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Sherif NA, Hoyek S, Wai K, Makhoul KG, Bitar R, Tieger M, Lorch AC, Patel NA, Armstrong GW. Recovery of Vision in Open Globe Injury Patients with Initial No Light Perception Vision. Ophthalmol Retina 2024:S2468-6530(24)00185-4. [PMID: 38636901 DOI: 10.1016/j.oret.2024.04.010] [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: 09/18/2023] [Revised: 03/31/2024] [Accepted: 04/08/2024] [Indexed: 04/20/2024]
Abstract
PURPOSE To identify clinical characteristics of injured eyes associated with visual recovery in patients with open globe injuries (OGIs) and presenting with no light perception (NLP) vision. DESIGN Retrospective chart review. SUBJECTS All patients presenting to Massachusetts Eye and Ear with OGI and NLP vision from January 1999 to March 2022. METHODS Manual data extraction to collect patient demographic characteristics, preoperative, intraoperative, and postoperative characteristics of OGI injury, laceration versus rupture, history of intraocular surgery, time from injury to repair, timing of vitrectomy, lensectomy, choroidal drainage, and silicone oil placement, visual acuity (VA) at last follow-up, and subsequent B-scan ultrasound findings of retinal detachment, choroidal hemorrhage, vitreous hemorrhage, and disorganized intraocular contents. Patients with >1 week of follow-up and a documented VA at most recent follow-up were included. Exclusion criteria included age <10 years. Multivariable regression was performed. MAIN OUTCOME MEASURES Visual acuity recovery defined as light perception or better in patients with OGI and initial NLP vision. RESULTS One hundred forty-seven eyes with NLP vision after OGI were included. Twenty-five (17%) eyes regained vision at last follow-up. The majority of patients recovered light perception vision (n = 15, 60%) followed by 20/500 or better (n = 5, 20%), hand motions (n = 3, 12%), and counting fingers (n = 2, 8%). Most injuries were zone III (n = 102, 69%) and presented with rupture (n = 127, 86%). The mean time from OGI to surgical repair was 0.85 ± 1.7 days. B-scan was obtained in 104 (71%) cases. Pars plana vitrectomy was performed in 9 eyes (6%) with NLP at time of vitrectomy. Disorganized intraocular contents on B-scan (odd ratio, 0.170; 95% confidence interval, 0.042-0.681; P = 0.012) was the only clinical variable significantly associated with visual recovery, corresponding to a lack of visual improvement. CONCLUSIONS Recovery of vision in OGI with NLP vision at presentation cannot be predicted based on presenting clinical features. B-scan findings of disorganized intraocular contents after initial OGI repair was the only factor negatively associated with vision recovery in this patient population. Therefore, all eyes presenting with an OGI and NLP vision should undergo primary repair in hopes of subsequent visual recovery. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Noha A Sherif
- Department of Ophthalmology, New England Eye Center, Tufts University, Boston, Massachusetts
| | - Sandra Hoyek
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Karen Wai
- Department of Ophthalmology, Byers Eye Institute, Stanford University, San Francisco, California
| | - Kevin G Makhoul
- Department of Ophthalmology, University of Kansas School of Medicine, Prairie Village, Kansas
| | - Racquel Bitar
- Department of Ophthalmology, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Marisa Tieger
- Department of Ophthalmology, New England Eye Center, Tufts University, Boston, Massachusetts
| | - Alice C Lorch
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Nimesh A Patel
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Grayson W Armstrong
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts.
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Tieger M, Armstrong GW, Eliott D. Review of Management and Outcomes of Delayed Repair Open Globe Injuries. Semin Ophthalmol 2024; 39:139-142. [PMID: 38069614 DOI: 10.1080/08820538.2023.2286015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 01/28/2022] [Indexed: 01/17/2024]
Abstract
The standard of care for open globe injuries is prompt surgical closure, as delay in repair is a reported risk factor for post-traumatic endophthalmitis and is associated with worse visual outcomes. This article serves as a review of the current management and outcomes of open globe injuries repaired greater than 24 hours from the time of injury, specifically evaluating the rates of endophthalmitis in cases with and without intraocular foreign bodies, visual outcomes and rates of primary enucleation or evisceration.
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Affiliation(s)
- Marisa Tieger
- Harvard Medical School Department of Ophthalmology, Massachusetts Eye and Ear, Boston, MA, USA
| | - Grayson W Armstrong
- Harvard Medical School Department of Ophthalmology, Massachusetts Eye and Ear, Boston, MA, USA
| | - Dean Eliott
- Harvard Medical School Department of Ophthalmology, Massachusetts Eye and Ear, Boston, MA, USA
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Meng X, Wang Q, Chen S, Zhang S, Yu J, Li H, Chen X, Wang Z, Yu W, Zheng Z, Zhou H, Luo J, Wang Z, Chen H, Wu N, Hu D, Chen S, Wei Y, Cui H, Song H, Chen H, Wang Y, Zhong J, Chen Z, Zhang H, Yang T, Li M, Liu Y, Dong X, Du M, Wang X, Yao X, Lin H, Li MJ, Yan H. An interpretable model predicts visual outcomes of no light perception eyes after open globe injury. Br J Ophthalmol 2024; 108:285-293. [PMID: 36596662 DOI: 10.1136/bjo-2022-322753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 12/17/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND The visual outcome of open globe injury (OGI)-no light perception (NLP) eyes is unpredictable traditionally. This study aimed to develop a model to predict the visual outcomes of vitrectomy surgery in OGI-NLP eyes using a machine learning algorithm and to provide an interpretable system for the prediction results. METHODS Clinical data of 459 OGI-NLP eyes were retrospectively collected from 19 medical centres across China to establish a training data set for developing a model, called 'VisionGo', which can predict the visual outcome of the patients involved and compare with the Ocular Trauma Score (OTS). Another 72 cases were retrospectively collected and used for human-machine comparison, and an additional 27 cases were prospectively collected for real-world validation of the model. The SHapley Additive exPlanations method was applied to analyse feature contribution to the model. An online platform was built for real-world application. RESULTS The area under the receiver operating characteristic curve (AUC) of VisionGo was 0.75 and 0.90 in previtrectomy and intravitrectomy application scenarios, which was much higher than the OTS (AUC=0.49). VisionGo showed better performance than ophthalmologists in both previtrectomy and intravitrectomy application scenarios (AUC=0.73 vs 0.57 and 0.87 vs 0.64). In real-world validation, VisionGo achieved an AUC of 0.60 and 0.91 in previtrectomy and intravitrectomy application scenarios. Feature contribution analysis indicated that wound length-related indicators, vitreous status and retina-related indicators contributed highly to visual outcomes. CONCLUSIONS VisionGo has achieved an accurate and reliable prediction in visual outcome after vitrectomy for OGI-NLP eyes.
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Affiliation(s)
- Xiangda Meng
- Department of Ophthalmology, Tianjin Medical University General Hospital, Tianjin, China
| | - Qihua Wang
- Department of Ophthalmology, Tianjin Medical University General Hospital, Tianjin, China
- Department of Ophthalmology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Song Chen
- Department of Ophthalmology, Tianjin Medical University General Hospital, Tianjin, China
| | - Shijie Zhang
- Department of Pharmacology, Tianjin Key Laboratory of Inflammation Biology, School of Basic Medical Sciences, Tianjin Medical University, Tianjin, China
| | - Jinguo Yu
- Department of Ophthalmology, Tianjin Medical University General Hospital, Tianjin, China
| | - Haibo Li
- Department of Ocular Trauma, Xiamen University Xiamen Eye Center, Xiamen, Fujian, China
| | - Xinkang Chen
- Department of Pharmacology, Tianjin Key Laboratory of Inflammation Biology, School of Basic Medical Sciences, Tianjin Medical University, Tianjin, China
| | - Zhaoyang Wang
- Department of Ophthalmology, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Wenzhen Yu
- Department of Ophthalmology, Peking University People's Hospital, Beijing, China
| | - Zhi Zheng
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Heding Zhou
- Department of Ophthalmology, Ningbo Eye Hospital, Ningbo, Zhejiang, China
| | - Jing Luo
- Department of Ophthalmology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Zhiliang Wang
- Department of Ophthalmology, Fudan University Huashan Hospital, Shanghai, China
| | - Haoyu Chen
- Department of Ocular Trauma, Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, Shantou, Guangdong, China
| | - Nan Wu
- Department of Ophthalmology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Dan Hu
- Department of Ophthalmology, Eye Institute of Chinese PLA, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Suihua Chen
- Department of Ophthalmology, General Hospital of Eastern Theater Command, Nanjing, Jiangsu, China
| | - Yong Wei
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Haibin Cui
- Department of Ocular Trauma, Heilongjiang Province Ophthalmology Hospital, Harbin, Heilongjiang, China
| | - Huping Song
- Department of Ophthalmology, Xi'an People's Hospital (Xi'an No.4 Hospital), Xi'an, Shaanxi, China
| | - Huijin Chen
- Department of Ophthalmology, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China
| | - Yun Wang
- Department of Ophthalmology, Xining First People's Hospital, Xining, Qinghai, China
| | - Jie Zhong
- Department of Ophthalmology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Zhen Chen
- Eye Center, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Haokun Zhang
- Department of Ophthalmology, Tianjin Medical University General Hospital, Tianjin, China
| | - Tiantian Yang
- Department of Ophthalmology, Tianjin Medical University General Hospital, Tianjin, China
| | - Mengxuan Li
- Department of Ophthalmology, Tianjin Medical University General Hospital, Tianjin, China
| | - Yuanyuan Liu
- Department of Ophthalmology, Tianjin Medical University General Hospital, Tianjin, China
| | - Xue Dong
- Department of Ophthalmology, Tianjin Medical University General Hospital, Tianjin, China
- Laboratory of Molecular Ophthalmology and Tianjin Key Laboratory of Ocular Trauma, Tianjin Medical University, Tianjin, China
| | - Mei Du
- Department of Pharmacology, Tianjin Key Laboratory of Inflammation Biology, School of Basic Medical Sciences, Tianjin Medical University, Tianjin, China
- Laboratory of Molecular Ophthalmology and Tianjin Key Laboratory of Ocular Trauma, Tianjin Medical University, Tianjin, China
| | - Xiaohong Wang
- Department of Pharmacology, Tianjin Key Laboratory of Inflammation Biology, School of Basic Medical Sciences, Tianjin Medical University, Tianjin, China
- Laboratory of Molecular Ophthalmology and Tianjin Key Laboratory of Ocular Trauma, Tianjin Medical University, Tianjin, China
| | - Xuyang Yao
- Tianjin Medical University Eye Hospital, Eye Institute & School of Optometry and Ophthalmology, Tianjin, China
| | - Haotian Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Vision Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
- Hainan Eye Hospital and Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Haikou, Hainan, China
- Center for Precision Medicine and Department of Genetics and Biomedical Informatics, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Mulin Jun Li
- Department of Pharmacology, Tianjin Key Laboratory of Inflammation Biology, School of Basic Medical Sciences, Tianjin Medical University, Tianjin, China
- Department of Bioinformatics, The Province and Ministry Co-sponsored Collaborative Innovation Center for Medical Epigenetics, School of Basic Medical Sciences, Tianjin Medical University, Tianjin, China
| | - Hua Yan
- Department of Ophthalmology, Tianjin Medical University General Hospital, Tianjin, China
- Laboratory of Molecular Ophthalmology and Tianjin Key Laboratory of Ocular Trauma, Tianjin Medical University, Tianjin, China
- School of Medicine, Nankai University, Tianjin, China
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Porapaktham T, Choovuthayakorn J, Nanegrungsunk O, Phinyo P, Tanasombatkul K, Watanachai N, Kunavisarut P, Chaikitmongkol V, Patikulsila D. Open Globe Injury in a Tertiary Hospital of Northern Thailand: No Vision Survival and Ocular Trauma Score. Clin Ophthalmol 2023; 17:365-373. [PMID: 36721667 PMCID: PMC9884457 DOI: 10.2147/opth.s401643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 01/19/2023] [Indexed: 01/26/2023] Open
Abstract
Purpose To determine characteristics and factors associated with no vision survival (included no light perception, enucleation, and evisceration) following open globe injury (OGI) and to correlate the proportion of final vision to predictive values of ocular trauma score (OTS). Patients and Methods The medical records of consecutive patients diagnosed as OGI between January 2015 and December 2020 were retrospectively reviewed. Data collected included demographics, mechanisms and modes of injuries, ophthalmic presentations, managements, and visual outcomes at the final visit. Results Three hundred and seventy-one patients with a mean (standard deviation, SD) age of 44.0 (17.4) years were included. Male with workplace injury was the most frequent scenario. High-velocity metallic objects were the predominant causative materials. Following treatments, fifty-six eyes (14.9%) obtained no vision survival. Factors associated with no vision survival following OGI were low presenting vision, globe perforation, larger wound, presence of relative afferent pupillary defect, retinal detachment, and vitreous hemorrhage. Compared to OTS predictive values, eyes in OTS categories 1 and 2 had a lower proportion of no vision survival. Conclusion This study identified the importance of workplace injuries. Overall, there were comparable final visions between OTS and this study. However, a reduced proportion of no vision survival among severely injured eyes signifies the challenges of OGI management.
