[Posttraumatic endophthalmitis : Complication following severe eye injury]

Open Globe Injuries: Classifications and Prognostic Factors for Functional Outcome

This paper explored epidemiology and evaluation of posterior segment involvement as prognostic factors for functional outcome of patients with open globe injuries. A retrospective analysis of 151 patients with open globe injuries was conducted. Pre- and postoperative-corrected distance visual acuity (CDVA), epidemiologic data, classification of the injuries including the ocular trauma score (OTS), performed surgeries, intraocular pressure (IOP) and correlation analyses between OTS and postoperative CDVA were obtained. A total of 147 eyes were included in the study. Mean age was 42.9 ± 22.2 years, 78.2% were male, and 36.7% of injuries occurred in the workplace. Thirty-eight patients (25.9%) had intraocular foreign bodies. Concerning injury location, 51.7% of the injuries were located in zone I (cornea, corneoscleral limbus), 15.0% in zone II (up to 5 mm posterior the sclerocorneal limbus) and 32.0% in zone III (posterior of zone 2). Affected structures were eyelids (17.7%), cornea (74.8%), iris (63.9%), lens (56.5%), sclera (48.3%), retina (47.6%) and optic nerve (19.7%). Mean preoperative CDVA was 1.304 ± 0.794 logMAR and 1.289 ± 0.729 logMAR postoperatively (p = 0.780). Patients with posterior segment involvement had significantly worse postoperative CDVA than patients without (1.523 ± 0.654 logMAR vs. 0.944 ± 0.708 logMAR, p < 0.01). Predictive factors for good visual outcome of open globe injuries are good initial CDVA and ocular trauma affecting only zone I and II.

Damage to the eye and optic nerve in seriously traumatized patients with concomitant head injury: analysis of 84,627 cases from the TraumaRegister DGU® between 2002 and 2015

BACKGROUND

To determine the prevalence and characteristics of prechiasmatic visual system injuries (VSI) among seriously injured patients with concomitant head trauma in Europe by means of a multinational trauma registry.

METHODS

The TraumaRegister DGU® was searched for patients suffering from serious trauma with a Maximum Abbreviated Injury Scale (AIS) ≥ 3 between 2002 and 2015 in Europe. After excluding cases without significant head injury defined by an AIS ≥ 2, groups were built regarding the existence of a concomitant damage to the prechiasmatic optic system comprising globe and optic nerve. Group comparisons were performed with respect to demographic, etiological, clinical and outcome characteristics.

RESULTS

2.2% (1901/84,627) of seriously injured patients with concomitant head trauma presented with additional VSI. These subjects tended to be younger (mean age 44.7 versus 50.9 years) and were more likely of male gender (74.8% versus 70.0%) compared to their counterparts without VSI. The most frequent trauma etiologies were car accidents in VSI patients (28.5%) and falls in the control group (43.2%). VSI cases were prone to additional soft tissue trauma of the head, skull and orbit fractures as well as pneumocephalus. Primary treatment duration was significantly longer in the VSI cohort (mean 23.3 versus 20.5 days) along with higher treatment costs and a larger proportion of patients with moderate or severe impairment at hospital discharge despite there being a similar average injury severity at admission in both groups.

CONCLUSIONS

A substantial proportion of patients with head injury suffers from additional VSI. The correlation between VSI and prolonged hospitalization, increased direct treatment expenditures, and having a higher probability of posttraumatic impairment demonstrates the substantial socioeconomic relevance of these types of injuries.

Clinical and visual outcome of endophthalmitis patients: a single-center experience

PURPOSE

To report the clinical and visual outcome and the therapeutical management in a large cohort of endophthalmitis patients.

METHODS

In a monocentric, observational study, we retrospectively analyzed the data of all patients with endophthalmitis who were referred to the department of ophthalmology of the Carl Gustav Carus Hospital Dresden between 2006 and 2018.

RESULTS

In total, data of 104 patients (49 female, 55 male) were included in the present analysis. The most frequent clinical scenario for endophthalmitis was postcataract surgery (30.8%). The most frequent treatment at presentation was a pars plana vitrectomy (ppV) in 42 patients, followed by an intravitreal antibiotic in 41 patients. Out of 41 patients who received an intravitreal antibiotic, 35 patients (85%) needed additional treatment. In contrast, out of 42 patients who received a ppV as the initial treatment, 19 patients (42%) needed additional therapy, which was significantly different (p < 0.0001). The best presenting visual acuity improved significantly after treatment (p < 0.0001).

CONCLUSION

The results of the present study suggest that, compared with an intravitreal antibiotic, a ppV as the initial therapy of endophthalmitis might reduce the number of additional treatments. From our data, it can be hypothesized that a ppV should be performed as early as possible to achieve the best visual outcome in most endophthalmitis patients. Prospective studies are now needed to address this issue in greater detail and to confirm our findings.