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Demographic trends of open globe injuries in a large inpatient sample. Eye (Lond) 2020; 35:2270-2276. [PMID: 33132385 DOI: 10.1038/s41433-020-01249-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 09/13/2020] [Accepted: 10/21/2020] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To evaluate demographic trends of open globe injuries (OGIs) using a large dataset representative of United States population. METHODS Retrospective cross-sectional observational study using the National Inpatient Sample (NIS) database from 2002 to 2013. Only patients with a primary admitting diagnosis of OGI were included. Data included age (in years), gender, race, type of OGI, death rate and length and cost of stay. RESULTS During the 12-year period, 27,467 adults (age > 20) with acute OGIs were admitted to the US hospitals. The incidence of OGIs in the adult US population was 10.6 cases per 1,000,000 persons. The mean age was 50.4 years (SD 21.52); the average ages of men and women were 44.34 (SD 17.63) and 65.69 (SD 22.77), respectively. Men accounted for 71% of all cases, with 84% of patients under 60. A decrease in the number of OGIs was seen with advancing age in men, whereas the opposite was true for women. Men, elderly over 80 and Blacks were at the highest risk of sustaining an OGI. The most and least common types of injuries were penetrating injuries (73%) and IOFBs (11%), respectively. Over half of young adults in the 21-40 cohort and 43% of men were uninsured (p < 0.001). The average length of hospital stay increased with age and was significantly much higher in women than men (3.4 vs 2.5 days). CONCLUSIONS Racial, gender and age disparities are prevalent in patients with OGIs. Although the majority of cases were seen in Whites and young men age 21-40 years, the incidence of OGIs per 1,000,000 persons per year was the highest in Blacks and Hispanics, elderly over 80, and men. One-third of all cases were uninsured. These disparities should be the basis of future public health safety measures.
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Morikawa S, Okamoto F, Okamoto Y, Mitamura Y, Ishikawa H, Harimoto K, Ueda T, Sakamoto T, Sugitani K, Sawada O, Mori J, Takamura Y, Oshika T. Visual Outcomes and Mechanism of Open-Globe Injuries with No Light Perception. Ophthalmol Retina 2020; 5:489-491. [PMID: 33080366 DOI: 10.1016/j.oret.2020.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 10/14/2020] [Accepted: 10/14/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Shohei Morikawa
- Department of Ophthalmology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Fumiki Okamoto
- Department of Ophthalmology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
| | - Yoshifumi Okamoto
- Department of Ophthalmology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Yoshinori Mitamura
- Department of Ophthalmology, Institute of Health Biosciences, The University of Tokushima Graduate School, Tokushima, Japan
| | - Hiroto Ishikawa
- Department of Ophthalmology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Kozo Harimoto
- Department of Ophthalmology, National Defense Medical College, Tokorozawa, Japan
| | - Tetsuo Ueda
- Department of Ophthalmology, Nara Medical University, Kashihara, Japan
| | - Taiji Sakamoto
- Department of Ophthalmology Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Kazuhiko Sugitani
- Department of Ophthalmology and Visual Science, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Osamu Sawada
- Department of Ophthalmology, Shiga University of Medical Science, Otsu, Japan
| | - Junya Mori
- Department of Ophthalmology, Sapporo City General Hospital, Sapporo, Japan
| | - Yoshihiro Takamura
- Department of Ophthalmology, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Tetsuro Oshika
- Department of Ophthalmology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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Joussen AM, Müller B, Kirchhof B, Stappler T, Zeitz O. Rupture of the Globe: What to Do, What not to Do. Klin Monbl Augenheilkd 2020; 237:1070-1078. [PMID: 32967031 DOI: 10.1055/a-1233-8997] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Due to their complexity, globe ruptures are highly compromising traumas for the patient. This is due on the one hand to the eye injury itself with the accompanying loss of vision and on the other hand due to the need for extended treatment with uncertain prognosis and the resulting psychological stress. Globe ruptures are among the prognostically most unfavorable injuries due to the force and peak pressure impacting the eye. Furthermore, contusional retinal necrosis may be of significance prognostically. In the present review, we discuss treatment of globe ruptures involving retinal surgery. We discuss the primary sugery, its chronological planning and extent as well as the necessity for follow-up interventions. We also discuss the origin of traumatic retinal detachment with differential diagnosis of giant retinal tear versus oradialysis as well as secondary sequelae of traumas such as formation of macular holes and their treatment. On this basis, the use of buckling surgery versus pars-plana vitrectomy is discussed. Further focus is set on the role of the iris lens diaphragm in surgery of globe ruptures.