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Affiliation(s)
- Tuangprot Porapaktham
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Janejit Choovuthayakorn
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand,Correspondence: Janejit Choovuthayakorn, Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, 110 Intavaroros Road, Maung, Chiang Mai, 50200, Thailand, Tel +66 53 935512, Fax +66 53 936121, Email
| | - Onnisa Nanegrungsunk
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Phichayut Phinyo
- Clinical Epidemiology and Clinical Statistics Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand,Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand,Musculoskeletal Science and Translational Research (MSTR), Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Krittai Tanasombatkul
- Clinical Epidemiology and Clinical Statistics Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand,Department of Family Medicine, 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
| | - Direk Patikulsila
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Li KX, Durrani AF, Zhou Y, Zhao PY, Tannen BL, Mian SI, Musch DC, Zacks DN. Outcomes of Penetrating Keratoplasty After Open Globe Injury. Cornea 2022; 41:1345-1352. [PMID: 34759204 PMCID: PMC9555754 DOI: 10.1097/ico.0000000000002918] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 08/23/2021] [Accepted: 09/08/2021] [Indexed: 12/03/2022]
Abstract
PURPOSE The purpose of this study was to investigate the clinical features, surgical outcomes, and prognostic factors of penetrating keratoplasty (PKP) after open globe injury (OGI). METHODS A retrospective review of all patients treated for OGI between January 2000 and July 2017 was conducted. Demographic, preoperative, perioperative, and postoperative data were collected for those who underwent PKP after OGI. The predictive value of each preoperative variable on graft failure was assessed using univariate and multivariable Cox proportional hazards models, and the predictive value of variables on post-PKP visual outcome was assessed using both univariate and multivariable logistic regression models. All eyes that underwent PKP after OGI were included unless they had less than 365 days of follow-up. RESULTS Forty-six eyes that underwent PKP met inclusion criteria. The median age was 46 years (interquartile range = 23.00-61.25), median follow-up was 78.5 months (interquartile range = 38.63-122.02), and 37 of 46 subjects (80.4%) were male. The observed 1- and 5-year graft survival estimates were 80.4% and 41.7%, respectively. Factors statistically associated with graft failure in multivariable analyses were rejection episode, hazard ratio (HR) = 3.29; retinal detachment (RD), HR = 3.47; and endophthalmitis, HR = 6.27. Fifteen of 42 eyes (35.7%) regained ambulatory vision (20/200 or better). The strongest predictors of vision worse than 20/200 at the last follow-up were RD, odds ratio (OR) = 43.88; graft rejection, OR = 12.42; and injury outside the workplace, OR = 25.05. CONCLUSIONS Despite a high graft survival at 1 year, most of the patients did not regain ambulatory vision. Graft rejection, RD, and endophthalmitis were risk factors for graft failure. These factors should be considered when counseling patients regarding PKP after OGI.
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Affiliation(s)
- Katie X. Li
- Department of Ophthalmology and Visual Sciences, W. K. Kellogg Eye Center, University of Michigan, Ann Arbor, MI; and
| | - Asad F. Durrani
- Department of Ophthalmology and Visual Sciences, W. K. Kellogg Eye Center, University of Michigan, Ann Arbor, MI; and
| | - Yunshu Zhou
- Department of Ophthalmology and Visual Sciences, W. K. Kellogg Eye Center, University of Michigan, Ann Arbor, MI; and
| | - Peter Y. Zhao
- Department of Ophthalmology and Visual Sciences, W. K. Kellogg Eye Center, University of Michigan, Ann Arbor, MI; and
| | - Bradford L. Tannen
- Department of Ophthalmology and Visual Sciences, W. K. Kellogg Eye Center, University of Michigan, Ann Arbor, MI; and
| | - Shahzad I. Mian
- Department of Ophthalmology and Visual Sciences, W. K. Kellogg Eye Center, University of Michigan, Ann Arbor, MI; and
| | - David C. Musch
- Department of Ophthalmology and Visual Sciences, W. K. Kellogg Eye Center, University of Michigan, Ann Arbor, MI; and
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI
| | - David N. Zacks
- Department of Ophthalmology and Visual Sciences, W. K. Kellogg Eye Center, University of Michigan, Ann Arbor, MI; and
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Kuhn F. Decision-making when your patient has an open globe injury. EXPERT REVIEW OF OPHTHALMOLOGY 2022. [DOI: 10.1080/17469899.2022.2124969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- Ferenc Kuhn
- Helen Keller Foundation for Research and Education, Birmingham, AL, USA
- Department of Ophthalmology, University of Pécs Medical School, Pécs, Hungary
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Yan H, Yang K, Ma Z, Kuhn F, Zhang W, Wang Z, Hu Y, Lu H, Shigeo Y, Sobaci G, Ozdek S, Forlini M, Huang B, Hui Y, Zhang M, Xu G, Wei W, Jiang Y, Park D, Fernandes RB, He Y, Rousselot A, Hoskin A, Sundar G, Liu Y, Wang Y, Shen L, Chen H, Chen H, Han G, Jiang R, Jin X, Lin J, Luo J, Wang Z, Wei Y, Wen Y, Xie Z, Wang Y, Yang X, Yu W, Zheng Z, Sun X, Liang J, Liu Q, Yu J, Wei S, Li Z, Chen L, Wang X, Wei L, Zhang H, Chen S, Liu Y, Guo X, Liu S, Xu X, Tao Y, Chen Y, Chen Y. Guideline for the treatment of no light perception eyes induced by mechanical ocular trauma. J Evid Based Med 2022; 15:302-314. [PMID: 36151612 PMCID: PMC9826528 DOI: 10.1111/jebm.12496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 08/26/2022] [Indexed: 01/11/2023]
Abstract
Severe mechanical ocular trauma with no light perception (NLP) predicts a poor prognosis of visual acuity and enucleation of the eyeball. Since the innovative treatment concept of exploratory vitreoretinal surgery has developed and treatment technology has advanced, the outcomes of severe ocular trauma treatment in NLP patients have greatly improved. However, there remains a lack of unified standards for the determination, surgical indication, and timing of vitrectomy in NLP eye treatment. To address these problems, we aimed to create evidence-based medical guidelines for the diagnosis, treatment, and prognosis of mechanical ocular trauma with NLP. Sixteen relevant recommendations for mechanical ocular trauma with NLP were obtained, and a consensus was reached. Each recommendation was explained in detail to guide the treatment of mechanical ocular trauma associated with NLP.
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Epidemiological Characteristics of Pediatric Ocular Trauma in China: A Multicenter Retrospective Hospital-Based Study. J Ophthalmol 2022; 2022:4847027. [PMID: 35847351 PMCID: PMC9279087 DOI: 10.1155/2022/4847027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 06/15/2022] [Indexed: 11/24/2022] Open
Abstract
Purpose The objective of the study was to obtain the incidence characteristics of pediatric ocular trauma in mainland China and provide some feasible suggestions of prevention. Methods The patients with pediatric ocular injuries, who were (≤14) hospitalized between January 1, 2019, and December 31, 2020, were included. Patient demographics (age and sex), injury natural characteristics (causes, site, and types), geographic location, and interval of hospital admission were analyzed. Results A total of 13525 cases were identified, and 1973 (14.6%) occurred in children (male accounts 70.9%) with a mean (SD) age of 6.5 (3.4) years. Cases among minors in 2020 dropped by 8.3% compared to 2019, while the former vulnerability to eye injuries has been shifted from the outdoors to home (51.4%, 1015/1973). The main causes of injury are flying objects (31.9%), traffic injury (23.5%), and blunt injury (21.8%), which lead to the main types of injury such as penetrating injury (48.3%), rupture of the globe (18.1%), and contusion trauma (13.1%). If the VA after injury is above CF, the VA after discharge is more likely to be above CF (OR 18.3, 11.9–28.1; p < 0.001). Similarly, age (OR 2.0, 1.3–3.1; p=0.001) and intraocular pressure after injury (OR 0.9, 0.9–1.0; p=0.009) also affect the intraocular pressure at discharge. Conclusions In mainland China, the main injury types are penetrating injury and rupture of the globe with home being the most dangerous place. Prevention strategies should focus on parents' education and protective measures indoors. Visual acuity after injury can be used as a predictor of visual acuity after treatment.
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Rauchman SH, Albert J, Pinkhasov A, Reiss AB. Mild-to-Moderate Traumatic Brain Injury: A Review with Focus on the Visual System. Neurol Int 2022; 14:453-470. [PMID: 35736619 PMCID: PMC9227114 DOI: 10.3390/neurolint14020038] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 05/23/2022] [Accepted: 05/25/2022] [Indexed: 02/01/2023] Open
Abstract
Traumatic Brain Injury (TBI) is a major global public health problem. Neurological damage from TBI may be mild, moderate, or severe and occurs both immediately at the time of impact (primary injury) and continues to evolve afterwards (secondary injury). In mild (m)TBI, common symptoms are headaches, dizziness and fatigue. Visual impairment is especially prevalent. Insomnia, attentional deficits and memory problems often occur. Neuroimaging methods for the management of TBI include computed tomography and magnetic resonance imaging. The location and the extent of injuries determine the motor and/or sensory deficits that result. Parietal lobe damage can lead to deficits in sensorimotor function, memory, and attention span. The processing of visual information may be disrupted, with consequences such as poor hand-eye coordination and balance. TBI may cause lesions in the occipital or parietal lobe that leave the TBI patient with incomplete homonymous hemianopia. Overall, TBI can interfere with everyday life by compromising the ability to work, sleep, drive, read, communicate and perform numerous activities previously taken for granted. Treatment and rehabilitation options available to TBI sufferers are inadequate and there is a pressing need for new ways to help these patients to optimize their functioning and maintain productivity and participation in life activities, family and community.
