机械性眼外伤玻璃体手术时机选择及眼外伤评分的应用

发布时间：2018-06-08 03:09

本文选题：机械性眼外伤 + 玻璃体切除手术　；参考：《昆明医科大学》2017年硕士论文

【摘要】：[目的]本研究通过分析玻璃体切除手术(Pars plana vitrectomy,PPV)时机的选择对机械性眼外伤患眼术后视力(Visual activity,VA)恢复的影响,探讨玻璃体切除手术治疗机械性眼外伤手术时机的选择,用以指导临床中机械性眼外伤的救治。同时根据眼外伤评分(ocular trauma score,OTS)标准,对眼外伤患眼进行国际标准化分级,对眼外伤的严重程度及预后提供客观准确的信息,评估OTS在后节机械性眼外伤手术中的临床应用价值,从而指导我们准确而快速的制定出更为合理的诊断和治疗方案。[方法]收集昆明医科大学第一附属医院眼科2015年6至2016年9月收住的机械性眼外伤且行玻璃体切除手术患者62例(62眼)的资料进行回顾性分析。按照机械性眼外伤后玻璃体切除手术时间不同分为1-6天(A组)20眼、7～14天(B组)25眼和14天以上(C组)17眼三组;并对每组入选患者进行眼外伤评分,A组OTS 1级4眼,2级12眼,3级4眼;B组OTS 1级5眼,2级12眼,3级8眼;C组OTS 1级4眼,2级7眼,3级6眼,三组间术前OTS无统计学差异(P0.05),三组患者术前情况大致相同,具有可比性。纳入病例均由同一医师实施手术,且排除眼内异物或因发生眼内炎需行急诊玻璃体切除手术的患者。术后随访六个月以上,对所有患者进行术前和术后视力恢复情况比较、三组间两两比较术后视力恢复情况、对不同组间OTS相同的患者比较术后视力恢复情况以及术后并非症的发生情况。从而对机械性眼外伤后玻璃体切除手术时机的选择进行综合分析及评价。同时,对伤眼进行OTS,根据OTS数据表推算出最终视力的概率,对比本组病例的终视力比率与OTS数据表的终视力概率,研究其愈后视力与OTS系统预测视力的关系。[结果]62例(62眼)伤眼中,伴视网膜脱离(Retinal detachment,RD)45眼,首次玻璃体切除术后视网膜成功复位39眼,其余6眼视网膜贴服欠佳,6眼均行二次玻璃体切除术,其中2眼行三次玻璃体切除术后视网膜仍贴伏欠佳形成硅油依赖眼。术中联合巩膜外加压术2眼,视网膜前膜剥除9眼,术中联合硅油填充31眼,气体填充13眼,视网膜激光光凝49眼。术后1周、1个月、3个月、6个月定期门诊复查,随访时间6～22个月,平均(11.54±3.4)个月。62例(62眼)中,5眼(8.06%)视力达到伤前视力水平,其余57眼(91.94%)视力均低于伤前视力。50眼(80.65%)经玻璃体切除术治疗后视力较术前视力明显提高。62例患眼术前术后视力差异有统计学意义(P0.05)。其中功能痊愈(视力提高2行或以上,或术前视力光感,术后视力提高至0.02以上)50眼(80.65%),解剖痊愈(屈光间质透明、视网膜解剖复位眼球重建成功,而视力未达上述标准,或婴幼儿视力检查不合作者)10眼(16.13%),未痊愈(术后视力未改善或更差,眼球萎缩或无法治疗的视网膜脱离)2眼(3.22%),无眼内炎和交感性眼炎的发生。其中A组,功能痊愈17眼(85%),解剖痊愈3眼(15%),没有未愈眼;B组,功能痊愈24眼(96%),解剖痊愈1眼(4%),没有未愈眼;C组,功能痊愈9眼(52.94%),解剖痊愈6眼(35.29%),未愈2眼(11.76%)。三组间术后视力差异有统计学意义(P0.05)。三组OTS为25～80分,平均(53.73±21.92)分,其中OTS 3级的18眼均功能痊愈;OTS 2级的31眼功能痊愈25眼,解剖痊愈6眼,无未愈眼;OTS1级的13眼功能痊愈7眼,解剖治愈4眼,未愈2眼。OTS1级的终视力在0.5及以上者为0眼,OTS3级的终视力为无光感(No light perception,NLP)者也为0眼。本研究计算出的终视力概率与由美国眼外伤协会提供的眼外伤评分表计算出的终视力的概率相比,没有明显差异(P0.05)。但是OTS 1-2级的患者,术后最终视力显著优于OTS预后。同时终视力与伤后的初视力呈明显的正相关(Pearson = 0.581,P =0.000),且OTS分值越高,术后视力恢复越好。[结论]1.大多机械性眼外伤患者经过玻璃体切除手术治疗,在很大程度上可以挽救患者的眼球并且恢复一定的视功能。2.机械性眼外伤后行玻璃体切除手术的最佳时间是伤后7-14天,其次是1-6天手术,外伤后大于14天后手术治疗效果较差。3.对机械性眼外伤患者进行OTS评分可以很好的为眼科医生对伤情初判及快速制定出治疗方案提供较好的帮助,并可以提供机械性眼外伤手术的预后参考。4.机械性眼外伤患者伤后6个月的终视力(最佳矫正视力)与患者的性别、年龄、受伤眼别无相关性,而与伤后的初视力呈明显的正相关;同时,OTS越高,术后视力恢复越好。
[Abstract]:[Objective] to explore the effect of vitrectomy (Pars plana vitrectomy, PPV) on the recovery of postoperative visual acuity (Visual activity, VA) after ocular trauma in mechanical eye, and to explore the choice of surgical opportunity for surgical treatment of mechanical ocular trauma in order to guide the treatment of mechanical ocular trauma. According to the standard of ocular trauma score (OTS), the international standardized classification of ocular trauma patients is carried out to provide objective and accurate information on the severity and prognosis of ocular trauma, and to evaluate the clinical value of OTS in the operation of mechanical ocular trauma in the posterior segment, thus guiding us to accurately and quickly develop a more reasonable diagnosis and treatment. Methods. [Methods] a retrospective analysis was made to collect data from 62 cases (62 eyes) of mechanical ocular trauma received from 6 to September 2016 2015 in the First Affiliated Hospital of Kunming Medical University and 62 cases (62 eyes) with vitrectomy. 1-6 days (group A) were divided into 20 eyes, 7~14 days (group B) 25 eyes and 1. 4 days or more (group C) 17 eyes three groups, and each group of selected patients with ocular trauma score, group A OTS 1 4 eyes, 2 class 12 eyes, 3 level 4 eyes, B group OTS 1 level 5 eye, 2 12 eyes, 3 grade eyes, C group OTS grade eyes, OTS level eyes, no statistical difference before surgery (P0.05), patients before operation are roughly the same, comparable. Included cases are the same A doctor who performed surgery, excluded intraocular foreign bodies or needed emergency vitrectomy for endophthalmitis. After six months of follow-up, the visual acuity was compared between the three groups before and after the operation. 