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目的：评价玻璃体手术救治眼球爆炸伤的效果和因眼外伤眼球摘除的目前概念。方法：复习连续的３６例（４４眼）严重眼球爆炸伤患者的临床资料。结果：本组包括雷管炸伤１０例，鞭炮伤７例，火药及土枪炸伤１９例。其中１０只眼（２２．７％）眼球破裂，４０只眼（９０．９％）因玻璃体出血、异物、眼内炎、视网膜脱离等后节损伤在伤后或初期缝合后实行了玻璃体手术。手术后视力改善２５只眼（６２．５％），不变１１只眼（２７．５％），下降４只眼（１０％）。最终视力≥０．０２（最好０．７）的有２０只眼。除２只眼（４．５％）因破裂已在基层医院摘除外，未再行眼球摘除手术。结论：虽然爆炸伤常造成严重眼球损伤及破裂，但经过初期显微缝合和二期玻璃体手术，多数眼能重建眼球并部分恢复视力。因此，除个别例外不宜推荐初期眼球摘除术。
OBJECTIVE: To evaluate the efficacy of vitrectomy for the treatment of eyeball blast injuries and the current concept of eyeball removal due to ocular trauma. Methods: The clinical data of 36 consecutive patients (44 eyes) with severe eyeball explosion were reviewed. Results: This group includes 10 cases of detonator injury, 7 cases of firecrackers and 19 cases of gunpowder and gun damage. Of these, 10 eyes (22.7%) had ocular rupture and 40 eyes (90.9%) had posterior vitreous hemorrhage, foreign bodies, endophthalmitis, and retinal detachment. Vitreous surgery was performed after the injury or initial suture. Visual acuity improved 25 eyes (62.5%) after surgery, unchanged in 11 eyes (27.5%), decreased in 4 eyes (10%). Twenty eyes had a final visual acuity ≥0.02 (best 0.7). Except for 2 eyes (4.5%) who had been removed due to rupture in the primary hospital, no further enucleation was performed. CONCLUSIONS: Although blast injuries often cause serious eye damage and rupture, most eyes can reconstruct the eyeball and partially restore vision after initial microsurgical suture and two-stage vitrectomy. Therefore, with a few exceptions should not recommend the initial enucleation.