| Background:Eye trauma is one of the main causes of blindness in China.Severe ocular trauma is complicated,involving many tissues,often leading to serious consequences,especially open globe trauma.Open globe trauma is a type of ocular trauma in which the integrity of the whole layer of the eye wall is destroyed.The damage is characterized by complex and diverse,individual differences,treatment difficulties,and poor prognosis.Severe open globe trauma not only has a large wound area,but also a wide range of eyeballs,and often combined with intraocular foreign bodies,can cause complex damage of multiple intraocular tissues such as cornea,iris,crystal,vitreous,choroid and retina;The integrity of the eye wall is destroyed and the foreign body remains in the eye.Pathogens such as bacteria and fungi can enter the eye or carry foreign objects into the eye to cause infectious endophthalmitis.If not handled properly,it will cause a devastating blow to the injured eye.In the past,the high blindness rate of severe ocular trauma,partial injury or even the removal of the eyeball,and the rapid development of modern minimally invasive vitrectomy has brought hope to many severe eye injuries that were originally considered to be incurable.Studies have shown that open ocular trauma combined with retinal detachment is an important factor affecting the diagnosis and treatment,but what are the characteristics of open ocular trauma with retinal detachment,and the prognosis of traumatic eyes after minimally invasive vitrectomy in different sections,related aspects There are few reports on the study;in addition,the timing of the second-stage vitreous surgery for open ocular trauma with retinal detachment remains controversial.Based on the classification and zoning criteria of the International Society for the Prevention of Ocular Injury,this study investigated the clinical features of different segments of open ocular trauma with open retinal detachment and the effect of minimally invasive vitreous surgery at different timings.Objections:To study the clinical data of patients with open ocular trauma combined retinal detachment,summarize its epidemiological characteristics of different zones and evaluate the difference of curative effect of minimally invasive vitrectomy under different phase,and provide experience and reference for clinical diagnosis and treatment.Methods:A retrospective study was performed on patients with open ocular trauma combined retinal detachment who were hospitalized from January 1,2014 to June 30,2018.(1)Case grouping:According to the characteristics of open ocular trauma,there are three groups:group A:wound is located in zone ?;group B:wound is located in zone ?;group C:wound is located in zone ?.According to the timing of the first vitrectomy,two groups were included:early surgery group:vitreous surgery within 6 days after injury;routine surgery group:vitreous surgery was performed 7-14 days after injury.(2)Observation index:study and analyze the clinical data of the three groups of patients,including age,gender,occupation,injury,injury,initial visit time,eye,best corrected visual acuity,blindness of single eye,type of trauma,front of the eye Conditions(including open wounds,cornea,iris,ciliary body,lens condition),posterior segment of the eye(including vitreous,retina,choroid),time of first vitrectomy,best corrected visual acuity at last visit,and follow-up.(3)Surgical procedure:All patients underwent one-stage emergency debridement and suture,except for 3 cases of second-stage enucleation,3 cases of second-stage surgery,and 45 cases of elective minimally invasive vitrectomy.)3 months(average 11.9 months).(4)Statistical processing:SPSS 21.0 statistical software was used for data analysis.For the categorical variables,the Pearson chi-square test,the continuous calibration chi-square test and the Fisher exact probability test method were used.For the grade data,according to the grouping situation,The rank sum test of the independent samples was statistically significant at P<0.05.Results:(1)In this group,51 patients(51 eyes)with open globe trauma combined retinal detachment were enrolled.Male:female = 6.29:1,with an average age of 33.49+110.16 years.Group A was mostly splattered(42.86%),and group B and group C were most common with sharp injuries,accounting for 55.56%and 41.67%of the group.(2)14 cases(26.92%)were located in the I area,9 cases(17.31%)in the II area,and 24 cases(53.85%)in the III area.The most common type of trauma was ocular rupture in 18 cases(35.29%).There were significant differences in the types of injury between the three groups(P<0.05).The damage types in group A and group B were mainly intraocular foreign bodies,accounting for 57.14%and 55.56%,respectively.The most common eyeball rupture in group C was(57.14%).The most common injury complication was vitreous hemorrhage in 49 cases(96.08%).The incidence of corneal laceration and crystal damage was significantly different among the three groups(p<0.05).Group A corneal laceration,crystal damage,infectious eye The incidence of endophthalmitis was higher than that of group B and group C.(3)After treatment,the preservation rate of the eyeball was 84.31%.There was no significant difference in the preservation rate of the eyeball between the three groups(P>0.05)..After invasive vitrectomy,all intraocular foreign bodies were removed at one time.The retinal reattachment rate was 95.56%.The difference of retinal reattachment was between the three groups.was not statistically significant(P>0.05).(4)There was a significant difference in visual acuity between the three groups after vitrectomy(P<0.05).Group B was better than group A than group C.(5)The difference of visual acuity between the early group and the conventional group was statistically significant(P<0.05).The early operation group was superior to the conventional operation group.There was significant difference in the incidence of TPVR between the two g:roups(P<0.05).The incidence of TPVR was higher in the conventional group than in the early group.Conclusion:This study found that open globe trauma combined with retinal detachment:(1)There are more patients in Zone ? than in Zone ? than in Zone ?.(2)The type of injury in zone ? and zone ? is mainly intraocular foreign bodies,and zone ? is mainly eyeball rupture..(3)Vision prognosis zone ? is better than zone I is better than zone ?.(4)Early vitreous surgery(? 6 days)has a relatively good prognosis. |
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