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Affiliation(s)
- Steven H. Rauchman
- The Fresno Institute of Neuroscience, Fresno, CA 93730, USA
- Correspondence:
| | - Jacqueline Albert
- Department of Medicine, Biomedical Research Institute, NYU Long Island School of Medicine, Mineola, NY 11501, USA; (J.A.); (A.B.R.)
| | - Aaron Pinkhasov
- Department of Psychiatry, NYU Long Island School of Medicine, Mineola, NY 11501, USA;
| | - Allison B. Reiss
- Department of Medicine, Biomedical Research Institute, NYU Long Island School of Medicine, Mineola, NY 11501, USA; (J.A.); (A.B.R.)
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10
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Zhang C, Xiao R, Wang A, Zhao Z. SILICONE OIL-FILLED FOLDABLE CAPSULAR VITREOUS BODY VERSUS SILICONE OIL ENDOTAMPONADE FOR TREATMENT OF NO LIGHT PERCEPTION AFTER SEVERE OCULAR TRAUMA. Retina 2022; 42:553-560. [PMID: 35188493 PMCID: PMC9561226 DOI: 10.1097/iae.0000000000003336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
PURPOSE To compare the anatomical and functional outcomes of silicone oil (SO)-filled foldable capsular vitreous body (FCVB) and SO endotamponade in vitrectomy for patients with no light perception after ocular trauma. METHODS A total of 64 patients (64 eyes) with no light perception caused by severe ocular trauma were divided into FCVB and SO groups based on the surgical treatment. The main outcome measurements were retinal reattachment rate, intraocular pressure, best-corrected visual acuity, and number of operations. RESULTS Both the FCVB group (29 eyes) and the SO group (35 eyes) showed significant improvement in postoperative best-corrected visual acuity and intraocular pressure. The two groups showed no significant differences in final intraocular pressure and the retinal reattachment rate. The postoperative vision (≥LP) in the FCVB group was significantly worse than in the SO group (FCVB [4/29] vs. SO [18/35], P = 0.003). However, the number of surgeries in the FCVB group was significantly lower than in the SO group (FCVB [1.10] vs. SO [2.23], P < 0.001). CONCLUSION Vitrectomy combined with SO endotamponade shows better short-term improvement in the treatment of no light perception caused by severe ocular trauma. However, SO-filled FCVB can effectively prevent many complications caused by direct SO endotamponade, such as secondary surgeries or SO dependence.
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Affiliation(s)
- Chun Zhang
- Department of Ophthalmology, Jiangxi Clinical Research Center for Ophthalmic Disease, Affiliated Eye Hospital of Nanchang University, Nanchang, China
| | - Ruihan Xiao
- Department of Ophthalmology, Jiangxi Clinical Research Center for Ophthalmic Disease, Affiliated Eye Hospital of Nanchang University, Nanchang, China
| | - Anan Wang
- Department of Ophthalmology, Jiangxi Clinical Research Center for Ophthalmic Disease, Affiliated Eye Hospital of Nanchang University, Nanchang, China
| | - Zhenquan Zhao
- Department of Ophthalmology, Eye Hospital of School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China; and
- Department of Ophthalmology, National Clinical Research Center for Ocular Diseases, Wenzhou, Zhejiang, China
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Chen H, Yang J, Wang C, Feng X, Feng K, Ma Z. Novel Suturing Methods for the Management of Traumatic Choroidal Avulsion in Globe Injuries. Front Med (Lausanne) 2022; 8:801068. [PMID: 35111782 PMCID: PMC8801457 DOI: 10.3389/fmed.2021.801068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 12/20/2021] [Indexed: 11/13/2022] Open
Abstract
PurposeTo explore the long-term efficacy of novel choroidal suturing methods including trans-scleral mattress suturing (TSS) and intraocular suturing (IOS) in the treatment of choroidal avulsion.DesignProspective cohort, hospital-based study.MethodsA total of 24 patients who were diagnosed with choroidal avulsion were enrolled in this study. The demographic characteristics, baseline information of trauma, best-corrected visual acuity (BCVA), and intraocular pressure (IOP) were collected before surgery, and the anatomic abnormities of the globe were recorded before or during surgery. All patients were diagnosed with choroidal avulsion and underwent choroid suturing treatment during vitrectomy, postoperative functional variables including BCVA and IOP, anatomic variables including retinal and choroidal reattachment rate, and silicone oil migration rate, which were recorded at the regular follow-ups at least 1 year after surgery.ResultsAll patients with open globe injury involved zone III, 70.8% of the patients presented with two quadrants of the avulsed choroid, and 29.2% with one quadrant involved; moreover, all patients had complications with retinal detachment (RD), of which 58.3% of patients had closed funnel retinal detachment. TSS was applied in nineteen patients and IOS in five patients. Postoperatively, a significant improvement on LogMAR BCVA was observed at each follow-up from 3.57 ± 0.69 before surgery to 2.82 ± 0.98 at the last follow-up (p < 0.05), and the proportion of no light perception (NLP) was also reduced from 69.6 to 37.5%. IOP was markedly elevated from 6.4 ± 4.1 mmHg preoperatively to 11.3 ± 4.3 mmHg at the last follow-up (p < 0.05). Choroidal reattachment was achieved in 91.7% of patients; two patients were observed with silicone oil migration at 3 months after surgery and underwent drainage of suprachoroidal silicone oil and sclera buckling. Meanwhile, retinal attachment was observed in 95.8% of patients, only one patient developed partial RD due to postoperative proliferative vitreoretinopathy, and secondary vitrectomy was performed; all patients were observed with complete retinal and choroidal attachment at the last follow-up. Eventually, four patients were silicone oil-free, and 20 patients were silicone oil-dependent.ConclusionsChoroidal suturing proved to be an effective method to fix the avulsed choroid, which greatly improved the BCVA and maintained the IOP, and efficiently increased the choroidal and retinal reattachment rate and preservation of the eyeball.
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Affiliation(s)
- Huijin Chen
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Beijing, China
| | - Jiarui Yang
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Beijing, China
| | - Changguan Wang
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Beijing, China
| | - Xuefeng Feng
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Beijing, China
| | - Kang Feng
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Beijing, China
| | - Zhizhong Ma
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Beijing, China
- *Correspondence: Zhizhong Ma
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Puodžiuvienė E, Valeišaitė G, Žemaitienė R. Clinical Characteristics, Visual Outcomes, and Prognostic Factors of Open Globe Injuries. Medicina (B Aires) 2021; 57:medicina57111198. [PMID: 34833416 PMCID: PMC8618771 DOI: 10.3390/medicina57111198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 10/25/2021] [Accepted: 11/01/2021] [Indexed: 01/24/2023] Open
Abstract
Background and Objectives: Open globe injuries (OGI) remain an important cause of visual impairment and loss, impacting all ages. A better understanding of the factors influencing visual outcomes is important in an attempt to improve the results of the treatment of OGI patients. The author aimed to contribute to this knowledge with the analysis of clinical characteristics, prognostic factors, and visual outcomes of their cohort of OGI patients. Materials and Methods: A retrospective medical record review was performed for 160 patients (161 eyes) who sustained an open globe injury between January 2015 and December 2017 and presented to the Hospital of Lithuanian University of Health Sciences. Data analyzed included age, sex, type, cause, place of OGI, initial visual acuity (VA), final best-corrected visual acuity (BCVA), and tissue involvement. Open globe injuries were classified using the Birmingham Eye Trauma Terminology (BETT) and Ocular Trauma Classification System (OTCS). Univariate analysis was conducted to evaluate the prognostic factors. Results: The mean age of the patients was 41.9 years. The male-to-female ratio was found to be 8.4:1. The home was the leading place of eye injury (59.6%), followed by an outdoor environment (14.3%) and workplace (11.8%). Penetrating injury accounted for 43.5%, followed by intraocular foreign body injury (39.1%) and globe rupture (13%). Overall, 19.5% of patients regained a good final vision of ≥0.5, but for 48.1% of them, eye trauma resulted in severe visual impairment (BCVA ≤ 0.02). In the univariate analysis, a bad visual outcome of less than 0.02 was correlated with bad initial VA, iris dialysis, hypotony, vitreous hemorrhage, and vitreous prolapse at presentation. Phthisis bulbi was correlated with eyelid laceration, iris prolapse, iris dialysis, hyphema, vitreous prolapse, vitreous hemorrhage, and choroidal rupture at initial examination. Conclusions: Open globe injury remains an important preventable cause of ocular morbidity. This study provides data indicating that open globe injuries are a significant cause of visual impairment in our research group.
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Dulz S, Dimopoulos V, Katz T, Kromer R, Bigdon E, Spitzer MS, Skevas C. Reliability of the ocular trauma score for the predictability of traumatic and post-traumatic retinal detachment after open globe injury. Int J Ophthalmol 2021; 14:1589-1594. [PMID: 34667737 DOI: 10.18240/ijo.2021.10.17] [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: 12/16/2020] [Accepted: 04/30/2021] [Indexed: 11/23/2022] Open
Abstract
AIM To elucidate the question of whether the ocular trauma score (OTS) and the zones of injury could be used as a predictive model of traumatic and post traumatic retinal detachment (RD) in patients with open globe injury (OGI). METHODS A retrospective observational chart analysis of OGI patients was performed. The collected variables consisted of age, date, gender, time of injury, time until repair, mechanism of injury, zone of injury, injury associated vitreous hemorrhage, trauma associated RD, post traumatic RD, aphakia at injury, periocular trauma and OTS in cases of OGI. RESULTS Totally 102 patients with traumatic OGI with a minimum of 12mo follow-up and a median age at of 48.6y (range: 3-104y) were identified. Final best corrected visual acuity (BCVA) was independent from the time of repair, yet a statistically significant difference was present between the final BCVA and the zone of injury. Severe trauma presenting with an OTS score I (P<0.0001) or II (P<0.0001) revealed a significantly worse BCVA at last follow up when compared to the cohort with an OTS score >III. OGI associated RD was observed in 36/102 patients (35.3%), whereas post traumatic RD (defined as RD following 14d after OGI) occurred in 37 patients (36.3%). OGI associated RD did not correlate with the OTS and the zone of injury (P=0.193), yet post traumatic RD correlated significantly with zone III injuries (P=0.013). CONCLUSION The study shows a significant association between lower OTS score and zone III injury with lower final BCVA and a higher number of surgeries, but only zone III could be significantly associated with a higher rate of RD.
