Objective: We analyzed the incidence of secondary glaucoma, the surgery rate, and the efficacy of intraocular (IOP)-lowering medication following blunt ocular trauma. We also correlated these factors with the ocular trauma score (OTS) system suggested by the International Society of Ocular Trauma and evaluated the applicability of the OTS in predicting the likelihood of secondary glaucoma onset and the optimal treatment of it. Methods: We conducted a retrospective review of 265 patients (267 eyes) with ocular contusion admitted to Xijing Hospital from January 2014 to December 2016. The initial visual acuity (VA), zone of injury, relative afferent papillary defect, and OTS were evaluated to analyze the clinical characteristics and the incidence of secondary glaucoma. Data were analyzed using chi-square tests, linear correlation analysis, t-tests, and analysis of variance. Results: Overall, the final VA was better than the initial VA ( χ2=65.99, P<0.001). The incidence of secondary glaucoma was 13.1％ (35 eyes), and higher OTSs were associated with lower occurrences ( χ2= 8.593, P=0.035). All glaucoma patients had eye injury in zones Ⅰ and Ⅱ, and 12 eyes were involved in zone Ⅲ. Glaucoma patients with worse OTSs had higher surgery rates (r=-0.980, P<0.001). All glaucoma patients with an OTS of 2 received surgery graded over level 3. At 6 months after injury, the IOP of glaucoma patients in each OTS group was significantly lower than at the initial visit (t=6.93, 8.21, 8.24, 6.36, P<0.01), but there were no significant differences in IOP between each group. The number of IOP lowering medications taken at 6 months after injury by patients with a score 2, 3, or 4 trauma was significantly reduced compared with the initial treatment (t=13.50, 4.75, 3.20, P<0.05). However, there was no statistical difference in the number of medications used between groups with score 3, 4, and 5 at the initial treatment or at 6 months. Conclusions: The OTS is of value in predicting secondary glaucoma after blunt trauma. Poorly scoring victims are more likely to develop secondary glaucoma and need surgical intervention. A larger data sample is needed to determine differences in the number of IOP lowering medication needed for patients with different scores.%目的:分析钝挫伤后外伤性青光眼的发生率、手术率和降眼压用药情况,评价眼外伤评分(OTS)对钝挫伤后外伤性青光眼的预测和治疗的价值.方法:回顾性系列病例研究.观察2014年1月至2016年12月西京医院收治的眼钝挫伤患者265例(267眼).对伤后初始视力、损伤分区和相对性瞳孔传入障碍(RAPD)等伤情给予评估并进行OTS评分.采用卡方检验、直线相关分析、t检验、方差分析进行数据分析.结果:钝挫伤患者最终视力较初始视力整体上有提高(χ2=65.99,P<0.001).外伤性青光眼发生率为13.1％(35眼),OTS评分越高,外伤性青光眼发生率越低(χ2=8.593,P=0.035);所有青光眼患者Ⅰ、Ⅱ区均有累及,12眼累及到Ⅲ区.OTS评分越低的青光眼患者手术率越高,两者间呈负相关(r=-0.980,P<0.001);评分2分的青光眼患者均接受了3级以上的手术治疗.在伤后6个月时,各OTS评分组青光眼患者眼压较首诊时均显著降低(t=6.93、8.21、8.24、6.36,P<0.01),但各组之间的眼压差异均无统计学意义.除OTS 5分评分组患者外,2、3和4分评分组的降眼压药物种类和首次治疗时比较均显著减少(t=13.50、4.75、3.20,P<0.05),但3、4和5分评分组间使用的药物种类差异并无统计学意义.结论:OTS对钝挫伤后外伤性青光眼有一定的预测价值.评分低的伤者出现外伤性青光眼和需手术治疗的可能性高.对于不同评分的患者使用的降眼压药物的数量差异,还需要更多的数据来评价.
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