作者：徐哲 ,殷鸿波 ,刘 谊 作者单位：(作者单位：1610041中国四川省成都市，成都爱尔眼科医院;2610041中国四川省成都市，四川大学华西医院眼科)
【摘要】 目的：探讨联合手术治疗外伤性白内障的疗效。方法：角巩膜裂伤清创缝合、白内障摘除、人工晶状体植入、玻璃体切除联合手术治疗外伤性白内障73例(73眼)。结果：患者73例中，眼球钝挫伤27例，穿通伤46例，术后 3mo矫正视力 < 0.05者5例 (7%) , 0.05～0.3者17例 (23%) , >0.3者49例 ( 67%)，手术脱盲率为 93%，2例(3%)眼球萎缩,平均随访时间7.8(3～15)mo。结论：掌握好联合手术的适应证，合理设计手术方式，巧妙地处理并发症，可以最大限度恢复患者的最佳视力。
【关键词】 眼外伤;白内障;联合手术·Original article·
Open globe injuries in the child population in hyderabad
Sameen Afzal Junejo, Arshad Ali Lodhi, Mahtab Alam Khanzada
Liaquat University Eye Hospital Liaquat University of Medical and Health Sciences/Jamshoro Hyderabad, Sindh,Pakistan
Abstract
AIM: To evaluate the causes, frequency, severity of eye injury, management, visual outcome and prevention in children with penetrating ocular injury.
METHODS: The study was conducted on patients under 15 years presenting with penetrating ocular injuries. Anterior segment slit lamp examination was performed for cornea and corneoscleral penetration, hyphema, iris prolapse, etc. Posterior segment slit lamp examination wih 90D funduscopes was done in selected cases. After performing necessary investigations, urgent surgical intervention was carried out.
RESULTS: Out of 43 (55%) registered patients; boys were 67%, and girls 33%. The agents of trauma were glass, pencil, stick, etc. The site of entrance through cornea was 62.7%, sclera 25.6%, and limbus 11.7%. The presenting visual acuity was 6/60 and above in 32.5% children, 6/24 in 9.3%, and 6/12 and above in 2.3% cases. 37.2% cases had perception of light. Out of 36 operated eyes, twentynine completed post operative follow up. 10.4% subjects had final visual acuity (FVA) of 3/60. 24.2% had FVA of 6/60. 17.2% children had FVA of 6/24 partial. In 34.4% subjects, the FVA was restricted to perception of light. 10.4% developed phthisis bulbi.
CONCLUSION: Ocular trauma is a significant cause of visual loss in child population. Preventive efforts are extremely important in domestic and outdoor activities.
KEYWORDS: ocular injuries; children; visual outcome; blindness
INTRODUCTION
Ocular trauma is one of the main causes of severe visual impairment in young adults and children leading to blindness[1]. The penetrating eye injury is indeed an important preventable global public health problem with a remarkable socioeconomic impact[2]. The children due to limited common sense and poor motor skills frequently suffer from penetrating eye injuries[3]. According to WHO declaration, out of 55 million ocular injuries occurring each year worldwide, about 1.6 million patients developed total loss of vision[4]. A survey from United States reported that approximately 2 million eye injuries per year. Out of which more than 40 thousands subjects developed permanent blindness[5]. In an recent study from 1992 through 2002, there was a remarkable decline in the global incidence of ocular trauma that ranged from 8.2 to 13.0 per 1000 population[6]. In Queensland rural setting, the rate of eye injury was 11.8 per 100000 populations[7]. The extent of eye injury is related to the involvement of ocular tissue. Proper evaluation and prompt treatment can prevent visual loss[8]. In spite of timely approach and a good surgical intervention, the cosmetic disparity and the chances of developing amblyopia has an impact on social status of a child who has still to move along[9].
PATIENTS AND METHODS
Patients This is a retrospective clinical study conducted on the patients having serious eye injury requiring hospitalization, over a thirty months period, from January 2005 to June 2007 at Liaquat University Eye Hospital Hyderabad.