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Affiliation(s)
- Simon Dulz
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Vasilis Dimopoulos
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
| | | | - Robert Kromer
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Eileen Bigdon
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Martin Stephan Spitzer
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Christos Skevas
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
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Kwon L, Cho YW, Seo SW, Kim SJ, Chung IY, Yoo WS. Endophthalmitis and Retinal Detachment after Ocular Injury by Animal Inoculation Needle. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2021. [DOI: 10.3341/jkos.2021.62.9.1305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Purpose: To report a case of endophthalmitis and retinal detachment after injury caused by an animal inoculation needle. Case summary: A 39-year-old man received an injury to his left eye with an animal inoculation needle while vaccinating a pig came to the hospital due to decreased visual acuity. At initial presentation, the best-corrected visual acuity in the left eye was “counting fingers,” and slit lamp examination revealed corneal lacerations, anterior capsule rupture, and traumatic cataract. Ultrasonography showed no specific findings in the vitreous and retina. Primary corneal suture, phacoemulsification, anterior vitrectomy due to rupture of the posterior capsule and vitreous prolapse, intraocular lens implantation, and intravitreal antibiotic injection were performed. On day 1 postoperatively, vitrectomy, anterior chamber irrigation, intravitreal antibiotic injection, and silicone oil injection were performed as signs of endophthalmitis, such as hypopyon and retinal tear, and focal retinal detachment were observed during surgery. Silicone oil removal was performed 7 months after the operation and the best-corrected visual acuity was 0.6. There has been no recurrence during follow-up. Conclusions: This is the first report in Korea of ocular injury caused by an animal inoculation needle. If the fundus is not observed in such injuries, there is a possibility of endophthalmitis and retinal detachment and early vitrectomy should be considered.
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Feng K, Yao Y, Wang Z, Nie H, Pang X, Chen H, Jiang Y, Hu Y, Ma Z. Mechanism and prognostic indicators for explosion-related eye trauma: eye injury vitrectomy study. Acta Ophthalmol 2021; 99:e956-e962. [PMID: 33417310 DOI: 10.1111/aos.14713] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 10/23/2020] [Accepted: 11/15/2020] [Indexed: 01/13/2023]
Abstract
PURPOSE To explore the clinical features, surgical interventions and prognosis of injured eyes following explosion and to develop the risk factors for poor prognosis. METHODS A nested case-control study. To the date of 31 December 2018, 99 explosion-related eye globes were selected from the Eye Injury Vitrectomy Study database, which is a multicenter prospective cohort study and began in 1990s. All cases selected underwent vitreoretinal surgery or enucleation and were followed up for at least 6 months. Clinically meaningful preoperative variables and outcomes were used to develop logistic regression models. RESULTS The unfavourable outcomes were defined as silicone oil-filled eyes, phthisis bulbi, enucleation and anatomically restored eyes whose final BCVA is worse than initial vision after 6 months of follow-up. The proportion of unfavourable outcomes was 92.0%, 60.9% and 66.7% in large festive fireworks, detonator and beer bottle groups respective. The anatomic and visual outcome of injured eyes with combined injury of blast wave and projectile were worse than that of ruptured eyes (Fisher's exact = 0.041). The extrusion of iris/lens (OR = 3.20, p = 0.015), PVR-C (OR = 6.08, p = 0.036) and choroid damage (OR = 5.84, p = 0.025) is independent risk factors of unfavourable prognosis for explosion-related eye trauma. CONCLUSION The extrusion of iris/lens, PVR-C and choroid damage is the independent risk factors for unfavourable outcomes in explosion-related eye trauma. There is a unique injury mechanism in explosion-related eye trauma. SUMMARY STATEMENT Through the nested case-control study, the extrusion of iris/lens, PVR-C, and choroid damage are the independent risk factors for unfavorable outcomes in explosion-related eye trauma. The mechanism of open globe mixture and close globe mixture in explosion-related eye trauma need more cases and participating units to explore together in the future.
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Affiliation(s)
- Kang Feng
- From the Peking University Third Hospital Peking University Eye Center Beijing Key Laboratory of Restoration of Damaged Ocular Nerve Beijing China
| | - Yi Yao
- Chinese PLA General Hospital Beijing China
| | - Zhi‐Jun Wang
- Department of Ophthalmology China‐Japan Friendship Hospital Beijing China
| | - Hong‐Ping Nie
- Department of Ophthalmology Peking University First Hospital Beijing China
| | - Xiu‐Qin Pang
- Department of Ophthalmology Tongren Hospital Capital University of Medical Sciences Beijing China
| | - Hui‐Jin Chen
- From the Peking University Third Hospital Peking University Eye Center Beijing Key Laboratory of Restoration of Damaged Ocular Nerve Beijing China
| | - Yan‐Rong Jiang
- Department of Ophthalmology Peking University People’s Hospital Beijing China
| | - Yun‐Tao Hu
- Tsinghua University Affiliated Beijing Tsinghua Changung Hospital Beijing China
| | - Zhi‐Zhong Ma
- From the Peking University Third Hospital Peking University Eye Center Beijing Key Laboratory of Restoration of Damaged Ocular Nerve Beijing China
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He K, Liao M, Zhu Y, Cui B, Chen H, Wang T, Wu N, Xie Z, Luo J, Wei Y, Wang Z, Zhou H, Shen Z, Yan H. Risk Factors for Band Keratopathy in Aphakic Eyes With Silicone Oil Tamponade for Open-Globe Injuries: A Multicenter Case-Control Study. Front Med (Lausanne) 2021; 8:713599. [PMID: 34368200 PMCID: PMC8342885 DOI: 10.3389/fmed.2021.713599] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 06/30/2021] [Indexed: 11/13/2022] Open
Abstract
Band keratopathy (BK) is a common complication in aphakic eyes with silicone oil tamponade for open-globe injury (OGI), characterized by the grayish-white opacities in the cornea, resulting in a significantly decreased vision when extending to the visual axis. To identify the risk factors for BK in aphakic eyes following vitreoretinal surgical treatment with silicone oil tamponade for OGIs, we performed a multicenter case-control study. The incidence of BK was 28% (28/100 eyes). The multivariate binary logistic regression revealed the silicone oil retention time (SORT) ≥6 months and zone III injury were significant risk factors for BK. From the hierarchical interaction, SORT ≥6 months had a significant risk for BK in eyes with rupture, aniridia, and zone III injury, while zone III injury had a significant risk for BK in eyes with rupture, incomplete/complete iris, and SORT ≥6 months. By using restricted cubic splines with three knots at the 25th, 50th, and 75th centiles to model the association of SORT with BK, we also found a marked increase in the risk for BK at ≥10 months and a slow increase after 6 months, but almost stable within 4-6 months.
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Affiliation(s)
- Kai He
- Department of Ophthalmology, Tianjin Medical University General Hospital, Tianjin Medical University, Tianjin, China
| | - Mengyu Liao
- Department of Ophthalmology, Tianjin Medical University General Hospital, Tianjin Medical University, Tianjin, China
| | - Yun Zhu
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Bohao Cui
- Department of Ophthalmology, Tianjin Medical University General Hospital, Tianjin Medical University, Tianjin, China
| | - Haoyu Chen
- Department of Ophthalmology, Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, Shantou, China
| | - Ting Wang
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Department of Ophthalmology, Shandong Eye Institute, Eye Hospital of Shandong First Medical University, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China
| | - Nan Wu
- Department of Ophthalmology, Southwest Hospital, Southwest Eye Hospital, Army Medical University, Chongqing, China
| | - Zhenggao Xie
- Department of Ophthalmology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Jing Luo
- Department of Ophthalmology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Yong Wei
- The Eye Hospital of Wenzhou Medical University, Wenzhou, China
| | - Zhiliang Wang
- Department of Ophthalmology, Huashan Hospital of Fudan University, Shanghai, China
| | - Heding Zhou
- Department of Ophthalmology, Ningbo Eye Hospital, Wenzhou Medical University, Ningbo, China
| | - Zhansheng Shen
- Department of Ophthalmology, Zhengzhou Second Hospital, Zhengzhou, China
| | - Hua Yan
- Department of Ophthalmology, Tianjin Medical University General Hospital, Tianjin Medical University, Tianjin, China
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Wang A, Zhao Z. COMPARING VITRECTOMY, SILICONE OIL ENDOTAMPONADE WITH/WITHOUT CYCLOPEXY TO TREAT CYCLODIALYSIS CLEFTS WITH SEVERE OCULAR TRAUMA. Retina 2021; 41:1174-1181. [PMID: 33079790 PMCID: PMC8140664 DOI: 10.1097/iae.0000000000002996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Comparing the anatomical and functional outcomes of vitrectomy, silicone oil endotamponade without cyclopexy (VEWOC) and with cyclopexy (VEWC) in patients with traumatic cyclodialysis clefts and severe ocular comorbidities. METHODS A total of 55 patients (55 eyes) with traumatic cyclodialysis clefts were divided into VEWOC and VEWC groups according to the surgery undergone. Besides the cyclodialysis clefts, all study eyes had one or more additional conditions caused by severe ocular trauma: cataract, lens dislocation, vitreous hemorrhage, retinal detachment, choroidal detachment, maculopathy, suprachoroidal hemorrhage, subretinal hemorrhage, or proliferative vitreoretinopathy. The minimum postoperative follow-up period for all patients was six months. The main measures of outcome were rate of successful anatomical repair, intraocular pressure, and best-corrected visual acuity. RESULTS Both the VEWOC group (33 eyes) and the VEWC group (22 eyes) showed significant improvement in postoperative best-corrected visual acuity and intraocular pressure at the final follow-up. The groups had no significant differences in terms of anatomical success rates (VEWOC 29/33 vs. VEWC 20/22, P = 1.000), final best-corrected visual acuity (VEWOC 1.60 ± 0.76 [median Snellen acuity: counting fingers, range: light perception to 20/20] vs. VEWC 1.46 ± 0.66 [median Snellen acuity: 20/800, range: light perception to 20/32], P = 0.485), and final intraocular pressure (VEWOC 13.40 [8.20-17.80] vs. VEWC 11.40 [6.65-14.00] mmHg, P = 0.311). However, the intraocular pressure on postoperative Day 1 was significantly different between the groups (VEWOC 10.40 [6.40-14.60] vs. VEWC 6.40 [4.70-7.98] mmHg, P = 0.002). CONCLUSION This study showed that both surgical approaches were equally effective in treating cyclodialysis clefts secondary to severe ocular trauma. Therefore, it may be unnecessary to perform cyclopexy in addition to the vitrectomy procedure in such cases.
