Objective To evaluate the clinical efficacy and influencial factors of vitrectomy for open-globe injuries in different timing.Methods Prospective cohort study.The clinical effect and complication of the vitrectomy performed by the same surgeon for open-globe injury in different timing (2-4 d or 10-14 d) from April 2011 to January 2013 were compared.Emergent intraocular surgeries such as intraocular foreign body and traumatic endophthalmitis were excluded.Result A total of 33 patients (33 eyes) were included in the study with 15 cases in the early group (2-4 d) and 18 cases in routine group (l0-14 d).The rate of retinal re-attachment showed that 11 of 13 eyes that had retinal detachment were re-attached in the early group.One of 13 eyes had retinal re-attachment after the second surgery and 1 eye failed to re-attach.Five of 15 eyes with retinal detachment had retina re-attached in the routine group.Four of 15 eyes had retina re-attached after second surgery and 6 eyes failed to re-attach.There was a statistical significance between the two groups (U =46.500,Z =-2.638,P =0.008).The eye-globe saving rate had no statistical significance (x2 =3.48,P =0.095).Fourteen eyes had been saved and 1 eye failed to have vitrectomy in the early group.Twelve eyes had been saved and 6 eyes failed to have vitrectomy in the routine group.The incidence of traumatic proliferative vetreo-retinopathy(TPVR) had statistical significance between the two groups (x2 =12.34,P =0.001).One eye occurred TPVR in the early group and 12 eyes occurred TPVR in the routine group.The visual acuity recovery showed that patients in the early group had better vision recovery than patients in the routine group (U =61.500,Z =-2.858,P=0.004).Complications like intraoperative bleeding and postoperative infection had no significant difference between the two groups.Conclusion Cases performing vetrectomy earlier had relatively good prognosis.%目的 探讨开放性眼外伤不同时机行二期玻璃体手术的临床效果.方法 病例对照研究.对2011年4月至2013年1月第=军医大学西南医院眼科收治的伤及眼后节的开放性眼外伤患者,排除眼内异物及外伤性眼内炎等需急诊玻璃体手术者,共33例,按随机数字表法分为2组:早期组(15例),于伤后早期(2 ～4d)行玻璃体手术;常规组(18例),于伤后常规时间(10 ～ 14 d)行玻璃体于术,两组手术由同一术者完成.采用确切概率法检验及秩和检验比较其临床效果及并发症等发生率情况.结果 视网膜复位率:早期组13只眼视网膜脱离患者中1 1只眼经一次玻璃体手术成功复位视网膜,1只眼经二次手术复位成功,1只眼手术失败;常规组15只眼视网膜脱离患者中5只眼经一次手术复位视网膜,4只眼经二次或多次手术后复位,6只眼手术失败,组间有统计学差异(U=46.500,Z=-2.638,P=0.008);眼球保存率:早期组14只眼获得救治,1只眼因损伤重、眼内结构紊乱而手术失败、常规组12只眼获得救治,6只眼因眼内增生、角膜血染影响术野等导致手术失败,组间差异无统计学意义(x2=3.48,P=0.095).外伤性增殖性玻璃体视网膜病变(TPVR)发生率:早期组1只眼发生TPVR,常规组12只眼发生不同程度的TPVR,组间差异有统计学意义(x2=12.34,P =0.001).视力恢复:早期组15只眼中8只眼视力明显提高,另外6只眼有一定提高,1只眼手术失败;常规组18只眼中2只眼视力明显提高,9只眼有一定提高,另外7只眼无提高或手术失败(U =61.500,Z=-2.858;P =0.004).并发症:早期组和常规组发生术中出血及术后感染等并发症无明显差异.结论 伤后早期行玻璃体手术治疗的病例,预后相对较好.
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