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Affiliation(s)
| | - Bert Müller
- Klinik für Augenheilkunde, Charité - Universitätsmedizin Berlin
| | - Bernd Kirchhof
- Netzhauterkrankungen und vitreoretinale Chirurgie, Augenklinik, Universität Köln
| | - Theodor Stappler
- Rétine chirurgicale, Hôpital Ophtalmique Jules Gonin, Lausanne, Schweiz
| | - Oliver Zeitz
- Klinik für Augenheilkunde, Charité - Universitätsmedizin Berlin
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Vidne-Hay O, Fogel Levin M, Luski S, Moisseiev J, Moisseiev E. Blunt ocular trauma in patients over 70: Clinical characteristics and prognosis. Eur J Ophthalmol 2020; 31:2705-2709. [PMID: 32715795 DOI: 10.1177/1120672120946579] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To describe the mechanisms and outcomes of open globe injuries (OGIs) in patients 70 years or older. METHODS A retrospective chart review of patients from two large academic centers in Israel who were underwent surgery for OGI. Data was collected from surgical and clinic charts. Anatomical and functional results were recorded as well any additional surgeries and complications. RESULTS Thirty-two eyes of 32 patients were included. The mechanism of OGI consisted of blunt trauma with ocular rupture secondary to falls. All eyes underwent immediate primary closure of the corneal and scleral lacerations. Additional surgeries were performed in 34.3% of cases. In 31.2% of cases additional surgery was not required, and in 21.9% of cases the damage was so devastating that additional procedures were not recommended. Four patients (12.5%) chose not to undergo additional surgery. Mean visual acuity at presentation was 2.24 ± 0.72 logMAR and it improved to 1.92 ± 0.89 logMAR at final follow-up (p = 0.002). VA at presentation was significantly correlated to final VA (p < 0.001). CONCLUSIONS OGI in the elderly represents a unique group. It is mostly related to falls, with a female predominance and a poor visual prognosis. In this patient population, general health concerns and increased risks of anesthesia require special attention. Care should be taken to educate elderly patients and their caretakers on how to avoid falls.
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Affiliation(s)
- Orit Vidne-Hay
- Department of Ophthalmology, Sheba Medical Centre, Ramat Gan, Israel
| | - Miri Fogel Levin
- Department of Ophthalmology, Sheba Medical Centre, Ramat Gan, Israel
| | - Shahar Luski
- Department of Ophthalmology, Tel Aviv Medical Centre, Tel Aviv, Israel
| | - Joseph Moisseiev
- Department of Ophthalmology, Sheba Medical Centre, Ramat Gan, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Elad Moisseiev
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Ophthalmology, Meir Medical Centre, Kfar Saba, Israel
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Dorman A, O'Hagan S, Gole G. Epidemiology of severe ocular trauma following the implementation of alcohol restrictions in Far North Queensland. Clin Exp Ophthalmol 2020; 48:879-888. [DOI: 10.1111/ceo.13811] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 04/25/2020] [Accepted: 06/14/2020] [Indexed: 01/24/2023]
Affiliation(s)
- Andrew Dorman
- Department of Ophthalmology Cairns Hospital Cairns Queensland Australia
- University of Queensland Brisbane Queensland Australia
| | - Stephen O'Hagan
- Department of Ophthalmology Cairns Hospital Cairns Queensland Australia
- James Cook University Cairns Queensland Australia
| | - Glen Gole
- Department of Ophthalmology Cairns Hospital Cairns Queensland Australia
- Discipline of Paediatrics and Child Health University of Queensland, Queensland Children's Hospital Brisbane Queensland Australia
