陨灶贼允韵责澡贼澡葬造皂燥造熏灾燥造援 5熏晕燥援 6熏 Dec.18, 圆园12 www.IJO.cn 栽藻造押8629原愿圆圆源缘员苑圆 8629-83085628 耘皂葬蚤造押ijopress岳员远猿援糟燥皂 窑Monograph窑 ClinicalstudyonHypotonyfollowingbluntocular trauma

DepartmentofOphthalmology, theSecondXiangya INTRODUCTION HospitalofCentralSouthUniversityandInstitutionof ypotonyfollowingbluntoculartraumaisasevere OphthalmicCenter,Changsha410011,HunanProvince, H complicationwhoseexactpathogenesisisnotclear. China Ocular hypotension canbeassociatedwithseveral Correspondenceto: JunZeng.DepartmentofOphthalmo- complications suchasmacularedema,discedema, logy,theSecondXiangyaHospitalof CentralSouth hypotonymaculopathy,cornealedema,shallowanterior UniversityandInstitutionofOphthalmicCenter,139# chamber,choroidaleffusionorhemorrhage,exudative RenminMiddleRoad,Changsha410011,HunanProvince, retinaldetachment,orcataractformation,ultimatelyleading [email protected] tophthisisbulbi [1-3].Anyofthesecomplicationscanbe Received:2012-04-15 Accepted:2012-11-01 associatedwithvisualsymptomsorareductioninvisual acuity.Thereisrelativelylessdataontheriskfactorsfor Abstract hypotonyafterbluntoculartrauma.Sothisarticlebriefly · AIM:Toevaluatetheincidenceandriskfactorsof discussestheriskfactorsofhypotonyfollowingbluntocular hypotonyinpatientswithbluntoculartrauma. trauma. MATERIALSANDMETHODS ·METHODS:Themedicalrecordsof145patientswithblunt StudyDesign Thiswasaretrospectivestudyofpatients oculartraumawerereviewed.Hypotonywasdefinedasan seenintheophthalmologydepartmentattheSecond averageintraocularpressure(IOP)of5mmHgorlessfor threetimes. XiangyaHospital'semergencyserviceovertwoandahalf yearsperiod(January2006toJuly2008).Allpatients,who ·RESULTS:Amongthese145patients,hypotonywasnoted had suffered bluntoculartraumawithoutpenetrating in 10(6.9%)patients.Therateofhypotonyinpatientswith laceration,wereincludedinthestudy.Thenatureofinjury ciliochoroidaldetachmentwas66.7%(2outof3eyes),and includedboxingin45,carcrashin32,ballorstonedamage 5.6%(8outof142eyes)inpatientswithoutciliochoroidal in25,ironstickinjuryin21,firecrackerinjuriesin19,toy detachment，thedifferencewasstatisticallysignificant （ = 0.003）.Therateofhypotonyinpatientswithtraumatic gunshotinjuryin3patients.Datawasobtainedby retinaldetachmentwas18.5%(5outof27eyes),and4.2% reviewingthecasesheets.Patients'demography(age,sex), (5outof118eyes)inpatientswithouttraumaticretinal eyefindingsat clinicalpresentation(visualacuity, detachment,thedifferencewasstatisticallysignificant(= intraocularpressurewithapplanationtonometry,ocular 0.026).Therateofhypotonyinthepatientswithanterior injuryasfoundonexaminationbyslitlampbiomicroscopy, proliferativevitreoretinopathywas42.9%(3outof7eyes) UBM, B-scanandfundusexaminationwerenoted. and5.1%(7outof138eyes)inthepatientswithoutanterior Hypotonywasdefinedasanaverageintraocularpressure proliferativevitreoretinopathy,thedifferencewasstatistically (IOP)of5mmHgorlessforthreetimes [4].Thestudywas significant（ =0.002）. approvedbytheEthicsCommitteeoftheSecondXiangya · CONCLUSION:Ocularhypotensionisacomplicationof Hospital. bluntoculartrauma.Theriskfactorsincludeciliochoroidal StatisticalAnalysis Thestatisticalanalysiswasconducted detachment,traumaticretinaldetachment,andanterior usingSPSS12.0 (StatisticalPackageforSocialScience, proliferativevitreoretinopathy. Chicago,IL).Alltestsweretwo-tailed,and valuesofless ·KEYWORDS:hypotony;blunttrauma;anteriorproliferative than0.05wereconsideredtobesignificant.The 2 testwas 字 vitreoretinopathy;ciliochoroidaldetachment;traumaticretinal utilizedfortheanalysisofparameters. detachment RESULTS DOI:10.3980/j.issn.2222-3959.2012.06.21 Atotalof10outofthe145patients(6.9%)presentedwitha diagnosisofhypotonyduringthestudyperiodinthe DingC,ZengJ.ClinicalstudyonHypotonyfollowingbluntocular ophthalmologydepartment.Themeanagewas(19.54 6.1) 依 trauma. 2012;5(6):771-773 years(range,6-78years).Totally123(84.8%)patientswere 771 Hypotonyfollowingbluntoculartrauma