22 of the three groups compared the visual acuity after the operation, and the postoperative visual acuity recovery was compared to the same OTS patients in different groups. A comprehensive analysis and evaluation of the choice of the timing of vitrectomy after mechanical ocular trauma. At the same time, the OTS was performed on the injured eye, the probability of the final vision was calculated according to the OTS data sheet, the final visual acuity ratio and the final visual acuity probability of the OTS data sheet were compared. The relationship between visual acuity and the prediction of visual acuity with the OTS system. [results]62 cases (62 eyes) (62 eyes) with retinal detachment (Retinal detachment, RD) 45 eyes, 39 eyes after first vitrectomy, 6 eyes with poor retina and two vitrectomy in 6 eyes, 2 eyes were still under the retina after three vitrectomy. Excellent formation of silicone oil dependent eyes. Intraoperative combined intraoperative scleral external pressure surgery 2 eyes, retinal detachment 9 eyes, intraoperative silicone oil filled 31 eyes, gas filled 13 eyes, retinal laser photocoagulation 49 eyes. 1 weeks, 1 months, 3 months, 6 months after operation, 6~22 months, average (11.54 + 3.4) months of.62 cases (62 eyes), the average visual acuity Visual acuity before injury, the other 57 eyes (91.94%) of visual acuity were lower than pre injury.50 eyes (80.65%), after vitrectomy, visual acuity was significantly higher than preoperative vision. There was significant difference in visual acuity before and after operation in.62 cases (P0.05). Functional recovery (visual acuity above 2 lines or above, or preoperative vision light sensation, and postoperative visual acuity to 0) .02 above) 50 eyes (80.65%), anatomic recovery (translucent interstitial transparency, retinal anatomic reduction and reconstruction of the eyeball, visual acuity without the above criteria, or the unmatched author of infant vision) in 10 eyes (16.13%), 2 eyes (3.22%) without recovery (postoperative vision improvement or worse, eye atrophy or untreatable retinal detachment), without endophthalmitis and sympathetic In group A, 17 eyes (85%), 3 eyes (15%), 3 eyes (15%), 24 eyes (96%), 1 eyes (4%) and no non healing eyes; group C, 9 eyes (52.94%), 6 eyes (35.29%), and no more 2 eyes (P0.05). OTS in group OTS was of statistical significance. Score, average (53.73 + 21.92), of which 18 eyes of OTS 3 were all healed; 31 eye function of grade 2 healed 25 eyes, dissection recovered 6 eyes, no non healing eye; 13 eye function of grade OTS1 healed 7 eyes, anatomically cured 4 eye,.OTS1 grade final vision of unchanged 2 eyes was 0 eyes, OTS3 class final vision was No light perception (NLP), too. For 0 eyes, the probability of final visual acuity calculated in this study was not significantly different from that calculated by the eye trauma score table provided by the American Eye Trauma Association (P0.05). However, the final visual acuity of the OTS 1-2 patients was significantly better than the OTS prognosis. The final vision was positively correlated with the initial vision after the injury (Pearson = 0.58). 1, P =0.000), and the higher the OTS score, the better the postoperative vision recovery. [conclusion]1. most mechanical ocular trauma patients are treated by vitrectomy. To a large extent, the best time to save the patient's eyeball and restore a certain visual function.2. mechanical ocular trauma is the best time for the vitreous resection 7-14 days after injury, followed by 1-6. Day surgery, more than 14 days after trauma, the effect of surgical treatment is worse than 14 days later, the OTS score for the patients with mechanical ocular trauma can be well provided by the ophthalmologist for the initial and rapid development of the treatment program, and the prognosis of mechanical ocular trauma surgery can be provided for the end of 6 months after the injury of the.4. mechanical ocular trauma patients. Visual acuity (best corrected visual acuity) has no correlation with the sex, age, and injury of the patient, but has a significant positive correlation with the initial visual acuity after injury. At the same time, the higher the OTS, the better the recovery of the visual acuity after the operation.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R779.1

【参考文献】