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Affiliation(s)
- Anan Wang
- Department of Ophthalmology, Affiliated Eye Hospital of Nanchang University, Nanchang, China; and
| | - Zhenquan Zhao
- Department of Ophthalmology, Eye Hospital of Wenzhou Medical University, Wenzhou, China
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Liu X, Wang L, Yang F, Xie J, Zhao J, Liu Z, Su G, Yang L. Surgical management and outcomes of pediatric open globe injuries requiring vitrectomy. Eur J Ophthalmol 2021; 32:546-552. [PMID: 33706579 DOI: 10.1177/11206721211000648] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To describe surgical management and establish visual outcomes of open globe injury (OGI) in pediatric patients requiring vitrectomy. METHODS Forty-eight eyes of 48 pediatric patients underwent vitrectomy for OGI with secondary vitreoretinal complications in the eye center of Jilin University were included. Characteristics of patients, details of ocular examination and operation, presenting and final visual acuity were recorded. RESULTS Presenting visual acuity less than 20/400 was found in 44 eyes (91.7%), which included no light perception (NLP) in four eyes. At last visit, there was no eyes with visual acuity of NLP, and 19 eyes (39.6%) had a vision recovery to 20/400 or better. Mechanisms of injury, intraocular contents prolapse, presence of hyphema, intraocular foreign body, vitreous hemorrhage, retinal detachment, and total time from injury to PPV > 2 weeks were significant predictors of visual prognosis. Logistic regression analysis showed that hyphema was a significant predictive factor for poor visual outcome. CONCLUSION Visual acuity was improved in most of the patients with OGI in this study. Hyphema is an important presenting ocular sign in estimating the post-vitrectomy visual outcome for OGI in children. Proper timing of vitrectomy is suggested, and in this study patients may benefit more with early vitrectomy as less proliferative vitreoretinopathy (PVR) was found together with a better visual acuity.
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Affiliation(s)
- Xin Liu
- Eye Center, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Lufei Wang
- Eye Center, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Fengjuan Yang
- Eye Center, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Jia'nan Xie
- Eye Center, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Jinsong Zhao
- Eye Center, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Zaoxia Liu
- Eye Center, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Guanfang Su
- Eye Center, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Longfei Yang
- Jilin Provincial Key Laboratory on Molecular and Chemical Genetics, The Second Hospital of Jilin University, Changchun, Jilin, China
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Prognostic factors and long-term outcomes of eye-globe perforation: Eye injury vitrectomy study. Injury 2021; 52:286-291. [PMID: 33032800 DOI: 10.1016/j.injury.2020.09.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 09/19/2020] [Accepted: 09/29/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To delineate anatomic and visual outcomes of injured eye globes with perforating, and to develop the prognostic indicators for perforating eyes. METHODS The case series study, from a multicenter prospective cohort database. To the date of December 31st, 2018, of 63 perforating globes were selected. All cases underwent vitreoretinal surgeries or enucleations, and were followed up for at least 6 months. Demographic characteristics, basic examination for traumatized eyes, and intraocular tissue damages were recorded by surgery-in-chief. At the follow-up visit, best corrected VA, intraocular pressure, the intraocular tamponade material, retinal anatomic outcome of eye-globes, and phthisis or enucleation were evaluated. RESULTS Fifty injured eyes (79%) were caused by sharp objects and 13 eyes (21%) were injured by a missiles. Twenty-two injured eyes can be anatomically restored with final vision of more than 4/200 through vitreoretinal surgery. The PVR-C (OR = 5.67, P = 0.01), area of retinectomy more than 2 times of optic disk (OR = 5.16, P = 0.04), and macular damage (OR = 6.38, P = 0.01) were correlated with unfavorable outcomes. CONCLUSION The injured eyes with perforation can be saved through vitreoretinal surgery, the PVR-C, retinectomy more than 2 times of optic disk, and macular damage were independent risk factors for poor long-term prognosis.
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Djalali-Talab Y, Mazinani B, Djalali-Talab Y. Traumatic open globe injury—epidemiology, risk factors and visual outcome at the University Hospital Aachen. SPEKTRUM DER AUGENHEILKUNDE 2021. [DOI: 10.1007/s00717-020-00480-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Summary
Background
Ocular trauma is still a major cause leading to enucleation. This study aims to analyze the visual outcome, epidemiology and risk factors of open globe injury (OGI) at the University Hospital Aachen, Germany.
Material and methods
A retrospective analysis of patient records involving traumatic OGI treated surgically between 2005 and 2015 was conducted. Age, gender, cause of accident, ocular trauma score, best corrected visual acuity (BCVA) at presentation and after treatment as well as location of injury were evaluated.
Results
Of 2272 eyes with trauma, 102 patients with OGI were identified, of which 65% were male and 35% were female. Women were significantly older than men (p < 0.001). The most common cause of injury was domestic syncopal episodes (47%). Work-related injuries occurred exclusively in men in 8.8%. A total of 16% had no light perception (NLP) at presentation, 69% of which improved post intervention to hand movement or better. Endophthalmitis was observed in 4% of all cases. Enucleation was needed mostly due to rupture. Location of OGI, pseudophakia and initial BCVA are risk factors for poor final BCVA. Patients’ BCVA did not improve further after three surgeries.
Conclusion
Traumatic OGI still poses a challenge in terms of treatment planning and prognostic outcome. A rise in elderly patients with multimorbidity represents a secondary obstacle to treatment. Patients with initial NLP can be treated with moderate success. Nevertheless, risk factors and ocular trauma score are unable to provide definitive therapy decisions. OGI should be assessed case by case, taking risk factors for OGI into account. Treating physicians should consider the ethical and economic reasons with regard to whether a high number of surgeries with possible comorbidities is justified.
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Gauthier AC, Oduyale OK, Fliotsos MJ, Zafar S, Mahoney NR, Srikumaran D, Woreta FA. Clinical Characteristics and Outcomes in Patients Undergoing Primary or Secondary Enucleation or Evisceration After Ocular Trauma. Clin Ophthalmol 2020; 14:3499-3506. [PMID: 33149543 PMCID: PMC7602916 DOI: 10.2147/opth.s273760] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 09/23/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose To investigate the frequency of primary versus secondary eye removal, frequency of enucleation versus evisceration, and characteristics and outcomes of patients undergoing these procedures after presenting with severe ocular trauma. Patients and Methods Retrospective chart review of patients presenting to the emergency department (ED) with severe eye trauma necessitating enucleation or evisceration between 2010 and 2018. Results There were 92 eyes from 90 patients included in our study. Twenty-seven percent of eyes underwent primary removal (n=25, 14 enucleation, 11 evisceration), while 73% of eyes underwent secondary removal (n=67, 50 enucleation, 17 evisceration). The mean patient age was 45.2 years (range 4.2–92.6); primary enucleation/evisceration patients were older on average than secondary eye removal patients [53.8 years (range 15.9–91.2) versus 42.2 years (range 4.2–91.6 years), p=0.04]. A median of 34 days passed between ED presentation and secondary enucleation/evisceration. Before undergoing secondary enucleation/evisceration, patients underwent a median of one ocular procedure (range 0–14) for various complications of trauma including orbital infection, choroidal or retinal tear or detachment, and wound dehiscence. Open globe injury repairs comprised 43 of the 92 total procedures (47%) performed prior to secondary enucleation/evisceration. Secondary enucleations/eviscerations required a median of seven clinic visits compared to two clinic visits required after primary surgeries (p<0.01). 10.7% of all patients (n=10) had at least one implant-related complication following enucleation/evisceration, with all but one of these patients being in the secondary enucleation/evisceration group. Conclusion Primary enucleation or evisceration was performed in 27% of all eye removals, and enucleation was performed in 69.6% of all eye removals. Future research is warranted to determine if primary eye removal may be appropriate and when to consider enucleation versus evisceration.
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Affiliation(s)
- Angela C Gauthier
- Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Oluseye K Oduyale
- Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Michael J Fliotsos
- Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Sidra Zafar
- Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Nicholas R Mahoney
- Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Divya Srikumaran
- Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Fasika A Woreta
- Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, MD, USA
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Yoon JH, Son BJ. The Role of Orbital Computed Tomography as a Prognostic Indicator for Open Globe Injury. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2020. [DOI: 10.3341/jkos.2020.61.9.983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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23
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Toh ZH, Agrawal S, Raje D, Hoskin A, Agrawal R, Khandelwal R. International globe and adnexal trauma epidemiology study (IGATES): a report from Central India on visual outcome in open globe injuries and correlation with ocular trauma score. Int Ophthalmol 2020; 40:2797-2806. [DOI: 10.1007/s10792-020-01429-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 05/15/2020] [Indexed: 11/28/2022]
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24
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25
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Acupuncture resulting in eye penetration and proliferative vitreoretinopathy - Surgical and medical management with intraocular methotrexate. Am J Ophthalmol Case Rep 2020; 18:100605. [PMID: 32181412 PMCID: PMC7063175 DOI: 10.1016/j.ajoc.2020.100605] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 10/31/2019] [Accepted: 11/05/2019] [Indexed: 12/19/2022] Open
Abstract
Purpose To highlight the surgical and medical management used in an extensive globe penetrating injury caused by an acupuncture needle. Observations We report on a case of acupuncture treatment error resulting in needle penetration of the eye, retinal detachment, and progressive post-traumatic proliferative vitreoretinopathy (PVR). This patient required aggressive surgical management with multiple vitrectomies along with adjunctive intravitreal methotrexate to control ongoing PVR. At last follow-up, 15 months after presentation, the patient's BCVA was 20/40 and the periphery was flat with fibrosis stable. Conclusions and Importance Open globe injuries are a subtype of ocular trauma which can cause irreparable vision loss. This case highlights the extensive potential complications which can occur following traumatic injury to the retina and choroid, as well as the role of both surgical and medical management of retinal detachment and PVR. In addition, this is the first report of the use of off-label adjunctive intravitreal methotrexate to control post-traumatic PVR. Further research into this treatment approach could reveal a role of adjunctive methotrexate in the management of such injuries.
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26
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Chen X, Zha Y, Du S, Yang X. Timely Use of Conventional Vitrectomy and Endoscope-Assisted Vitrectomy for Endophthalmitis Following Open Ocular Trauma: A Retrospective Study of 18 Patients. Med Sci Monit 2019; 25:8628-8636. [PMID: 31732711 PMCID: PMC6874835 DOI: 10.12659/msm.918017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background Endophthalmitis, or inflammation of the internal tissues of the eye, may follow trauma and results in loss of vision if not treated promptly. Vitrectomy is used to debride the inflamed vitreous. This retrospective study aimed to compare the outcome from conventional vitrectomy (CV) and endoscope-assisted vitrectomy (EAV) performed for endophthalmitis within five days and 10 days after open ocular trauma. Material/Methods The clinical data from 18 patients (18 eyes) with endophthalmitis caused by open ocular trauma were analyzed at a single center. CV or EAV was performed based on the degree of vision and the involvement of the vitreous cavity. Results Of the 18 patients with endophthalmitis, seven patients underwent EAV, and 11 patients underwent CV. The number of cases with preoperative corneal laceration, edema, bleeding, and formation of corneal nebular opacity was higher in the EAV group compared to the CV group. Four patients had retinal detachment, of which three patients were treated with EAV. Seventeen patients had their sight restored by a single vitrectomy procedure. In 10 cases, the culture of the vitreous fluid was positive for infection, and eight patients had Gram-positive Staphylococcus epidermidis infection. Follow-up showed that vitrectomy performed within five days (P=0.001) and 10 days (P=0.047) of open ocular trauma resulted in significant improvement of visual acuity. Conclusions Vitrectomy for endophthalmitis due to open ocular trauma performed within five days of injury restored visual acuity. EAV was shown to be an effective alternative to CV.