Table 1 The visual acuity of the eyes with blunt injury Table 2 Eye findings in 145 eyes of blunt injury Visual acuity Eyes (n) Percentage (%) Eye finding Eyes (n) Percentage(%) Macular hole 2 1.4 No light perception 3 2.1 Choroidal rupture 2 1.4 Light perception 20 13.8 Cilio-choroidal detachment 3 2.1 Hand motion 35 24.1 Optic nerve contusion 3 2.1 Finger counting 26 17.9 Anterior proliferative retinopathy (aPVR) 7 4.8 0.02-0.04 16 11.0 Traumatic mydriasis 13 9.0 Angle recession 43 29.7 0.05- 0.09 11 7.6 Iridodialysis 20 13.8 0.1-0.2 11 7.6 Corneal contusion 19 13.1 0.3-0.5 13 9.0 Traumatic retinal detachment 27 18.6 0.6- 1.0 7 4.8 Lens dislocation 42 29.0 Hyphema 67 46.2 Uncooperative 3 2.1 Vitreous hemorrhage 53 36.6 Total 145 Commotio retinae 78 53.8

Table 3 Risk factors in eyes with hypotony following blunt ocular trauma Eye finding Eyes (n) Hypotony Percentage(%) P Ciliochoroidal detachment 3 2 66.7 Without ciliochoroidal detachment 142 8 5.6 0.003 Iridodialysis 20 3 15 Without iridodialysis 125 7 5.6 0.287 Traumatic retinal detachment 27 5 18.5 Without traumatic retinal detachment 118 5 4.2 0.026 Anterior proliferative retinopathy (aPVR) 7 3 42.9 Without aPVR 138 7 5.1 0.002 Lens dislocation 42 6 14.3 Without lens dislocatiom 103 4 3.9 0.06 maleand22(15.2%)females.Allthe145patientswas definedasthelowpressure(whetheracute,transient, bluntinjuryunilateral(onlyoneeyeinvolved)(Table1). chronicorpermanent)which,inanindividualeye,leadsto Amongthepatientswithbluntoculartrauma:2(1.4%)eyes functionalchanges(whetherasymptomaticorsymptomatic) withmacularhole,2(1.4%)eyeswithchoroidalrupture,3 andstructuralchanges(whetherreversibleorirreversible)[5]. (2.1%)eyeswithciliochoroidaldetachment,3(2.1%)eyes Inthisstudy,weselectedcasesofthepatientswith withopticnervecontusion,7 (4.8%)eyeswithanterior intraocularpressureatorbelow5mmHgafterbluntocular proliferativeretinopathy(aPVR),13(9.0%)eyeswithtraumatic trauma. mydriasis,43(29.7%)eyeswithanglerecession,20(13.8%) Atpresent,theexactmechanismofhypotonyafterblunt eyeswithiridodialysis,19(13.1%)eyeshadacornealcontusion, traumaisnotclear,whichoccurswhenaqueoushumour 27(18.6%)eyeswithtraumaticretinaldetachment,and productiondoesnotkeeppacewithoutflowdecreased 42(29.0%)eyeswithlensdislocation,67(46.2%)eyeswith aqueoushumourproductionand/orenhancedaqueous hyphema,53 (36.6%)eyeswithvitreoushemorrhage,78 humourleakage [6,7].Ocularhypotonyafterbluntinjurycan (53.8%)eyeswithcommotionretinae(Table2). betransientorpersistent.Thetransienthypotony:external Asignificantassociationwasfoundbetweenciliochoroidal forcescanresultdirectlyinintraocularneurovascular detachment(=0.003),traumaticretinaldetachment(= dysfunction,ciliaryepithelialedema,circulatory 0.026),anteriorproliferativeretinopathy(=0.002)and disturbance,whichleadtoloweraqueousproduction.The hypotony;whileiridodialysis( =0.287)andlensdislocation persistinghypotony:thespecificmechanismofthe ( =0.06)werenotsignificantlyassociatedwithhypotony persistinghypotonyafterbluntoculartraumaisnotclear.In (Table3). presentstudy,wefoundthemainconsiderationsasthe DISCUSSION followingsituations:ciliochoroidaldetachmentcausedby Itisgenerallybelievedthatwhentheintraocularpressureis bluntoculartraumafrequentlyresultedinhypotony.Ciliary lowerthan10mmHg,itisdefinedhypotony.However, bodyinjuryand/ordetachmentresultedinthedeclined clinicalobservationshowedthatthemajoritypatientswith aqueoushumorsecretion.Cyclodialysisestablishedadirect intraocularpressureatorbelow5mmHgcanleadto outletpathwayfortheaqueoushumortothesupra-choroidal structuralandfunctionalchangesintheeye [4] .Mosteyes space,whichdeterminedapersistentocularhypotony [8]. willbesymptomaticatorbelow5mmHg.Hypotonycanbe Choroidalfluidwasbelievedtoaccumulateasaresultof

