CAJ | 학술논문

目的初步观察和探讨眼球钝挫伤的常见原因、临床表现、治疗经过和效果.方法对39例(53只眼)的眼球钝挫伤患者的病因、病情、治疗经过及结果进行详细记录,随访时间3～15个月,平均7个月.根据损伤的病程、部位和严重程度,结合眼底荧光m管造影(fundus fluorescence angiography,FFA)、超声生物显微镜(ultrasound biomieroscope,UBM)、眼B超、光学相干断层扫描(optical coherence tomography,OCT)、视诱发电位(visual evoked potential,VEP)等辅助检查,对其进行药物或手术治疗并观察疗效,分析眼球钝挫伤的主要原因和视力预后及其主要影响因素.结果拳击伤是引起眼球钝挫伤的最主要原因,其次分别为物体撞击伤、车祸外伤及爆炸伤.16只眼(30.19%)损伤仪累及眼前节,表现为角膜擦伤、水肿,前房积血,虹膜睫状体炎,外伤性扩瞳,虮膜根部断离,房角后退,睫状体脱离,晶状体混浊伴(或不伴)晶状体不全或全脱位;26只眼(49.57%)损伤仅累及眼后节,表现为玻璃体积血,视网膜震荡、裂孔及脱离,脉络膜破裂,视神经水肿、萎缩;其余11只眼(20.75%)前、后节均受累.伤后初诊时最佳矫正视力(best corrected visual acuity,BCVA)0.1者占32.08%;经药物或手术治疗,末次随访时51只眼(96.23%)视力较前有所提高,13只眼(24.52%)BCVA 0.5.伤后24h内就诊的患者中,41.18%末次随访时BCVA0.5.结论通过及时和有效的治疗,大部分眼钝挫伤患者的视功能可有所提高.视力预后与损伤部位、严重程度和伤后就诊时间有关,钝挫伤臻眼后节并发症者视力预后相对较差.
목적 초보관찰화탐토안구둔좌상적상견원인、림상표현、치료경과화효과.방법 대39례(53지안)적안구둔좌상환자적병인、병정、치료경과급결과진행상세기록,수방시간3～15개월,평균7개월.근거손상적병정、부위화엄중정도,결합안저형광m관조영(fundus fluorescence angiography,FFA)、초성생물현미경(ultrasound biomieroscope,UBM)、안B초、광학상간단층소묘(optical coherence tomography,OCT)、시유발전위(visual evoked potential,VEP)등보조검사,대기진행약물혹수술치료병관찰료효,분석안구둔좌상적주요원인화시력예후급기주요영향인소.결과 권격상시인기안구둔좌상적최주요원인,기차분별위물체당격상、차화외상급폭작상.16지안(30.19%)손상의루급안전절,표현위각막찰상、수종,전방적혈,홍막첩상체염,외상성확동,기막근부단리,방각후퇴,첩상체탈리,정상체혼탁반(혹불반)정상체불전혹전탈위;26지안(49.57%)손상부루급안후절,표현위파리체적혈,시망막진탕、렬공급탈리,맥락막파렬,시신경수종、위축;기여11지안(20.75%)전、후절균수루.상후초진시최가교정시력(best corrected visual acuity,BCVA)0.1자점32.08%;경약물혹수술치료,말차수방시51지안(96.23%)시력교전유소제고,13지안(24.52%)BCVA 0.5.상후24h내취진적환자중,41.18%말차수방시BCVA0.5.결론 통과급시화유효적치료,대부분안둔좌상환자적시공능가유소제고.시력예후여손상부위、엄중정도화상후취진시간유관,둔좌상진안후절병발증자시력예후상대교차.
Objective To report the common reasons and the clinical signs of ocular contusion,and to evaluate the therapeutic effectiveness.Methods Fifty-three contused eyes of 39 cases were studied and followed-up for 3 to 12 months(averaged 7 months)on reasons,clinical signs,therapeutic methods and prognosis.Patients were treated by drugs or surgery according to the position and severity of the trauma and combined with the outcome of examinations such as fundus fluorescence angiography(FFA),ultrasound biomicroscope (UBM),B scan ultrasonography,optical coherence tomograpby(OCT),visual evoked potential(VEP),etc.The therapeutic effectiveness was evaluated and the prognosis as well as the correlative factors were analyzed.Results Trauma by the fist was the most common reason for ocular contusion which was followed by impacting with objects,waffle accident and blast.Sixteen eyes were damaged only in anterior segment with signs of acute corneal abrasion and edema,hyphema,iridochoroiditis,traumatic mydriasis,angle recession,iridodialysis,choroidal detachment,cataract with or without subluxation and dislocation.The posterior segment was involved in 26 eyes which represented vitreous hemorrhage,commotion retina,retinal hole and detachment,choroidal rupture,optic disc edema and atrophy.The other 11 eyes were injured in both anterior and posterior segment.Before treatment,best corrected visual acuity(BCVA)of 17 eyes was less than 0.1,accounting to 32.08%.However,the visual acuity of 51 eyes(96.23%)improved and 13 eyes(24.52%)acquired BCVA of 0.5 or better after treatment by drug and surgery.41.18% patients who acquired effective treatment within 24 hours alter contusion got a BCVA of better than 0.5 at the last follow-up.Conclusions By effective and timely treatment,visual acuity can improve in most contused eyes.The prognosis is related to the position and severity of the trauma as well as the treating time.Visual acuity prognosis is usually poor when the posterior segment complications happen aider contusion.