摘要
目的 探讨栗刺所致眼外伤的临床特点和治疗方法.方法 回顾分析栗刺所致眼外伤256例（256眼）.位置各异、深浅不一、数目不等的角膜、结膜、巩膜异物伤及穿孔伤为其基本特点,部分病例合并有角膜感染、前房积血、晶状体破裂、继发性青光眼、玻璃体积血、睫状体脱离、全葡萄膜炎和感染性眼内炎等.在明确诊断后,分步骤在裂隙灯显微镜或手术显微镜摘出栗刺异物,并对相关并发症采用药物治疗或手术治疗.结果 256例中,单纯异物伤198例在异物剔除后给予抗炎营养角膜等对症治疗,视力恢复到术前视力,或视力下降在两行以内;25例角膜细菌感染预后较好,3例真菌感染预后较差;9例前房积血和7例玻璃体积血经药物治疗恢复良好;13例晶状体刺伤、破裂中5例晶状体浑浊不明显,仍在随访观察,其余8例中有5例继发青光眼,分别于受伤后6d～3个月行超声乳化＋人工晶状体植入术,术后眼压控制,视力恢复至0.4 ～1.0;2例睫状体脱离的原因均为栗刺经巩膜刺伤睫状冠部或平坦部引发的出血性脱离,药物治疗2个月后恢复.1例全葡萄膜炎药物治疗后视力由眼前指数恢复到1.0.2例感染性眼内炎视力恢复较差,分别为眼前手动和0.04.结论 栗刺相关性眼外伤为陕西商洛地区常见的眼外伤,推测其年发病率超过1/10000.多发于中年男性,男女比例约9∶1.主要表现为角膜异物伤,严重病例还合并角膜感染、前房积血、晶状体刺伤破裂、继发性青光眼甚至眼内炎等.在受伤后及时就诊,积极进行药物联合手术治疗,对改善预后至关重要.加强防护意识,作业时戴草帽或防护眼镜为有效的预防措施.
Objective To discuss the clinical features and treatment methods of chestnut thorn related ocular trauma.Methods 256 cases of chestnut thorn related ocular trauma were analyzed retrospectively.The trauma featured with corneal,conjunctival and scleral penetrating injury.Some cases complicated with corneal infection,hyphema,lens rupture,secondary glaucoma,vitreous hemorrhage,ciliary body detachment,pan-uveitis or endophthalmitis.All chestnut thorn was removed under slit lamp or operating microscope.The complications were treated by drugs or surgeries.Resnlts 198 cases of simple foreign body injuries restored the preoperative vision or the decreased vision was in less than two lines.25 cases of bacterial corneal infections had the favourable prognosis and three cases of fungal infections got the poor prognosis.Nine cases of hyphema and seven cases of vitreous hemorrhage recovered well after drug treatment.In the 13 cases of broken lens,five cases were in the follow-up observation with slightly lens turbidity.In the remaining eight cases,there were 5 cases with secondary glaucoma,2 cases cyclodialysis and 1 case panuveitis,all had a good result after treatment.Only two cases of infectious endophthalmitis had the poor result.Conclusion Chestnut thorn related ocular trauma was the common ocular trauma type in Shangluo,Sharnxi.The annual incidence rate was about 1/ 10000.Middle-aged men were the common injured population,and the male to female ratio was about 9∶ 1.The main manifestation was corneal foreign body injury and severe cases with corneal infeetion,hyphema,lens stabbed rupture,secondary glaucoma and endophthalmitis.Drug combined with surgery was the most effective treatment.Timely and active treatment were important for good prognosis.Strengthening protection awareness,wearing straw hat or safety glasses were the effective preventive measures.
出处
《中华眼外伤职业眼病杂志》
2014年第7期507-510,共4页
Chinese Journal of Ocular Trauma and Occupational Eye Disease
关键词
眼外伤
板栗刺
角膜异物
并发症
流行病学
预防
Trauma,ocular
Thorns,chestnut
Foreign body,corneal
Epidemiology
Prevention