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Affiliation(s)
- Xing Chen
- The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China (mainland).,Department of Fundus Diseases and Ocular Trauma, Lixiang Eye Hospital of Soochow University, Suzhou, Jiangsu, China (mainland).,Department of Ophthalmology, Wuxi 9th Affiliated Hospital of Soochow University, Wuxi, Jiangsu, China (mainland)
| | - Youyou Zha
- Department of Fundus Diseases and Ocular Trauma, Lixiang Eye Hospital of Soochow University, Suzhou, Jiangsu, China (mainland)
| | - Shu Du
- Department of Fundus Diseases and Ocular Trauma, Lixiang Eye Hospital of Soochow University, Suzhou, Jiangsu, China (mainland)
| | - Xun Yang
- The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China (mainland).,Department of Fundus Diseases and Ocular Trauma, Lixiang Eye Hospital of Soochow University, Suzhou, Jiangsu, China (mainland)
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27
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Hoskin AK, Watson SL, Mackey DA, Agrawal R, Keay L. Eye injury registries - A systematic review. Injury 2019; 50:1839-1846. [PMID: 31378543 DOI: 10.1016/j.injury.2019.07.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 07/18/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Registries are integral to monitoring, surveying, treating, preventing and prognosticating trauma. The quantity and quality of data must justify a change or intervention in treatment and/or preventive strategies and must be collected while balancing the cost and time invested in the registry. This review documents the quality, completeness and operational and funding models for ocular trauma registries worldwide. METHODS The databases CENTRAL, MEDLINE, EMBASE and Informit Health Collection were searched using key word and mesh terms for: "Eye injury, "Ocular trauma", "Eye injury prevention", "Eye protection", "Registry". To find relevant unpublished articles and theses, clinicaltrials.gov, Trip, MedNar and Google Scholar were searched using the key words "eye injury" OR "ocular trauma" AND "registry*". No date or language restrictions were applied. The quality of registry data was assessed against published measures including design, operation and data quality. RESULTS The electronic search retrieved 528 distinct published articles; 61 articles were assessed for eligibility. Of the 61 articles identified, 28 were eligible to be included in the review, with cross-referencing identifying a further 7 articles. The source of most articles on ocular trauma registries was the United States, followed by Germany and China. Patient follow-up was conducted in 31 studies, with 6 months being the most frequently reported period. Issues with data quality included incomplete data such as presence or absence of eye protection and initial visual acuity. Attrition bias was controlled by the United States Eye Injury Register with follow-up. Patients without follow-up data were removed for some studies and this may have introduced bias. CONCLUSION National, state and hospital-based ocular trauma registries have contributed significantly to our understanding of ocular trauma. The United States has the most frequently cited and well-resourced ocular trauma registries. It is anticipated that this review will guide the development of future registries for ocular trauma in order to inform evidence-based prevention strategies and, ultimately, improve visual outcomes. We recommend the development of a consensus guidelines for international ocular trauma registry that includes mechanism and context of injury and visual outcomes, to permit international comparison that can be implemented at low cost with secure data capture.
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Affiliation(s)
- Annette K Hoskin
- The University of Sydney, Save Sight Institute, Discipline of Ophthalmology, Sydney Medical School, Sydney, New South Wales, Australia; Lions Eye Institute. Nedlands, Western Australia, Australia; Department of Ophthalmology, University of Western Australian, Nedlands, Western Australia, Australia.
| | - Stephanie L Watson
- The University of Sydney, Save Sight Institute, Discipline of Ophthalmology, Sydney Medical School, Sydney, New South Wales, Australia
| | - David A Mackey
- Lions Eye Institute. Nedlands, Western Australia, Australia; Department of Ophthalmology, University of Western Australian, Nedlands, Western Australia, Australia
| | | | - Lisa Keay
- The School of Optometry and Vision Science, UNSW, Sydney, New South Wales, Australia; The George Institute for Global Health, UNSW, Sydney, New South Wales, Australia
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28
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Mayalı H, Kayıkçıoğlu Ö, Altınışık M, Bıçak F, Kurt E. Clinical Results in Patients with Combined Penetrating Keratoplasty and Vitreoretinal Surgery Using Landers Wide-field Temporary Keratoprosthesis. Turk J Ophthalmol 2019; 49:270-276. [PMID: 31650801 PMCID: PMC6823587 DOI: 10.4274/tjo.galenos.2019.87059] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objectives To evaluate the clinical results of combined pars plana vitrectomy (PPV) with Landers wide-field temporary keratoprosthesis and penetrating keratoplasty (PK). Materials and Methods From January 2016, traumatic eyes with coexisting corneal and vitreoretinal diseases that underwent combined keratoprosthesis/PPV/PK surgery were retrospectively evaluated. Demographic characteristics, visual acuity (VA), intraocular pressure (IOP) and clinical findings of the cornea, lens, and retina were recorded during the follow-up. Cases with clear corneal graft, attached retina, normotonic IOP, and improved or stable VA were considered successful. Results Eight eyes were enrolled in the study. The mean follow-up time was 21.1±8.20 months. Surgery was performed a mean of 23 (10-40) days after trauma. Preoperative VA ranged from no light perception to counting fingers from 50 cm. Postoperatively, corneal graft was clear in 5 patients (62.5%) and retina was attached in 6 eyes (75%). Chronic hypotonia developed in 3 patients (37.5%). VA was unchanged in 3 patients and improved in 5 patients. A total of 5 cases (50%) were considered successful. Shorter interval between trauma and surgery was associated with higher likelihood of success (p=0.043). No significant difference was observed between the groups in terms of type or location of trauma (p=1; p=0.143). Conclusion Although the functional results are not very satisfactory, the combined procedure provides a final opportunity for preserving remaining vision and anatomic reconstruction in eyes that will otherwise result in phthisis due to severe anterior and posterior segment pathologies.
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Affiliation(s)
- Hüseyin Mayalı
- Manisa Celal Bayar University Faculty of Medicine, Department of Ophthalmology, Manisa, Turkey
| | - Özcan Kayıkçıoğlu
- Manisa Celal Bayar University Faculty of Medicine, Department of Ophthalmology, Manisa, Turkey
| | - Muhammed Altınışık
- Manisa Celal Bayar University Faculty of Medicine, Department of Ophthalmology, Manisa, Turkey
| | - Faruk Bıçak
- Manisa Celal Bayar University Faculty of Medicine, Department of Ophthalmology, Manisa, Turkey
| | - Emin Kurt
- Manisa Celal Bayar University Faculty of Medicine, Department of Ophthalmology, Manisa, Turkey
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29
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Hughes E, Fahy G. A 24-month review of globe rupture in a tertiary referral hospital. Ir J Med Sci 2019; 189:723-726. [DOI: 10.1007/s11845-019-02097-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 09/05/2019] [Indexed: 11/30/2022]
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30
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Guven S, Durukan AH, Erdurman C, Kucukevcilioglu M. Prognostic factors for open-globe injuries: variables for poor visual outcome. Eye (Lond) 2018; 33:392-397. [PMID: 30258128 DOI: 10.1038/s41433-018-0218-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 08/06/2018] [Accepted: 08/14/2018] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To determine prognostic factors for open-globe Injuries (OGI). METHODS Open-globe injuries referred to a tertiary referral clinic in Turkey between January 1998 and January 2016 were retrospectively analyzed. Univariate and multivariate logistic regression analyses were conducted to find out the most important variables for poor visual outcome. RESULTS Six hundred and thirty-three patients were studied with an average age of 24.37 ± 11.1 years (range 1-80).The male/female ratio was 18.6/1. Most of the cases (48.2%) were conflict related, whereas the rate of work, accidental, and sports related cases were (33.1%), (17.9%) and (0.01%), respectively. Final visual acuity (VA) ranged from no perception of light (23%) to 200/200 (17.1%). The number of cases with a final VA > 20/200 were 388 (49.3%). Initial visual acuity < 20/200, ocular trauma score category 1, zone 3 injury, additional vitrectomy surgery, and lens damage were found to be the main variables related with poor visual outcome in multivariate logistic regression analysis. CONCLUSION Besides ocular trauma score category and initial VA; zone of injury, additional surgeries, and initial lens damage had negative effects on visual outcome in OGI.
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Affiliation(s)
- Soner Guven
- Department of Ophthalmology, Kayseri Research and Training Hospital, Kayseri, Turkey.
| | | | - Cuneyt Erdurman
- Department of Ophthalmology, Gulhane Medical School, Ankara, Turkey
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31
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Han L, Cho YL, Ma Z, Zhao X, Chang X. Clinical histopathology of intrachoroidal splitting in open-globe injury: A retrospective case series of four patients. Taiwan J Ophthalmol 2018; 8:36-41. [PMID: 29675348 PMCID: PMC5890583 DOI: 10.4103/tjo.tjo_61_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
PURPOSE: The purpose of this study is to observe the characteristics of intrachoroidal splitting (ICS) associated with choroidal detachment due to open-globe injury. METHODS: A retrospective, observational case series study of four eyes diagnosed with choroidal detachment exhibited ICS. The in vivo pathologic changes of the ICS were recorded during surgery. Four specimens were obtained from the inner part of the ICS region. One specimen was stained with hematoxylin and eosin; one specimen was examined under scanning electron microscopy, and the other two specimens were examined under transmission electron microscopy. RESULTS: All four patients presented with vortex vein rupture associated with large-scaled mid-peripheral ICS. The histopathologic observations indicated that ICS occurred between the medium-sized and large-sized choroidal vessel layers. Large vascular indentations and medium-sized choroidal vessels were observed on the inner part of the split interface. Postoperative outcomes of the four patients were poor. Vision in all four patients was no light perception before or after surgery. Three eyes became atrophic with silicon oil tamponade and band keratopathy, one eye was eventually enucleated for cosmetic reason. CONCLUSION: Intrachoroidal tissue has the potential to split during trauma. The outcome of ICS with choroidal detachment in open-globe injury was poor.
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Affiliation(s)
- Liang Han
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
| | - Yen-Ling Cho
- Department of Ophthalmology, Peking University International Hospital, Beijing, China
| | - Zhizhong Ma
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China.,Department of Ophthalmology, Peking University International Hospital, Beijing, China
| | - Xinrong Zhao
- Peking University Health and Science Center, Beijing, China
| | - Xin Chang
- Peking University Health and Science Center, Beijing, China
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32
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Wang H, Chen T, Ye L, Yang QC, Wei R, Zhang Y, Jiang N, Shao Y. Network centrality in patients with acute unilateral open globe injury: A voxel‑wise degree centrality study. Mol Med Rep 2017; 16:8295-8300. [PMID: 28983610 DOI: 10.3892/mmr.2017.7635] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 08/01/2017] [Indexed: 11/06/2022] Open
Abstract
The present study aimed to investigate functional networks underlying brain‑activity alterations in patients with acute unilateral open globe injury (OGI) and associations with their clinical features using the voxel‑wise degree centrality (DC) method. In total, 18 patients with acute OGI (16 males and 2 females), and 18 healthy subjects (16 males and 2 females), closely matched in age, sex and education, participated in the present study. Each subject underwent a resting‑state functional magnetic resonance imaging scan. The DC method was used to assess local features of spontaneous brain activity. Receiver operating characteristic curve analysis was used to distinguish OGIs from healthy controls (HCs). Correlation analysis was used to examine the association between the observed mean DC values of different brain areas and behavioral performance. Compared with HCs, patients with acute unilateral OGI had significantly increased DC values in the bilateral primary visual cortex (V1/V2) and left precuneus (PCUN), and significantly decreased DC values in the right insula, left insula, right inferior parietal lobule (IPL)/supramarginal gyrus (SMG), IPL/SMG, right supplementary motor area and right postcentral gyrus. Additionally, in the acute OGI group, it was observed that the duration of OGI was negatively correlated with the DC signal value of the bilateral V1/V2 (r=‑0.581; P=0.011) and left PCUN (r=‑0.508; P=0.031). Acute OGI led to brain functional network dysfunction in a number of brain regions, which may indicate impairment of the visual cortex and other vision‑associated brain regions in OGI.
