眼内异物视力预后影响因素的临床分析

摘要

OBJECTIVE To determine the risk factors in eyes with intraocular foreign bodies (IOFBs) and endophthalmitis, and study the clinical prognostic factors for visual outcome. METHODS A retrospective study of 80 consecutive cases(83 eyes)with IOFBs during the period of January 2008 to January 2010 was conducted. We compared the differences between IOFBs with or without endophthalmitis including traumatic factors and treatment methods and analyzed the size of IOFBs, location in eyeball ,with or without endophthalmitis, retinal damages and cataract to affect the final visual outcomes. RESULTS Of the 83 eyes with IOFBs, 36 eyes(43.37% )had evidence of infectious endophthalmitis. Delayed removal time (13.27±45.42) d of IOFB following trauma in IOFB with endophthalmitis group may increase the risk of endophthalmitis development(t=15.429 ,P=0.011) than that in IOFB without endophthalmitis group (6.25±8.18) d. There were no significant differences (P>0.05) between two groups of the IOFB location, size, metal or not. The final visual outcomes in patients with endophthalmitis, retinal detachment or hole, traumatic cataract and size of IOFBs were significantly lower than the patients without those complications (P< 0.05). CONCLUSIONS Delayed removal of IOFB following trauma may result in a significant increase in the development of clinical endophthalmitis. The clinical prognostic factors for poor visual outcome include size of IOFBs, endophthalmitis, retinal detachment or hole and cataract.%目的 探讨影响眼内异物视力预后的临床因素以及发生感染性眼内炎的危险因素.方法 对外伤性眼内异物(intraocular foreign bodies,IOFB)患者80例(83只眼)的临床资料进行回顾性分析,比较伴或不伴眼内炎者在外伤、治疗等方面的差异；分析异物大小、位置以及是否合并眼内炎、视网膜损害或白内障等对治疗后视力的影响.结果 1.IOFB眼内炎危险因素:合并眼内炎者36例36只眼,发病率为43.37％.伴或不伴眼内炎者外伤后至手术的间隔时间分别为(13.27±45.42)d和(6.25±8.18)d,差异有统计学意义(t=15.429,P=0.017);两类患者在异物性质、大小、位置等方面,差异无统计学意义(P＞0.05).2.IOFB视力预后影响因素:合并眼内炎、视网膜裂孔、视网膜脱离、外伤性白内障,或眼内大异物者的术后视力分别低于无眼内炎、无视网膜裂孔或脱离、无外伤性白内障以及眼内小异物者,差异均有统计学意义(P＜0.05).结论 眼内异物延迟取出是导致感染性眼内炎发生的主要因素；眼内大异物、合并眼内炎、视网膜裂孔或脱离、白内障等与视力预后差有明显相关性.