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DISCUSSION
Ocular trauma is a considerable cause of visual impairment[7]. In our study, male patients predominated over female (male/female ratio was 2.8/1). Male predominance and also peak incidence of eye injuries (mostly with metal objects) in male population were reported in other studies[812]. It is probably the result of the nature of mens job and other activities. High prevalence of eye injuries in average age of 21.7 years old in our study is similar to some studies, for instance, the studies by Khatry et al[13] and Smith et al[14] with an average age of 28 and 29 years old respectively. It was supposed in our society because of crowd and activity of young population. High prevalence of penetrating trauma (61.4%) rather than blunt trauma (38.6%) in our study has been reported by the survey of Entezari et al[15] in a prospective study on 116 injured eyes during 20012004. Penetrating trauma caused by metal and sharp objects was the most common type of eye injuries in age group of＜10 years old in our study. In the study of Cariello et al[16], the most frequent cause for ocular injuries in children was external agents such as stone, iron and wood objects. This study shows that among children the mechanisms of injury are quite variable, and that inappropriate attention of parents can lead to visual loss threatening injuries in pediatric group.
Table1 Frequency and percentage of causes（略）
Table 2 Frequency and percentage of causes according to age of patients（略）
Table 3 Duration from the time of injury to the initial treatment（略）
Table 4 Frequency and percentage of final visual acuity according to type of trauma（略）
Table 5 Frequency and percentage of final result of surgery（略）
Most patients were admitted to hospital 624 hours after eye injury in our study, while there was also an interval of longer than 3 hours (mean time) from injury to hospital admission in the study of Karaman et al[17]. This is important because immediate and appropriate intervention with modern microsurgical techniques in visionthreatening emergencies can reduce longterm visual loss, and functional vision salvage rate could be 60%70%[18].
In our study all of patients required surgery and 24.2% of patients needed enucleation, which is similar to the result in the study of Smith et al[14] (28% enucleation) on 390 cases of penetrating eye injuries, whereas in a study in Greece just 42.5% of patients needed operation and only 1% required enucleation[19]. In the studies by Smith et al[20] and Kuhn
et al[21], the enucleation rates were reported to be 12% and 14.1% respectively, whereas in the study of Karaman et al[17] there was not any eyes enucleated. This difference indicates types of case selection. We chose severe traumatic eye injuries and also severe eye injuries were common in our society, which may be due to the poor control of industrial use of protective eyewear. Light perception (LP) to 20/200 in 24%, 20/200 or better in 38% of 384 patients with penetrating eye injuries, and poor visual outcome associated with poor initial visual acuity and delayed presentation have also been shown in the study of Smith et al[14].
In our study the initial vision was a predictor of the final visual outcome. In the study by De Juan et al[5], they found that an initial visual acuity＜0.025 remained the same or worsened in 72% of the patients, whereas an initial visual acuity＞0.025 remained unchanged or improved in 96% of the patients. Poor initial visual acuity as an associated factor with visual impairment (visual acuity less than 6/18) has been concluded in a study on prognostic factors of ocular injuries in South India[22].
In conclusion, according to our results of investigation, ocular trauma remains an important cause of preventable, mostly monocular, visual impairment and blindness. To decide on the prognostic factors in ocular trauma, initial visual acuity is the most important factor associated with final visual acuity in patients with ocular injury.
Acknowledgment We give our thanks to Dr Mohammad Hasan Lotfi from health college for his kindly help for statistical analysis in this paper.
【参考文献】
1 Wong TY, Klein BE, Klein R. The prevalence and 5year incidence of ocular trauma. The Beaver Dam Eye Study. Ophthalmology2000;107:21962202
2 Négrel AD, Thylefors B. The global impact of eye injuries. Ophthalmic Epidemiol1998;5:143169
3 Karlson TA, Klein BE. The incidence of acute hospitaltreated eye injuries. Arch Ophthalmol1986;104:14731476
4 Kuhn F, Morris R, Witherspoon CD, Heimann K, Jeffers JB, Treister G. A standardized classification of ocular trauma. Graefes Arch Clin Exp Ophthalmol1996;234:399403
5 De Juan E Jr, Sternberg P Jr, Michels RG. Penetrating ocular injuries. Types of injuries and visual results. Ophthalmology1983;90:13181322
6 Pieramici DJ, Sternberg P Jr, Aaberg TM Sr, Bridges WZ Jr, Capone A Jr, Cardillo JA, de Juan E Jr, Kuhn F, Meredith TA, Mieler WF, Olsen TW, Rubsamen P, Stout T. A system for classifying mechanical injuries of the eye (globe). The Ocular Trauma Classification Group. Am J Ophthalmol1997;123:820831
7 Macewen CJ. Eye injuries: a prospective survey of 5671 cases. Br J Ophthalmol1989;73:888894
8 Desai P, MacEwen CJ, Baines P, Minassian DC. Incidence of cases of ocular trauma admitted to hospital and incidence of blinding outcome. Br J Ophthalmol1996;80:592596
9 Framme C, Roider J. Epidemiology of open globe injuries [in German]. Klin Monatsbl Augenheilkd1999;215:287293
10 May DR, Kuhn FP, Morris RE, Witherspoon CD, Danis RP, Matthews GP, Mann L. The epidemiology of serious eye injuries from the United States Eye Injury Registry. Graefes Arch Clin Exp Ophthalmol 2000;238:153157 上一页 [1] [2] |