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Boucenna W, Taright N, Delbarre M, El Sanharawi M, Khawaja O, Jany B, Froussart-Maille F, Milazzo S. [Functional results and prognostic factors in open-globe ocular trauma with presenting visual acuity of no-light perception]. J Fr Ophtalmol 2020; 43:517-524. [PMID: 32113668 DOI: 10.1016/j.jfo.2019.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 10/30/2019] [Accepted: 11/13/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE To analyse the clinical ocular characteristics and determine prognostic factors for functional recovery in eyes presenting with no light perception (NLP) after open globe ocular trauma. MATERIALS AND METHODS In this retrospective study were included all the patients with no light perception after open globe trauma who presented to Amiens University Hospital between October 2014 and June 2018. RESULTS Fifteen eyes of 15 patients were included in this study. The main mechanism of the trauma was globe rupture (80 %, n=12). The most common location was zone III (66 %, n=10). The wound size was greater than 10mm in 9 patients (60 %). The ocular lesions included expulsion of the crystalline lens or posterior chamber intraocular lens, hyphema, retinal detachment, vitreous hemorrhage and ciliochoroidal lesions. Damage to the ciliary body was a negative prognostic factor for functional recovery (P=0.04). Nine patients remained with no light perception, whereas 6 patients experienced an improvement in visual acuity (2.3 logMAR in 3 patients, 0.7 logMAR in 1 patient, 0.4 logMAR in 1 patient and 0.2 logMAR in 1 patient). These 6 patients had undergone posterior vitrectomy due to vitreoretinal involvement (P<0.001). CONCLUSION In the case of open globe trauma with no light perception on presentation, a functional recovery is possible if there is no irreversible anatomical damage.
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Affiliation(s)
- W Boucenna
- Service d'ophtalmologie, CHU d'Amiens-Picardie, 1, rond-point du Professeur-Christian-Cabrol, 80054 Amiens, France.
| | - N Taright
- Institut ophtalmique de Somain, 28, rue Anatole-France, 59490 Somain, France.
| | - M Delbarre
- Service d'ophtalmologie, hôpital d'instruction des armées Percy, 101, avenue Henri-Barbusse, 92140 Clamart, France.
| | - M El Sanharawi
- CHI de Villeneuve-St-Georges, 40, allée de la Source, 94190 Villeneuve-St-Georges, France.
| | - O Khawaja
- CHI de Villeneuve-St-Georges, 40, allée de la Source, 94190 Villeneuve-St-Georges, France.
| | - B Jany
- Service d'ophtalmologie, CHU d'Amiens-Picardie, 1, rond-point du Professeur-Christian-Cabrol, 80054 Amiens, France.
| | - F Froussart-Maille
- Service d'ophtalmologie, hôpital d'instruction des armées Percy, 101, avenue Henri-Barbusse, 92140 Clamart, France.
| | - S Milazzo
- Service d'ophtalmologie, CHU d'Amiens-Picardie, 1, rond-point du Professeur-Christian-Cabrol, 80054 Amiens, France.
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Supreeyathitikul P, Chokesuwattanaskul S, Choovuthayakorn J, Patikulsila D, Watanachai N, Kunavisarut P, Chaikitmongkol V. Epidemiology and Outcomes Following Open Globe Injury in Agricultural Region, an 11-Year Experience. Ophthalmic Epidemiol 2020; 27:246-251. [PMID: 31994961 DOI: 10.1080/09286586.2020.1716381] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE To determine the characteristics and epidemiology of open globe injury (OGI) in a third referral centre over 11 years. METHODS The study was a retrospective observational study. The medical records of 978 OGI cases (a total of 998 eyes), admitted to Chiang Mai University Hospital, Thailand from January 2006 to December 2016, were reviewed. RESULTS The mean age (SD) of patients was 39.1 (17.5) years. Patients were predominantly male (867, 88.7%). The age with the highest incidence of injury ranged from 41 to 60 years, in both genders. Most injuries happened at the workplace (64.8%), with flying objects from electric grass trimmers (23.9%) being the major injury-related mechanism. Penetration injuries were found in 479 eyes (48.0%). In elderly group (aged >60 years), a higher proportion of a globe rupture injuries were observed (13.3%). In general, intraocular foreign body group presented with better initial visual acuity (VA) compared to other injury types (p< 0.001). In all types of injury, final VA was significantly improved after treatment. However, rupture and perforation globe injuries had significantly worse final VA outcomes, compared to penetration and intraocular foreign body injuries (p< 0.001). With multivariable regression analysis, poor initial VA (p< 0.001), type of injury (p= 0.028), positive relative afferent pupillary defect (RAPD) (p< 0.001), and endophthalmitis (p< 0.001) were associated with poor visual outcomes. CONCLUSIONS Work-related eye injury is a major cause of OGI. Poor initial VA, endophthalmitis, presence of RAPD, and rupture were the predictors for poor final visual outcomes.
