果随访6个月时,Ⅲa组、Ⅲb组患眼logMAR BCVA分别为1.49±1.0、2.51±0.85;两组患眼logMAR BCVA比较,差异有统计学意义(t=−2.736,P<0.05)。与Ⅲa组比较,Ⅲb组患眼视力无光感、光感者占比更高,手动、数指、>0.01者占比更低,差异均有统计学意义(P<0.05)。与Ⅲa组比较,Ⅲb组患眼更易发生RD、PVR,差异均有统计学意义(χ^(2)=16.696、8.697,P<0.05)。Ⅲa组、Ⅲb组患眼中,最终解剖结局不良分别为14(24.1%,14/58)、95(73.6%,95/129)只眼;Ⅲb组患眼最终解剖结局不良发生率更高,差异有统计学意义(χ^(2)=40.332,P<0.01)。多元线性回归分析结果显示,初始视力、RD、葡萄膜脱出是影响最终视力的独立危险因素(比值比=2.407、4.162、3.413,P<0.05)。结论Ⅲb区OGI患眼视力预后更差,眼球结构解剖结局不良发生率更高;Ⅲ区亚分型有助于临床更好预测OGI的预后。Objective To compare and observe the visual acuity and ocular anatomical outcome of different subtypes in open-globe injury(OGI)Ⅲ.Methods A retrospective study.A total of 187 eyes of 187 patients with OGI involving zoneⅢwho were admitted to the Department of Ophthalmology of The First Affiliated Hospital of Army Medical University from January 2020 to December 2023 were included in the study.According to the 2022 International Globe and Adnexal Trauma Epidemiology Study groups consensus,zoneⅢwas further divided intoⅢa zone(5-8 mm posterior to the limbus)andⅢb zone(>8 mm posterior to the limbus),with 58 eyes(31%,58/187)in groupⅢa and 129 eyes(69%,129/187)in groupⅢb.Best corrected visual acuity(BCVA)was examined using the international standard decimal visual acuity chart,converted into the logarithm of the minimum angle of resolution(logMAR)visual acuity when recorded.The injured zone,initial visual acuity,final visual acuity,retinal detachment(RD),uveal prolapse,and proliferative vitreoretinopathy(PVR)were collected.The follow-up time after surgery≥6 months.The final visual acuity and anatomical prognosis of the two groups were observed.Silicone oil dependence,phthisis,and enucleation were defined as poor anatomical outcomes.Multiple linear regression analysis was performed to analyze the impact of zoneⅢb of OGI on the final visual acuity.Results At the 6-month follow-up,the logMAR BCVA of groupⅢa and groupⅢb was 1.49±1.0 and 2.51±0.85;there was a statistically significant difference in the logMAR BCVA between the two groups(t=−2.736,P<0.05).Compared with groupⅢa,the proportion with light perception in groupⅢb was higher,and the proportions with visual acuity of hand movement,counting fingers,and>0.01 were lower,and the differences were all statistically significant(P<0.05).Compared with groupⅢa,RD and PVR were more likely to occur in groupⅢb,and the differences were all statistically significant(χ^(2)=16.696,8.697;P<0.05).Among the affected eyes in groupⅢa and groupⅢb,there

关 键 词：开放性眼外伤 开放性眼外伤受伤分区亚分型 影响因素分析 

分 类 号：R779.1[医药卫生—眼科]