本文選題：機(jī)械性眼外傷 + 玻璃體切除手術(shù)�。� 參考：《昆明醫(yī)科大學(xué)》2017年碩士論文

【摘要】：[目的]本研究通過分析玻璃體切除手術(shù)(Pars plana vitrectomy,PPV)時(shí)機(jī)的選擇對(duì)機(jī)械性眼外傷患眼術(shù)后視力(Visual activity,VA)恢復(fù)的影響,探討玻璃體切除手術(shù)治療機(jī)械性眼外傷手術(shù)時(shí)機(jī)的選擇,用以指導(dǎo)臨床中機(jī)械性眼外傷的救治。同時(shí)根據(jù)眼外傷評(píng)分(ocular trauma score,OTS)標(biāo)準(zhǔn),對(duì)眼外傷患眼進(jìn)行國際標(biāo)準(zhǔn)化分級(jí),對(duì)眼外傷的嚴(yán)重程度及預(yù)后提供客觀準(zhǔn)確的信息,評(píng)估OTS在后節(jié)機(jī)械性眼外傷手術(shù)中的臨床應(yīng)用價(jià)值,從而指導(dǎo)我們準(zhǔn)確而快速的制定出更為合理的診斷和治療方案。[方法]收集昆明醫(yī)科大學(xué)第一附屬醫(yī)院眼科2015年6至2016年9月收住的機(jī)械性眼外傷且行玻璃體切除手術(shù)患者62例(62眼)的資料進(jìn)行回顧性分析。按照機(jī)械性眼外傷后玻璃體切除手術(shù)時(shí)間不同分為1-6天(A組)20眼、7～14天(B組)25眼和14天以上(C組)17眼三組;并對(duì)每組入選患者進(jìn)行眼外傷評(píng)分,A組OTS 1級(jí)4眼,2級(jí)12眼,3級(jí)4眼;B組OTS 1級(jí)5眼,2級(jí)12眼,3級(jí)8眼;C組OTS 1級(jí)4眼,2級(jí)7眼,3級(jí)6眼,三組間術(shù)前OTS無統(tǒng)計(jì)學(xué)差異(P0.05),三組患者術(shù)前情況大致相同,具有可比性。納入病例均由同一醫(yī)師實(shí)施手術(shù),且排除眼內(nèi)異物或因發(fā)生眼內(nèi)炎需行急診玻璃體切除手術(shù)的患者。術(shù)后隨訪六個(gè)月以上,對(duì)所有患者進(jìn)行術(shù)前和術(shù)后視力恢復(fù)情況比較、三組間兩兩比較術(shù)后視力恢復(fù)情況、對(duì)不同組間OTS相同的患者比較術(shù)后視力恢復(fù)情況以及術(shù)后并非癥的發(fā)生情況。從而對(duì)機(jī)械性眼外傷后玻璃體切除手術(shù)時(shí)機(jī)的選擇進(jìn)行綜合分析及評(píng)價(jià)。同時(shí),對(duì)傷眼進(jìn)行OTS,根據(jù)OTS數(shù)據(jù)表推算出最終視力的概率,對(duì)比本組病例的終視力比率與OTS數(shù)據(jù)表的終視力概率,研究其愈后視力與OTS系統(tǒng)預(yù)測(cè)視力的關(guān)系。[結(jié)果]62例(62眼)傷眼中,伴視網(wǎng)膜脫離(Retinal detachment,RD)45眼,首次玻璃體切除術(shù)后視網(wǎng)膜成功復(fù)位39眼,其余6眼視網(wǎng)膜貼服欠佳,6眼均行二次玻璃體切除術(shù),其中2眼行三次玻璃體切除術(shù)后視網(wǎng)膜仍貼伏欠佳形成硅油依賴眼。術(shù)中聯(lián)合鞏膜外加壓術(shù)2眼,視網(wǎng)膜前膜剝除9眼,術(shù)中聯(lián)合硅油填充31眼,氣體填充13眼,視網(wǎng)膜激光光凝49眼。術(shù)后1周、1個(gè)月、3個(gè)月、6個(gè)月定期門診復(fù)查,隨訪時(shí)間6～22個(gè)月,平均(11.54±3.4)個(gè)月。62例(62眼)中,5眼(8.06%)視力達(dá)到傷前視力水平,其余57眼(91.94%)視力均低于傷前視力。50眼(80.65%)經(jīng)玻璃體切除術(shù)治療后視力較術(shù)前視力明顯提高。62例患眼術(shù)前術(shù)后視力差異有統(tǒng)計(jì)學(xué)意義(P0.05)。其中功能痊愈(視力提高2行或以上,或術(shù)前視力光感,術(shù)后視力提高至0.02以上)50眼(80.65%),解剖痊愈(屈光間質(zhì)透明、視網(wǎng)膜解剖復(fù)位眼球重建成功,而視力未達(dá)上述標(biāo)準(zhǔn),或嬰幼兒視力檢查不合作者)10眼(16.13%),未痊愈(術(shù)后視力未改善或更差,眼球萎縮或無法治療的視網(wǎng)膜脫離)2眼(3.22%),無眼內(nèi)炎和交感性眼炎的發(fā)生。其中A組,功能痊愈17眼(85%),解剖痊愈3眼(15%),沒有未愈眼;B組,功能痊愈24眼(96%),解剖痊愈1眼(4%),沒有未愈眼;C組,功能痊愈9眼(52.94%),解剖痊愈6眼(35.29%),未愈2眼(11.76%)。三組間術(shù)后視力差異有統(tǒng)計(jì)學(xué)意義(P0.05)。三組OTS為25～80分,平均(53.73±21.92)分,其中OTS 3級(jí)的18眼均功能痊愈;OTS 2級(jí)的31眼功能痊愈25眼,解剖痊愈6眼,無未愈眼;OTS1級(jí)的13眼功能痊愈7眼,解剖治愈4眼,未愈2眼。OTS1級(jí)的終視力在0.5及以上者為0眼,OTS3級(jí)的終視力為無光感(No light perception,NLP)者也為0眼。本研究計(jì)算出的終視力概率與由美國眼外傷協(xié)會(huì)提供的眼外傷評(píng)分表計(jì)算出的終視力的概率相比,沒有明顯差異(P0.05)。但是OTS 1-2級(jí)的患者,術(shù)后最終視力顯著優(yōu)于OTS預(yù)后。同時(shí)終視力與傷后的初視力呈明顯的正相關(guān)(Pearson = 0.581,P =0.000),且OTS分值越高,術(shù)后視力恢復(fù)越好。[結(jié)論]1.大多機(jī)械性眼外傷患者經(jīng)過玻璃體切除手術(shù)治療,在很大程度上可以挽救患者的眼球并且恢復(fù)一定的視功能。2.機(jī)械性眼外傷后行玻璃體切除手術(shù)的最佳時(shí)間是傷后7-14天,其次是1-6天手術(shù),外傷后大于14天后手術(shù)治療效果較差。3.對(duì)機(jī)械性眼外傷患者進(jìn)行OTS評(píng)分可以很好的為眼科醫(yī)生對(duì)傷情初判及快速制定出治療方案提供較好的幫助,并可以提供機(jī)械性眼外傷手術(shù)的預(yù)后參考。4.機(jī)械性眼外傷患者傷后6個(gè)月的終視力(最佳矯正視力)與患者的性別、年齡、受傷眼別無相關(guān)性,而與傷后的初視力呈明顯的正相關(guān);同時(shí),OTS越高,術(shù)后視力恢復(fù)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.
【學(xué)位授予單位】：昆明醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R779.1

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