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Affiliation(s)
| | | | - Janejit Choovuthayakorn
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University , Chiang Mai, Thailand
| | - Direk Patikulsila
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University , Chiang Mai, Thailand
| | - Nawat Watanachai
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University , Chiang Mai, Thailand
| | - Paradee Kunavisarut
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University , Chiang Mai, Thailand
| | - Voraporn Chaikitmongkol
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University , Chiang Mai, Thailand
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Optimal timing of vitrectomy for severe mechanical ocular trauma: A retrospective observational study. Sci Rep 2019; 9:18016. [PMID: 31784659 PMCID: PMC6884543 DOI: 10.1038/s41598-019-54472-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 11/13/2019] [Indexed: 11/15/2022] Open
Abstract
Mechanical ocular trauma could lead to disastrous visual outcomes. There has been a controversy regarding the timing of vitrectomy for such cases. This study aimed to find out the optimal timing of vitrectomy for severe mechanical ocular trauma. Patients with severe mechanical ocular trauma who had undergone vitrectomy were enrolled and followed up for at least 6 months. Clinical data were collected including ocular trauma score (OTS), the timing of vitrectomy upon injury, visual acuity, vitrectomy results, post-operation complications and etc. All cases were classified according to the timing of vitrectomy upon injury into 3 groups: group A 1–7 days, group B 8–14 days, group C more than 14 days. A total of 62 cases were enrolled, including 20 eyes in group A, 25 eyes in group B, and 17 eyes in group C. No significant differences were shown of the gender, age or OTS among the 3 groups. Both functional success rate and visual outcome were optimal in group B, then in group A, and worst in group C. These results suggested that the best timing of vitrectomy for severe mechanical ocular trauma is 8–14 days upon injury; second best is 1–7 days; worst is after 14 days.
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Intraocular Foreign Bodies: Clinical Characteristics and Prognostic Factors Influencing Visual Outcome and Globe Survival in 373 Eyes. J Ophthalmol 2019; 2019:5208092. [PMID: 30895158 PMCID: PMC6393895 DOI: 10.1155/2019/5208092] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 11/27/2018] [Accepted: 01/29/2019] [Indexed: 11/17/2022] Open
Abstract
Aim To describe epidemiologic and clinical characteristics and prognostic factors influencing visual outcome after intraocular foreign bodies (IOFBs) injury. Methods Medical records of 370 patients (373 eyes) with IOFBs were reviewed to identify the factors influencing visual acuity by univariate and multivariate analyses. Results The majority of patients (97.0%) were men, with a mean age of 38.1 years. The most common cause of ocular injury was hammering (52.6%); magnetic IOFBs occurred in 84.7% of these cases. Factors associated with poor visual outcome (defined as <1.3 logMAR) included the following: age ≥50 years (P=0.046); worse presenting visual acuity (P < 0.001); complications of retinal breaks (P=0.006) and endophthalmitis (P=0.032); vitrectomy (P=0.035); and intraocular C3F8 gas tamponade (P=0.038). Excellent visual outcome (defined as ≥0.5 logMAR) was associated with age <50 years (P=0.003); better presenting visual acuity (PVA) (P < 0.001); wound length <4 mm (P=0.005); absence of vitreous hemorrhage (P=0.026) and retinal breaks (P < 0.001); nonvitrectomy surgery (P=0.043); and use of balanced saline (P=0.029). Conclusions Multiple prognostic factors were identified that may predict visual outcome and globe survival after IOFBs injury. Age, initial presenting visual acuity, wound length, complications (vitreous hemorrhage, retinal breaks, and endophthalmitis), surgical approach, and intraocular tamponade were significant predictors of visual outcome.
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