开放性眼外伤的预后因素分析

目的 探讨机械性眼外伤分类系统内各指标及系统外其他阂素对开放性眼外伤(OGI)预后视力的影响.方法 连续入选2005年2月至2007年2月住院的OGI患者68例,对眼外伤的类型(根据损伤机制)、程度(根据受伤后最初视力)、范围(根据外伤位置)、相对性瞳孔传入障碍(RAPD),及其他可能影响预后的伤口长度(<10mm与≥10mm)、视网膜脱离(retinal detachment,RD)、化脓性眼内炎及就诊延迟时间进行单因素及多因素逐步Logistic回归分析,以观察对预后视力的影响.结果 病例随访至少6个月.预后好(视力≥0.1)31例占45.59%,预后差(视力＜0.1)37例,占54.41%.单因素分析显示:眼外伤程度(P=0.000)、受伤范围(P=0.005)、RAPD(P=0.024)、伤口长度(P=0.001)、RD(P=0.002)、就诊延迟时间(P=0.025)是影响预后视力的危险因素.而在多因素逐步logistic回归分析之后显示:眼外伤程度(P=0.002,OR=6.040.95%CI=1.884～19.362)及RAPD(P=0.046,OR=4.871,95%CI=1.102～23.683)是影响预后视力的独立危险因素.结论 在OGI中外伤程度及RAPD是影响预后视力的主要因素.应用机械性眼外伤分类系统标准对眼外伤进行分类有助于对预后的判断.

Analysis of Prognostic Factors in Open GLO be Injury

Objective To evaluate prognostic factors for visual outcome in open globe injury involving the variables of a system for classifying mechanical injuries of the eye and the additional variables.Methods Medical records of 68 consecutive patients with open globe injury were retrospectively reviewed. Specific variables of a system for classifying mechanical injuries of the eye were analyzed: the types of injury (defined by the mechanism of injury), grade of injury (defined by initial visual acuity), zone of injury (defined by the location of the wound), and relative afferent pupillary defect. Additional variables, such as wound length, retinal detachment, endophthalmitis, and elapsed time between the injury and presentation were also included in the analysis.Final visual outcome were recorded.Data were analyzed for predictors with univariate analysis and multivariate logistic regression analysis.Results After a follow up of 6 months, 31 eyes (45.59% ) achieved visual acuity 0.1 or better, 37 eyes (54.41%) achieved visual acuity worse than 0.1.According to univariate analysis results, the following parameters were predictors of visual outcome: grade of injury (P=0.000), zone of injury (P=0.005), afferent pupillary response (P<0.024), wound length (P=0.001), and retinal detachment (P=0.002), time delay of visiting(P= 0.025).However, multivariate logistic regression analyses revealed that grade of injury (P=0.002; odds ratio, 6.040; 95% confidence interval, 1.884-19.362) and relative afferent pupillary defect (P=0.046; odds ratio, 4.871; 95% confidence interval, 1.102-23.683) was the only significant factors for visual outcome.Conclusions Grade of injury and relative afferent pupillary defect are significant prognostic factors for visual outcome in open globe injury .The classification system becomes useful prognostic tool for visual outcome in open globe injury.