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Affiliation(s)
- Hua Wang
- Department of Ophthalmology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - Ting Chen
- Department of Ophthalmology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - Lei Ye
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Jiangxi Province Clinical Ophthalmology Institute and Oculopathy Research Centre, Nanchang, Jiangxi 330006, P.R. China
| | - Qi-Chen Yang
- Eye Institute of Xiamen University, Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Xiamen, Fujian 361102, P.R. China
| | - Rong Wei
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Jiangxi Province Clinical Ophthalmology Institute and Oculopathy Research Centre, Nanchang, Jiangxi 330006, P.R. China
| | - Ying Zhang
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Jiangxi Province Clinical Ophthalmology Institute and Oculopathy Research Centre, Nanchang, Jiangxi 330006, P.R. China
| | - Nan Jiang
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Jiangxi Province Clinical Ophthalmology Institute and Oculopathy Research Centre, Nanchang, Jiangxi 330006, P.R. China
| | - Yi Shao
- Department of Ophthalmology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
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33
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Intraoperative B-scan ultrasonography and pars plana vitrectomy for severe open globe injury with hemorrhagic retinal and choroidal detachment. Graefes Arch Clin Exp Ophthalmol 2017; 255:2287-2291. [PMID: 28856428 DOI: 10.1007/s00417-017-3771-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 07/20/2017] [Accepted: 08/01/2017] [Indexed: 10/19/2022] Open
Abstract
PURPOSE Our purpose was to report the initial clinical experience of intraoperative B-scan ultrasonography in combination with 25-gauge pars plana vitrectomy for severe open globe injury with hemorrhagic retinal and choroidal detachment. METHODS Six eyes of six consecutive patients with severe open globe injury underwent intraoperative B-scan ultrasonography and 25-gauge pars plana vitrectomy at Osaka University Hospital in Japan. The feasibility of intraoperative B-scan ultrasonography, best-corrected visual acuity (BCVA), retinal reattachment, and intraoperative and postoperative complications were evaluated. RESULTS Five patients presented with a ruptured globe and one patient with double penetration. Preoperative best-corrected visual acuity was no light perception in four eyes and light perception in two eyes. All patients underwent intraoperative B-scan ultrasonography and 25-gauge pars plana vitrectomy within 12 h after open globe injury. Intraoperative B-scan ultrasonography was feasible in all cases and was useful for diagnosing choroidal hemorrhage (four eyes), massive subretinal hemorrhage (two eyes), and retinal detachment (five eyes). In addition, serial real-time B-scan imaging facilitated successful evacuation of the choroidal hemorrhage and massive subretinal hemorrhage by external drainage, resulting in opening of the vitreous space to allow subsequent pars plana vitrectomy without entry site-related complications. After surgery, all patients had successful retinal attachment, and there was no loss of light perception. CONCLUSION Intraoperative B-scan ultrasonography is technically feasible and may potentially improve the safety and efficacy of severe open globe injury repair.
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Fiorentzis M, Viestenz A, Heichel J, Seitz B, Hammer T, Viestenz A. Methods of fixation of intraocular lenses according to the anatomical structures in trauma eyes. Clin Anat 2017; 31:6-15. [DOI: 10.1002/ca.22898] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 05/05/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Miltiadis Fiorentzis
- Department of Ophthalmology; University Hospital Halle (Saale), Martin-Luther University Halle-Wittenberg; Halle Saale Germany
| | - Anja Viestenz
- Department of Ophthalmology; University Hospital Halle (Saale), Martin-Luther University Halle-Wittenberg; Halle Saale Germany
| | - Jens Heichel
- Department of Ophthalmology; University Hospital Halle (Saale), Martin-Luther University Halle-Wittenberg; Halle Saale Germany
| | - Berthold Seitz
- Department of Ophthalmology; Saarland University Medical Center; Homburg/Saar Germany
| | - Thomas Hammer
- Department of Ophthalmology; University Hospital Halle (Saale), Martin-Luther University Halle-Wittenberg; Halle Saale Germany
| | - Arne Viestenz
- Department of Ophthalmology; University Hospital Halle (Saale), Martin-Luther University Halle-Wittenberg; Halle Saale Germany
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35
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Kaneko H, Asami T, Sugita T, Tsunekawa T, Matsuura T, Takayama K, Yamamoto K, Kachi S, Ito Y, Ueno S, Nonobe N, Kataoka K, Suzumura A, Iwase T, Terasaki H. Better Visual Outcome by Intraocular Lens Ejection in Geriatric Patients with Ruptured Ocular Injuries. PLoS One 2017; 12:e0170094. [PMID: 28107485 PMCID: PMC5249204 DOI: 10.1371/journal.pone.0170094] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 12/28/2016] [Indexed: 11/18/2022] Open
Abstract
Ocular trauma is one of the leading causes of visual impairment worldwide. Because of the popularity of cataract surgeries, aged individuals with ocular trauma commonly have a surgical wound in their eyes. The purpose of this study was to evaluate the visual outcome of cases that were coincident with intraocular lens (IOL) ejection in the eyes with ruptured open-globe ocular injuries. Consecutive patients with open-globe ocular injuries were first reviewed. Patients’ characteristics, corrected distance visual acuities (CDVAs) over 3 years after the trauma, causes of injuries, traumatic wound patterns, and coexistence of retinal detachment were examined. The relationships between poor CDVA and the other factors, including the complications of crystalline lens and IOL ejection, were examined. A total of 105 eyes/patients [43 eyes with rupture, 33 with penetrating, 28 with intraocular foreign body (IOFB), and 1 with perforating injuries] were included. Rupture injuries were common in aged patients and were mostly caused by falls, whereas penetrating and IOFB injuries were common in young male patients. CDVAs of the eyes with rupture injuries were significantly worse than those of the eyes with penetrating or IOFB injuries. CDVA from more than 50% of the ruptured eyes resulted in no light perception or light perception to 20/500. CDVA of the ruptured eyes complicated by crystalline lens ejection was significantly worse than that of those complicated by IOL ejection. The wounds of the ruptured eyes complicated by IOL ejection were mainly located at the superior corneoscleral limbus, whereas those of the eyes complicated by crystalline lens ejection were located at the posterior sclera. There were significant correlations between poor CDVA and retinal detachment and crystalline lens ejection. These results proposed a new trend in the ocular injuries that commonly occur in aged patients; history of cataract surgery might affect the final visual outcome after open-globe ocular injuries.
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Affiliation(s)
- Hiroki Kaneko
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, Nagoya, Japan
- * E-mail:
| | - Tetsu Asami
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tadasu Sugita
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Taichi Tsunekawa
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Toshiyuki Matsuura
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kei Takayama
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kentaro Yamamoto
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shu Kachi
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasuki Ito
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shinji Ueno
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Norie Nonobe
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Keiko Kataoka
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Ayana Suzumura
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takeshi Iwase
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroko Terasaki
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Xia T, Bauza A, Soni NG, Zarbin MA, Langer PD, Bhagat N. Surgical Management and Outcome of Open Globe Injuries with Posterior Segment Complications: A 10-Year Review. Semin Ophthalmol 2016; 33:351-356. [DOI: 10.1080/08820538.2016.1242634] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Tian Xia
- Institute of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Alain Bauza
- Institute of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Nishant G. Soni
- Institute of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Marco A. Zarbin
- Institute of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Paul D. Langer
- Institute of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Neelakshi Bhagat
- Institute of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, NJ, USA
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Wang CG, Ma ZZ. Development of medical treatment for eye injuries in the mainland of China over the past decade. Chin J Traumatol 2016; 19:311-316. [PMID: 28088931 PMCID: PMC5198919 DOI: 10.1016/j.cjtee.2016.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
In the article, the development of medical treatment for eye injuries in the mainland of China was reviewed. According to the data provided in Eye Injury Vitrectomy Study (EIVS), 27% of 72 eyes with no light perception (NLP) gained recovery in term of antomy and visual function. Vitrectomy initiated at more than 4 weeks after open eye injury is an independent risk factor for developing PVR. Prognosis of anatomy and visual function of the injured eye with PVR is markedly worse than that without PVR. Serious injuries of ciliary body, choroid and retina are three key parts of the eye with NLP. The concept that the treatment of the eye injury gradually focus on the whole globe is embodied. The data from 13575 in patients with traumatic eyes in 14 hospitals revealed that the rate of immediate enucleation was remarkable reduced with comparison of 20 years ago.
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Yucel OE, Demir S, Niyaz L, Sayin O, Gul A, Ariturk N. Clinical characteristics and prognostic factors of scleral rupture due to blunt ocular trauma. Eye (Lond) 2016; 30:1606-1613. [PMID: 27589050 DOI: 10.1038/eye.2016.194] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 07/11/2016] [Indexed: 11/09/2022] Open
Abstract
PurposeTo describe and identify ocular and wound characteristics, and prognostic factors associated with final visual acuity (VA) in patients with scleral rupture due to blunt ocular trauma.MethodsThe medical records of 61 patients with globe rupture due to blunt ocular trauma who underwent primary repair were reviewed retrospectively. The data recorded included demographic characteristics, initial and final VA, ocular signs, wound characteristics, and surgeries. Initial VA, ocular signs, wound characteristics, and surgeries were analyzed to determine the association with the final VA.ResultsForty three women and 18 men with a mean age of 43.6±23.5 years were included in the study. The locations of scleral wounds were mostly in the superonasal quadrant (41.0%) and zone 2 (75.4%). In eyes with hyphema (P=0.009), vitreous hemorrhage (P=0.001), and retinal detachment (P=0.004), final VA was statistically worse than eyes without these signs. A moderate positive correlation was found between the initial and final VA (P<0.001). Final VA was statistically worse in eyes with horizontal midline wounds than in eyes with vertical midline wounds (P=0.002). A moderate negative correlation was found between scleral wound length and final VA (P<0.001). Patients who underwent cataract surgery had statistically better final VA (P=0.002).ConclusionsScleral rupture was detected mostly in females, superonasal quadrant and zone 2. Poor final VA was significantly associated with poor initial VA, longer wound length, horizontal midline wound, presence of hyphema, vitreous hemorrhage and retinal detachment at presentation, and cataract surgery not performed during follow-up period. Scleral ruptures have different demographic, ocular and wound characteristics than other open globe injuries.
