关键词: 开放性眼外伤, 增生性玻璃体视网膜病变, 曲安奈德, 玻璃体切除术

Abstract:  Objective  To evaluate the efficacy of intravitreal triamcinolone acetonide (TA) injection during primary repair surgery for severe open globe injury in preventing proliferative vitreoretinopathy (PVR). Design Retrospective case series. Participants Thirteen patients (13 eyes) with zone III open eye trauma who underwent primary surgical repair with immediate intravitreal TA injection followed by secondary PPV at Beijing Tongren Hospital between January 2023 and December 2023. The cohort included 10 males and 3 females, with ages ranging from 32 to 68 years (mean, 46.5±12.3 years). Methods PVR grading was documented during PPV. The patients were followed up for 3 to 24 months (mean, 12.1±7.0 months). Best-corrected visual acuity (BCVA), intraocular pressure (IOP), and axial length (AL) were compared between baseline and the final follow-up visit. Data on retinal reattachment, choroidal detachment resolution, and silicone oil removal were also recorded. Main Outcome Measures PVR grade, the condition of retinal reattachment and choroidal detachment recovery. Results PVR grading revealed 4 eyes (30.8%) at grade 0, 0 eye (0%) at grade I, 2 eyes (15.4%) at grade II, 4 eyes (30.8%) at grade III, and 3 eyes (23.1%) at grade IV. At the final follow-up, the mean BCVA was (1.25±0.90) LogMAR, which was significantly improved compared with the baseline value of (2.51±0.28) LogMAR (t=5.689, P<0.001). The mean IOP at final follow-up was (11.4±3.9) mmHg, showing a significant increase from the baseline value of (8.4±3.4) mmHg (t=-5.555， P<0.001). The mean AL at final follow-up was (23.28±1.72) mm, with no statistically significant difference from the baseline value of (23.20±1.56) mm (t=-0.883， P=0.454). Among the 9 eyes with preoperative retinal detachment, 8  eyes achieved complete retinal reattachment while 1 remained detached at the final follow-up. Of the 8 eyes with preoperative choroidal detachment, 6 showed complete resolution at the final follow-up. Silicone oil had been removed in 3 out of the 9 eyes that received silicone oil tamponade by the final follow-up visit. No TA-related adverse reactions were observed. Conclusions For severe open globe injury, intravitreal injection of TA during primary repair surgery can inhibit or alleviate PVR.

Key words:  Open globe injury, Proliferative vitreoretinopathy, Triamcinolone acetonide, Vitrectomy