772 陨灶贼允韵责澡贼澡葬造皂燥造熏灾燥造援 5熏晕燥援 6熏 Dec.18, 圆园12 www.IJO.cn 栽藻造押8629原愿圆圆源缘员苑圆 8629-83085628 耘皂葬蚤造押ijopress岳员远猿援糟燥皂 enhanceduveoscleral outflowanddecreasedaqueous andthereforeweshouldattachadequateimportancetoit. humourproduction,acyclethatwasoftenperpetuatedonce Accordingtothedifferentreasonsforhypotonyafterblunt choroidaleffusiondevelops.Aringofanteriorchoroidal oculartrauma,weshouldtakeeffectivemeasurestosave fluidcanrotatetheciliarybodyforward,impairingits thepatients'visualacuity. abilitytoproduceaqueoushumour [9].Ourstudyindicated REFERENCES thattraumaticretinaldetachmentwasalsoafactorresulting 1AminlariA,CallahanCE.Medical,laser,andsurgicalmanagementof inocularhypotonyfollowingbluntinjury.Wecanconsider inadvertentcyclodialysiscleftwithhypotony. 2004;122 theretinaldetachmentcausedhypotonybythefollowing (3):399-404 2RazeghinejadMR,DehghaniC.Effectofocularhypotonysecondaryto points:1)traumaticretinaldetachmentoftenincorporate cyclodialysiscleftoncornealtopography. 2008;27(5):609-611 withciliarybodyinjury,whichresultsinthereductionin 3KimHC,HayashiA,ShalashA,deJuanEJr.Amodelofchronic aqueoussecretion; 2) aqueousdrainingintothe hypotonyintherabbit. 1998;236(1): suprachoroidalspace.Themajorityofaqueoushumorflow 69-74 throughthevitreous,retinaltearstothesubretinalspace, 4PedersonJE.Ocularhypotony. 1986;105 andthenthroughtheretinalpigmentepithelialcellswhich (Pt2):220-226 canpumpchoroidalliquid,thenewdrainagechannel 5SchubertHD.Postsurgicalhypotony院relationshiptofistulization, increasestheuveoscleraloutflow [10].Inourstudy,wefound inflammationchorioretinallesions,andthevitreous. thataPVRwasareasonofhypotony.Itisreportedthat 1996;41(2):97-125 aPVRisalong-termcomplicationofbluntoculartrauma, 6CostaVP,ArcieriES.Hypotonymaculopathy. .2007;85 (6):586-597 once formed,theproliferativemembrane(ciliary 7Küükerd nmezC,BeutelJ,Bartz-SchmidtKU,GeliskenF. membrane)createstractionatthesurfaceofciliarybody, 觭 觟 Treatmentofchronicocularhypotonywithintraocularapplicationof [11] resultinginciliarybodyfunctionsandstructuredamage . sodiumhyaluronate. 2009;93(2):235-239 Thehyperplasiaanddistractionofciliarymembranecause 8Cerio-RamsdenCD,Mu oz-NegreteFJ,RebolledaG.Post-traumatic 觡 ciliarybodyedema,anddecreasedaqueoushumorsecretion, cyclodialysisclefttreatedwithtransscleraldiodelaser. whichmaybethemainreasonofchronichypotony [12];the 2009;84(1):47-50 serioustractionoftheaPVRmembranecancauseawide 9AminiH,RazeghinejadMR.Transscleraldiodelasertherapyfor rangeoftheciliarybody,choroid,retinaldetachment, cyclodialysiscleftinducedhypotony. 2005; resultinginalowsecretionofaqueousandenhanced 33(4):348-350 10FineHF,BiscetteO,ChangS,SchiffWM.Ocularhypotony:areview. uveoscleraloutflowresultsinhypotony;lateorobsolete 2007;8(1):29-37 aPVR,ciliarybodyorciliaryprocessfibrosisandciliary 11WatersT,VollmerL,SowkaJ.Proliferativevitreoretinopathyasalate epitheliumatrophyresultinalowsecretionofciliarybody. complicationofbluntoculartrauma. 2008;79(4):197-202 Hypotonycausedbybluntoculartraumaisnotuncommon, 12FaudeF,WiedemannP.Vitreoretinalendoscopefortheassessmentof andpersistinghypotonycausescomplicationsthatinvolve theperipheralretinaandtheciliarybodyafterlargeretinectomiesin alloculartissuesandleadstocorrespondingvisualloss [1,2] severeanteriorPVR. 2004;25(1):53-56

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