The patients of both sexes under 15 with open eye injury presenting for the first time during the study period were selected. All the subjects with blunt injury, previous ocular trauma coming for follow up, and above fifteen years were excluded.
Methods The initial examination was performed in the outpatient emergency section by two permanently posted senior ophthalmologists and four medical officers. After getting informed consent, the subjects were interviewed and assessed for: General History: (1) Age, sex, residency, eye affected, exact time, extent, location of trauma and financial status. (2) Use of corrective lenses to rule out spectacle injury.(3) Diplopia to rule out blow out orbit fracture, lens dislocation and cranial nerve palsy. Physical examination: (1) The initial visual acuity (IVA) was documented for injured and normal eye, using Snellens chart and Echart for illiterate children. (2) Slit lamp anterior segment examination if possible was performed in cooperative patients to localize the site of injury and to rule out associated injuries. Posterior segment slit lamp examination with 90 D funduscope was done in selected cases. (3) Pupils were examined for size, shape and light reflex. (4) The intraocular pressure was checked by applanation tonometer in selected cases to confirm hypotony in ocular penetration.
After admission routine investigations like complete blood count, bleeding and clotting time, XRay chest etc were done.
A three view plain xray orbit was performed: waters view for orbital floor and detection of airfluid levels in the maxillary sinuses; Caldwell or antero posterior view for medial and lateral orbital wall, superior orbital rims, ethmoidal and frontal sinuses; Lateral view for the orbital roof, maxillary and frontal sinuses, zygoma, and sella turcica.
CT scanning was done in selected cases to visualize anatomy of the globe and orbit and to detect any intraocular metallic foreign body. MRI was performed to localize a nonmetallic foreign body, etc. A and B scan ultrasonography was done in subjects with opaque media obstructing the posterior segment examination.
Type of management: After admission the injured eye was covered with plastic shield for protection. The emergency medications such as analgesics (paracetamol), antiemetics (promethazine etc) were given. Prophylactic antibiotic eye drops such as ofloxacin, chloramphenicol eye drops were administered half hourly to avoid secondary infections and endophthalmitis.
Tetanus antitoxin injection was given at the dose of 700 to 1500 international units depending on the age of a child. The patient was kept on empty stomach for six hours before surgical intervention.
The surgical repair for anterior segment was done within first 24 hours by either of two senior ophthalmic surgeons. Secondary repair was done in selected cases. All those penetrations which extended to posterior segment were referred to vitreoretinal surgeon.
All patients were requested to complete the postoperative follow up criteria of this study. The final visual acuity (FVA) was documented on the sixth week postoperative followup.
RESULTS
A total of seventy eight (78) subjects with ocular trauma presented within the study period. Out of which forty three (55%)children suffering penetrating eye injury were selected. Boys were twenty nine(67%), and girls fourteen(33%). Nine(21.0%) patients were under 5, twenty three(53.4%) between 6 to 10 years, eleven (25.5%) subjects were between 11 to 15 years. Twenty six (60.4%) children lived in rural area, and seventeen(39.6%) were of urban residency. Nine(21.0%) subjects were using corrective spectacles. Two (4.6%) patients presented with diplopia after injury. Four (9.3%) subjects belonged to upper class living standard, eleven (25.5%) to middle class and twenty eight (65.1%) had lower socioeconomic status. All of the patients had unilateral eye injury(Figure 1,2). The most commonly affected age group was between 6 to 10 years (23 cases).
Five patients of 6 to 10 years of age, and three of 11 to 15 years were injured by pencil, six subjects of 610 yrs and four of 1115 yrs were injured by stick. Glass injury was observed in three patients of 610 years. Two patients under 5 years and one under 10 years were injured by house scissors. Two children under 5 years and two under 10 years injured by knife. Two subjects under 15 years were injured by screw driver. Four children under 15 years were hit by stone. Two patients under 5 years, two under 10 and one under 15 years had the history of fall. The cause of eye injury in four patients
Figure 1Right eye corneoscleral perforation
Figure 2Left eye corneal limbal perforation with iris prolapse
[1] [2] 下一页 |
