The Choice Of Vitreous Surgery Timing In Mechanical Ocular Injuries And The Application Of Ocular Trauma Score

Objective:This study analyzes the timing of vitrectomy on mechanical trauma with eye effect of postoperative visual acuity to explore mechanical trauma surgery timing of vitrectomy,mechanical trauma in guiding clinical treatment.At the same time,according to the ocular trauma scoring criteria for an international standardized classification.It provides objective and accurate information for the severity and prediction of ocular trauma,and it evaluates OTS in the section of the clinical application value of mechanical trauma surgery,so as to guide us to develop a more reasonable diagnosis and treatment quickly and accurately.Methods:Collecting department ophthalmology of the first affiliated hospital of kunming medical university admitted mechanical ocular trauma patients with vitrectomy,62 cases(62 eyes)of data were retrospectively analyzed in June 2015 to September 2016.According to the mechanical ocular trauma after vitrectomy operation time,the datas are divided into 1-6 days(group A)20 eyes,7～14 days(group B)25 eyes and more than 14 days(group C)17 eyes three groups,And for selected patients with ocular trauma score in each group,A group of OTS grade1,4 eyes,2 levels of 12 eyes,level 3,4 eyes;Group B OTS 1 level 5,2 levels of 12 eyes,level 3,8 eyes;OTS group C grade 1,4 eyes,level 2,7eyes,grade 3,6eyes,There is no statistical difference between the three groups.(P>0.05),so three groups of patients with preoperative situation is roughly same,comparable.All cases were made by the same same physician surgery,exclusion of intraocular foreign bodies or endophthalmitis underwent emergency patients of vitrectomy with Postoperative follow-up of 6 months above,it compares preoperative and postoperative visual acuity in all patients,and makes the comparison between two groups of postoperative recovery of vision,the different groups of patients with same OTS are compared with postoperative visual acuity and operative complications after vitrectomy,in order to comprehensively analyze and evaluate the timing of vitrectomy after mechanical ocular trauma.At the same time,In ocular trauma patients with OTS,according to the final vision of OTS tables calculated probability,The paper contrasts ratio of incidence of vision and the final vision probability of OTS data table,to study the prognosis of visual acuity and the OTS system to predict the relationship between vision.Results:There are 62 cases(62 eyes)with eyes,and 45 eyes with retinal detachment,the result comes with retinal success in 39 eyes after vitrectomy for the first time,the remaining six eyes retina stick take poor,and 6 eyes were performed vitrectomy,among them 2 cases accepting three times vitrectomy,but they still did not remove silicone oil dependence,formed by the eye retina.Intraoperative joint scleral bucking 2 eyes,epiretinal membrane stripping 9 eyes,intraoperative joint silicone oil filled 31 eyes,C3F8 gas filling 13 eyes,retinal laser photocoagulation in 49 eyes.After operation,with 1 week,1 month,3 months,and 6 months regular outpatient care,followed up for 6～22 months,an average(11.54±3.4)months.In 62 cases(62 eyes),5 eyes(8.06%)vision reached to pre-injury level,the rest of the 57(91.94%),visual acuity is less than before the injury to the eye vision.50 eyes(80.65%)by vitrectomy visual acuity vision improved obviously after treatment.62 cases of preoperative and postoperative visual acuity comparative difference was statistically significant(P<0.05).The function recovery(Vision to improve 2 or more,or Preoperative visual acuity is light,visual acuity increased to more than 0.02)of 50 eyes(80.65%),anatomical recovered(Refractive stroma transparent anatomical repositioning,retina eyeball successful reconstruction,but vision did not meet the above criteria,or visual acuity is the author of an infant)10 cases(16.13%),not recovered(Postoperative vision did not improve or even worse,eyeball atrophy or unable to treat retinal detachment)2 eyes(3.22%).No endophthalmitis and sympathetic ophthalmia occurred.The group A,the function recovered 17 eyes(85%),the anatomy of the recovered 3 eyes(15%),no eye not cured;Group B,the function recovery of 24 eyes(9.6%),the anatomy of the recovered 1 eye(4%),no eye not cured;Group C,the function recovery 9 eyes(52.94%),the anatomy of the recovered 6 eyes(35.29%),2 eyes(11.76%)were not.Postoperative visual acuity’s differences between three groups was statistically significant(P<0.05).Three groups of OTS is 25-80,the average(53.73±21.92)points,including 18 eyes of OTS level 3 function recovery;OTS 2 levels of 31 eyes function recovered 25 eyes,anatomy of 6 eyes cured,no eye not cured;OTS grade 1 of 13 eyes function recovered 7 eyes,anatomical cure 4 eyes,2 eyes not cured.Level OTS1 eye eyesight in 0.5 and above 0 case,OTS3 level vision for NLP is also 0 case.This study calculates the ultimate vision of probability provided by the American association of ocular trauma and ocular trauma,compared to compute the probability of the final vision that there were no significant differences(P>0.05).But OTS 1-2 level of patients are significantly superior to the OTS prediction after the final vision.But final visual acuity of the patients whose OTS is 1-2 level significantly superior to the OTS prognosis after vitrectomy.Meanwhile,final vision and wound after early vision is obviously positive correlation,Pearson = 0.581,P = 0.000,the higher the score of OTS,the better of postoperative visual acuity.Conclusions:.1.Most mechanical trauma patients after treatment of vitrectomy,to a great extent,can save the patient’s eyeball and restore visual function.2.After mechanical trauma,the best vitrectomy surgery time is 7 to 14 days after injury,1-6 days followed by surgery,trauma after more than 14 days after the surgical treatment effect is poorer.3.OTS ratings on mechanical trauma patients,can be very good to the eye doctor for initial injury and quick to develop a treatment plan to provide good help,also can provide mechanical trauma surgery prediction for reference.4.To mechanical trauma patients,6 months after injury of final vision(Best corrected visual acuity)with the patient’s gender,age,injured eyes,there is no correlation,but after the injury early vision is obviously positive correlation.At the same time,the higher the OTS,postoperative visual acuity,the better.