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目的分析评价机械性眼球伤,特别是开放性眼外伤,玻璃体手术的效果及相关危险因素。方法机械性眼外伤398例(409眼),开放性眼外伤357眼,闭合性眼外伤52眼,均行玻璃体切除手术。术后随访至少6个月。各合作单位将所有的患者信息填表,录入数据库供统计分析。结果最终视力≥0.025者260眼(63.57%)。获得解剖功能修复者289眼(70.66%);获得解剖修复者34眼(8.31%);低眼压、眼球萎缩、硅油支持眼球和眼球摘除(预后不良)者86眼(21.03%)。增生性玻璃体视网膜病变(PVR)、视网膜脱离(RD)、伤后14d以上实施玻璃体手术者预后较差。受伤至手术时间与PVR的发生率密切相关。伤时有RD发生者促进PVR的发生。RD和PVR合并存在使后果更差。伤后30d以后实施手术者RD的发生率显著增加。单变量Logistic分析提示伤后无光感、视网膜闭合漏斗脱离、PVR形成、脉络膜上腔大出血4个变量是手术效果不良的危险因素。结论玻璃体手术时机和损伤程度直接影响眼外伤的治疗结果。
Objective To analyze and evaluate the effect of mechanical eyeball injury, especially open eye injury and vitreous surgery, and related risk factors. Methods 398 cases (409 eyes) of mechanical ocular trauma, 357 eyes of open ocular trauma and 52 eyes of closed ocular trauma were performed vitrectomy. The patients were followed up for at least 6 months. The cooperation unit will fill in all the patient information, enter the database for statistical analysis. Results The final visual acuity ≥0.025 260 eyes (63.57%). There were 28 eyes (70.66%) with anatomical repair, 34 eyes (8.31%) with anatomic repair, 86 eyes (21.03%) with low intraocular pressure, atrophic eyelid, silicone oil support and enucleation. Proliferative vitreoretinopathy (PVR), retinal detachment (RD), 14d after injury, the implementation of vitreous surgery, poor prognosis. Injury to surgery time is closely related to the incidence of PVR. Occurrence of RD when injury occurs to promote the occurrence of PVR. The combination of RD and PVR makes the consequences worse. The incidence of RD was significantly increased 30 days after injury. Univariate Logistic analysis showed that the four variables of non-light surgery, retinal closure funnel detachment, PVR formation and choroidal hemorrhage were the risk factors of poor operative outcome. Conclusion The timing and degree of vitreous surgery directly affect the outcome of ocular trauma.