【作者】 刘晓丹；

【导师】 李秋明；

【作者基本信息】 郑州大学 ， 眼科学， 2013， 硕士

【摘要】 目的分析机械性眼外伤行玻璃体切除手术后影响视力预后的主要因素,并探讨在伤后改善视力预后的措施。方法观察郑州大学第一附属医院眼科本治疗组自2011年7月至2012年10月收入院的初次行玻璃体切除手术的机械性眼外伤患者162例(163眼),记录患者的年龄、性别、受伤眼别、受伤原因、外伤类型、损伤部位、伤口大小、外伤阶段、入院视力、伤眼合并症(晶状体损伤、玻璃体积血、视网膜脱离、眼内炎、术前PVR、脉络膜脱离、眼内异物、视神经损伤)、受伤-初就诊时间、首次玻璃体切除手术时间、术后并发症、出院视力、院外随诊超过3个月的患者的矫正视力,并于住院期间完善相关眼部检查,经治疗视力未恢复至伤前视力的患者纳入分析。参与分析的影响因素与末次随访最佳矫正视力进行单因素Logistic回归分析,针对有统计学意义的因素,再应用多因素Logistic回归分析筛选影响视力预后的独立危险因素。分析各影响因素,并针对影响因素进行干预,以期最大限度的提高视力。结果162例163只伤眼中,5例5眼经治疗后视力达到伤前视力,余均低于伤前视力,占96.93%。158眼中0.4以上(含0.4)视力占65眼,占41.14%,0.2～0.4的视力29眼,占18.36%,0.1～0.19视力的34眼,占21.52%,0.05～0.09视力的8眼,占5.06%,0.05以下的22眼,占13.92%。年龄、性别、外伤阶段、术前PVR、外伤性白内障、脉络膜脱离、受伤部位与视力预后无关(P>0.05)。多因素Logistic回归分析结果显示外伤类型、伤口大小、受伤-初就诊时间、首次玻璃体手术时间、视网膜脱离、眼内炎、玻璃体积血、视神经损伤、术后并发症是玻璃体手术后视力预后的独立影响因素(P值均小于0.05)。结论机械性眼外伤视力预后与多种因素相关,外伤类型、伤口大小、受伤-就诊时间、首次玻璃体切除手术时间、视网膜脱离、眼内炎、玻璃体积血、视神经损伤、术后并发症是伤眼术后视力不良预后的独立危险因素。伤后早诊断早治疗,术后定期复查,及时处理眼底并发症,以减少视网膜再脱离,预防视力再损伤。更多还原

【Abstract】 ObjectivesThis study aims at exploring the prognostict factors which influence the visual outcome after vitrectomy about mechanical eye injury, and discussing the measures how to improve the visual outcome.MethodsTo observe162patients (163eyes) who received vitrectomy firstly because of mechanical eye injury, they all hospitalized in our treatment group of Ophthalmology in The First Affiliated Hospital of Zhengzhou University since July,2011to October,2012.Record their age, sexuality, reasons, types, injured position, size of the wound, stage of eye trauma, vision after injury, complications after injury, the time from injure to therapy, the time from injure to vitrectomy, complications in surgery and after surgery, and corrected visual acuity for at least3months, and with relative examination. Compared with the best corrected visual acuity before the injury, some patients were loss part of vision. Using Binary Logistic regression, to analyse the relation between the visual prognosis and influencing factors, and find out the relatively independent hazards. Put forward the best therapy time and remedy, in order to improve the best corrected visual acuity. ResultsIn this population, there are5patients(5eyes) arrived the best corrected visual acuity(1.0),and the others were all loss part of vision, accounting for96.03%. In this eyes, there are65eyes with corrected visual acuity of0.4or more, accounting for41.14%, there are29eyes with corrected visual acuity between0.2-0.4, accounting for18.36%,34eyes with corrected visual acuity between0.1～0.19, accounting for21.52%,8eyes with corrected visual acuity between0.05-0.09, accounting for5.06%,22eyes under0.05, accounting for13.92%.There is no relationship between visual prognosis and some reasons, like age, stage of eye trauma, PVR before surgery, traumatic cataract and choroidal detachment(P>0.05). The result was showed by Binary Logistic regression:size of the wound, types, the time from injure to therapy, the time from injure to vitrectomy, complications after surgery, amotio retinae, endophthalmitis, vitreous hemorrhage, optic nerve injury are the relatively independent hazards(P<0.05).ConclusionsThe patients with mechanical eye injury loss part of their vision. It is related with several factors:size of the wound, types, the time from injure to therapy, the time from injure to vitrectomy, complications after surgery, amotio retinae, endophthalmitis, vitreous hemorrhage, optic nerve injury. After injury, have a earlier diagnosis and treatment, avoid the complications in surgery, periodic inspection after surgery, process the complications timely, prevent vision damage again.更多还原