近年の開放性眼外傷の患者背景と予後についての検討

Recent clinical features, treatment and outcome of open-globe injury

要約　目的：近年の開放性眼外傷における臨床背景や治療法，予後について報告する。

対象と方法：2012〜2018年に，東京医科大学病院眼科で診断・加療した開放性眼外傷63例64眼について，診療録をもとに後ろ向きに検討し，患者背景，創の分類，受傷機転，治療方法，視力予後について調査した。

結果：症例は男性37例，女性26例で，受傷時の年齢は2〜89歳（平均58歳）であった。鋭的外傷が21例，鈍的外傷が43例，受傷機転は転倒が過半数を占めていた。治療方法は角膜および強膜の創の縫合のみが35眼，創の縫合とともに行われた一期的硝子体手術が26眼，眼球摘出が2眼，角膜移植が1眼であった。初診時視力（logMAR）は，鈍的外傷群が2.62，鋭的外傷群が1.79であり，術後最高視力は鈍的外傷群が1.69，鋭的外傷群が0.22で，初診時視力および術後視力ともに有意に鈍的外傷群が不良であった。

結論：近年の開放性眼外傷の受傷機転は転倒が多くを占めていた。今後，高齢化社会がさらに進行することによって転倒をはじめとした開放性眼外傷の増加が懸念される。

Abstract　Purpose：To report the recent clinical features, treatment and outcome of patients with open-globe injury.

Methods：In this retrospective study, medical records were reviewed to identify the case series. Sixty-three patients（64 eyes）diagnosed with open-globe injury at Tokyo Medical University Hospital between 2012 and 2018 were studied. Type of wound（sharp or blunt）, causative event, treatment method, and visual outcome were analyzed.

Results：The 63 patients comprised 37 males and 26 females, with mean age of 58 years（range；2 to 89 years）at the time of injury. Twenty-one patients had sharp injury and 43 had blunt trauma. The causative event was fall in the majority of patients with blunt trauma. Open-globe injury was treated by corneal and scleral wound closure in 35 eyes, wound closure with primary vitrectomy in 26 eyes, enucleation in 2 eyes, and corneal transplantation in 1 eye. Visual acuity（logMAR）at presentation was 2.62 in the blunt trauma group and 1.79 in the sharp injury group. Postoperative best visual acuity was 1.69 in the blunt trauma group and 0.22 in the sharp injury group. Visual acuity at presentation and after surgery were both significantly worse in the blunt trauma group compared to the sharp injury group.

Conclusion：Falls were the major cause of open-globe injury resulting from blunt trauma. Along with aging of the population, an increase of open-globe injury due to falls and other accidents in elderly persons is a concern.