早期玻璃体视网膜手术治疗严重开放性眼外伤的疗效观察

发布时间：2018-10-24 14:43

【摘要】：眼外伤是重要的公共健康问题,对个人以及社会造成不良的后果[1]。开放性眼外伤是一种全层眼球壁连续性遭到破坏的一种类型的眼外伤,其损伤具有多样性、个体差异性、预后较差、治疗棘手[2]等特点。针对不同的外伤类型,治疗的手段、方法不尽相同,根据国际眼外伤学会的分类、分区标准,我们将主要的研究内容放在严重开放性眼外伤手术时机的探讨上。目的:本研究通过对两类眼外伤病人的随访观察,探讨手术时间对其安全性及预后的影响。方法:本文分为两个部分:第一部分主要纳入的是排除球内异物和眼内炎的严重开放性眼外伤病人,通过对急诊48h内介入玻璃体手术和7~28天手术的疗效观察,评估急诊48h内行玻璃体手术的可行性及安全性。第二部分主要通过对伴有球内异物的眼外伤病人的不同手术时机的观察,评估在该类病人中两种不同的玻璃体手术时间的预后差异,以期为该类病人在临床手术时间的选择上提供依据。结果:第一部分:(1)目前纳入的研究病例显示:急诊48h内玻璃体手术与伤后7~28d手术在术前损伤差异、术后一次性视网膜复位、TPVR、眼球保存率、视力、眼压控制等情况的比较差异无统计学意义。(2)由于目前纳入的病例数较少,因此对于严重开放性眼外伤病人,早期48h内介入玻璃体手术对病人的安全性尚待进一步研究。第二部分:(1)球内异物病人中延迟玻璃体手术会增加其并发眼内炎的风险,24h内行PPV与24~48h行PPV比较,后者的眼内炎发生率明显高于前者。(2)尽早行玻璃体手术是治疗球内异物的开放性眼外伤安全、有效的手段。结论:对于伴有球内异物的开放性眼外伤病人,为了防止其眼内炎的发生,应尽可能的早期进行玻璃体手术。而不伴有球内异物或眼内炎的严重开放性眼外伤,因目前纳入的病例数少,故急诊48小时内行PPV的安全性尚待进一步研究。
[Abstract]:Eye trauma is an important public health problem, with adverse consequences for individuals and society. Open ocular trauma is a kind of ocular trauma which is damaged by the continuity of the whole eyeball wall. Its injury has the characteristics of diversity, individual difference, poor prognosis, difficult treatment and so on. According to the classification and zoning standard of the International Academy of Ocular Trauma, we put the main research contents on the discussion of the operative opportunity of severe open ocular trauma. Objective: to investigate the effect of operation time on the safety and prognosis of two kinds of ocular trauma patients. Methods: this article was divided into two parts: the first part mainly included the patients with severe open ocular trauma who excluded intraocular foreign bodies and endophthalmitis. The curative effect of interventional vitreous surgery and 728 days operation were observed. To evaluate the feasibility and safety of emergency vitrectomy within 48 hours. The second part is to evaluate the prognosis of two kinds of vitreous surgery in patients with ocular trauma with intraocular foreign bodies. In order to provide the basis for the choice of clinical operation time for this kind of patients. Results: the first part: (1) the results of the present study showed that the difference between vitreous surgery and operation 728 days after injury, retinal reattachment after operation, TPVR, eyeball preservation rate, visual acuity. There was no significant difference in intraocular pressure control. (2) because of the small number of cases, the safety of vitreous intervention in patients with severe open ocular trauma remains to be further studied within 48 hours. Part two: (1) delayed vitreous surgery increased the risk of endophthalmitis in patients with intraocular foreign body. The risk of intraocular inflammation was increased by PPV within 24 hours and PPV at 24 and 48 hours, respectively. The incidence of endophthalmitis in the latter was significantly higher than that in the former. (2) early vitrectomy is a safe and effective method for the treatment of open ocular trauma of intraocular foreign bodies. Conclusion: vitreous surgery should be performed as early as possible to prevent endophthalmitis in patients with open ocular trauma with intraocular foreign bodies. However, the safety of PPV in emergency department within 48 hours remains to be further studied for the severe open ocular trauma without intraocular foreign body or endophthalmitis.
【学位授予单位】：第三军医大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R779.6

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