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Affiliation(s)
- O E Yucel
- Department of Ophthalmology, Medical Faculty, Ondokuz Mayis University, Samsun, Turkey
| | - S Demir
- Department of Ophthalmology, Medical Faculty, Gaziosmanpasa University, Tokat, Turkey
| | - L Niyaz
- Department of Ophthalmology, Medical Faculty, Ondokuz Mayis University, Samsun, Turkey
| | - O Sayin
- Clinic of ophthalmology, Develi Hatice Muammer Kocaturk State Hospital, Kayseri, Turkey
| | - A Gul
- Department of Ophthalmology, Medical Faculty, Ondokuz Mayis University, Samsun, Turkey
| | - N Ariturk
- Department of Ophthalmology, Medical Faculty, Ondokuz Mayis University, Samsun, Turkey
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Page RD, Gupta SK, Jenkins TL, Karcioglu ZA. Risk factors for poor outcomes in patients with open-globe injuries. Clin Ophthalmol 2016; 10:1461-6. [PMID: 27536059 PMCID: PMC4975575 DOI: 10.2147/opth.s108901] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose The aim of this study was to identify the risk factors that are predictive of poor outcomes in penetrating globe trauma. Patients and methods This retrospective case series evaluated 103 eyes that had been surgically treated for an open-globe injury from 2007 to 2010 at the eye clinic of the University of Virginia. A total of 64 eyes with complete medical records and at least 6 months of follow-up were included in the study. Four risk factors (preoperative best-corrected visual acuity [pre-op BCVA], ocular trauma score [OTS], zone of injury [ZOI], and time lapse [TL] between injury and primary repair) and three outcomes (final BCVA, monthly rate of additional surgeries [MRAS], and enucleation) were identified for analysis. Results Pre-op BCVA was positively associated with MRAS, final BCVA, and enucleation. Calculated OTS was negatively associated with the outcome variables. No association was found between TL and ZOI with the outcome variables. Further, age and predictor variable-adjusted analyses showed pre-op BCVA to be independently positively associated with MRAS (P=0.008) and with final BCVA (P<0.001), while the calculated OTS was independently negatively associated with final BCVA (P<0.001), but not uniquely associated with MRAS (P=0.530). Conclusion Pre-op BCVA and OTS are best correlated with prognosis in open-globe injuries. However, no conventional features reliably predict the outcome of traumatized eyes.
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Affiliation(s)
| | | | | | - Zeynel A Karcioglu
- Department of Ophthalmology; Department of Pathology, University of Virginia, Charlottesville, VA, USA
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Chee YE, Kanoff JM, Eliott D. Remarkable visual recovery after severe open globe injury. Am J Ophthalmol Case Rep 2016; 3:34-35. [PMID: 29503904 PMCID: PMC5757399 DOI: 10.1016/j.ajoc.2016.06.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 06/01/2016] [Indexed: 11/26/2022] Open
Abstract
Purpose To describe a case of remarkable visual recovery after severe open globe injury. Observations We present a case of a 70-year-old man with an open globe injury with no light perception vision before and after primary repair of his ruptured globe and before secondary vitreoretinal surgery to repair a total retinal detachment with a 360° giant retinal tear and retinal incarceration in a posterior scleral wound who proceeded to recover vision to the 20/60 pinhole to 20/50 level. Conclusions and importance Poor presenting acuity is a known risk factor for poor visual outcome after open globe injury. We hypothesize this remarkable visual recovery could be attributable to the presence of a massive choroidal hemorrhage and limited intraocular hemorrhage elsewhere. In rare cases, vision can improve from the no light perception level after secondary vitreoretinal surgery.
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Affiliation(s)
- Yewlin E Chee
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, 243 Charles Street, Boston, MA, 02114, United States
| | - Justin M Kanoff
- Eye Care Center of Northern Colorado, 4745 Arapahoe Avenue Suite 100, Boulder, CO, 80303, United States
| | - Dean Eliott
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, 243 Charles Street, Boston, MA, 02114, United States
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du Toit N, Mustak H, Cook C. Visual outcomes in patients with open globe injuries compared to predicted outcomes using the Ocular Trauma Scoring system. Int J Ophthalmol 2015; 8:1229-33. [PMID: 26682179 DOI: 10.3980/j.issn.2222-3959.2015.06.28] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 01/15/2015] [Indexed: 11/02/2022] Open
Abstract
AIM To determine the visual outcomes in adult patients who sustained open globe injuries and to determine whether the visual prognosis following an eye injury in an African setting differs from the predicted outcomes according to the Ocular Trauma Score (OTS) study. A secondary aim was to establish the evisceration rate for these injuries and assess how this form of intervention affected outcomes in comparison to the OTS. METHODS A prospective case series of all patients admitted with open globe injuries over a two-year (July 2009 to June 2011) period. Injuries were scored using the OTS and the surgical intervention was recorded. The best corrected visual acuity at three months was regarded as visual outcome. RESULTS There were 249 open globe injuries, of which 169 patients (169 eyes) completed the 3-month follow-up. All patients underwent primary surgery, 175 (70.3%) repairs, 61 (24.5%) eviscerations and 13 (5.2%) other procedures. Globe eviscerations were mainly done on OTS Category 1 cases, but outcomes in this category were not found to be different from OTS outcomes. Outcomes were significantly worse in Category 2, but when the entire distribution was tested, the differences were not statistically significant. The overall association between OTS outcomes and the final visual outcomes in this study was found to be a strong (P<0.005). CONCLUSION Reliable information regarding the expected outcomes of eye injuries will influence management decisions and patient expectations. The OTS is a valuable tool, the use of which has been validated in many parts of the world-it may also be a valid predictor in an African setting.
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Affiliation(s)
- Nagib du Toit
- University of Cape Town/Groote Schuur Hospital, Anzio Road, Observatory, Cape Town 7925, Western Cape, South Africa
| | - Hamza Mustak
- University of Cape Town/Groote Schuur Hospital, Anzio Road, Observatory, Cape Town 7925, Western Cape, South Africa
| | - Colin Cook
- University of Cape Town/Groote Schuur Hospital, Anzio Road, Observatory, Cape Town 7925, Western Cape, South Africa
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Feng X, Feng K, Hu Y, Ma Z. Clinical features and outcomes of vitrectomy in pediatric ocular injuries-eye injury vitrectomy study. Indian J Ophthalmol 2015; 62:450-3. [PMID: 24178406 PMCID: PMC4064221 DOI: 10.4103/0301-4738.120222] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Context: Severe pediatric ocular injury remains a frequent and difficult problem. Vitrectomy is a major technique that has been used to manage severely damaged eyes. However, limited follow-up studies exist currently. Aims: To evaluate the clinical features and predictive factors of visual and anatomic outcomes in Eye Injury Vitrectomy Study (EIVS). Settings and Design: Retrospective, consecutive, interventional case series. Materials and Methods: Reviewing and analyzing records of children, aged 15 years or younger, who had undergone vitrectomy for eye injuries in EIVS database between January 1997 and December 2009. Statistical analysis used: Descriptive analyses and multiple Logistic regressions were employed for all variables using SPSS software (version 17.0, SPSS Inc.). Results: Eighty-seven children (89 eyes) with more than 6 months follow-up and complete records identified in EIVS were included in this study. Average follow-up was 12.7 months. The mean age was 9.4 ± 3.8 years. Seventy-seven eyes (86.5%) had open globe injuries, and 12 (13.5%) had closed globe injuries. Seventeen eyes (19.3%) presented with endophthalmitis. Seventy-five eyes (88.2%) presented with visual acuity of 4/200 or worse; however, 42 eyes (47.7%) achieved 4/200 or better vision with anatomical restoration after vitrectomy. Multiple analysis showed that choroidal damage, large scleral wound, and endophthalmitis were significantly associated with unfavorable outcome, the OR values were 16.7 (95% CI: 2.7-102.4, P = 0.002), 10.9 (95% CI: 1.7-71.6, P = 0.013), and 6.6 (95% CI: 1.0-42.4, P = 0.048), respectively. Conclusions: Vitrectomy intervention resulted in favorable visual and anatomic outcomes in almost half of the injured eyes. Choroidal damage, large scleral wound, and endophthalmitis were the prognostic indicators of unfavorable outcome.
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Affiliation(s)
| | | | | | - Zhizhong Ma
- Department of Ophthalmology, Peking University Third Hospital, Ministry of Education's Key Laboratory of Vision Loss and Restoration, Beijing, China
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Abstract
OBJECTIVES To determine the frequency, clinical characteristics, and visual outcomes of patients who present with high or normal intraocular pressure (IOP) and open globe injuries. DESIGN Retrospective chart review. SETTING University of Maryland Medical Center, a level 1 trauma center. PATIENT OR STUDY POPULATION All cases of open globe injury presenting to The University of Maryland Medical Center from July 2005 to January 2014. OBSERVATION Demographics, initial physical examination, computed tomography findings, IOP of the affected and unaffected eyes, and follow-up evaluations. MAIN OUTCOME MEASURES (1) IOP 10 mm Hg or greater and (2) visual acuity. RESULTS Of 132 eyes presenting with open globe injury, IOP was recorded in 38 (28%). Mean IOP for the affected and unaffected eyes was 14±10.3 mm Hg and 16.6±4.1 mm Hg, respectively. Twenty-three (59.4%) eyes had IOP greater than 10 mm Hg. Six eyes (16.2%) had IOP greater than 21 mm Hg. Using bivariate analysis, IOP greater than 10 mm Hg was associated with posterior open globe injury (P=0.01), posterior hemorrhage (P=0.04), and intraconal retrobulbar hemorrhage (P=0.05). Adjusting for age, sex, and race, IOP greater than 10 mm Hg was associated with the presence of posterior open globe injury on clinical examination (P=0.04). Higher presenting IOP was found to predict light perception or worse vision (P=0.01). Multivariate analysis showed that poor presenting vision was the best predictor of poor final vision (P<0.01). CONCLUSIONS High IOP does not exclude open globe injury. It is a frequent finding in patients with open globe injuries and may be associated with posterior injury and poor visual prognosis.
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Han YS, Kavoussi SC, Adelman RA. Visual recovery following open globe injury with initial no light perception. Clin Ophthalmol 2015; 9:1443-8. [PMID: 26316683 PMCID: PMC4540122 DOI: 10.2147/opth.s87852] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background The purpose of this study was to analyze eyes presenting with no light perception (NLP) after open globe injury (OGI) to determine visual outcomes and prognostic indicators for visual recovery. Methods The records of consecutive patients with at least 6 months of follow-up presenting with OGI and NLP to a single institution between January 1, 2003 and December 31, 2013 were reviewed for demographics, ophthalmic history, context and characteristics of injury, ocular examination findings, surgical interventions, and follow-up visual acuity. Unpaired t-tests and Fisher’s Exact tests were used for statistical analysis. Results Twenty-five patients met our inclusion criteria. The mean age was 50.4±25.5 (range 8–91) years. Four patients (16%) regained vision (hand motion in three patients and light perception in one patient) while 21 patients (84%) remained with NLP or had a prosthesis at final follow-up. Fourteen eyes (56%) were enucleated; nine (36%) were secondary enucleations. Although the sample sizes were small, neither ocular trauma score nor wound size was found to predict visual recovery. Conclusion Four patients regained some vision after presenting with NLP due to OGI. These findings suggest that, in select cases, physicians should discuss the possibility of regaining some vision.
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Affiliation(s)
- Yong S Han
- Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, CT, USA
| | - Shaheen C Kavoussi
- Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, CT, USA
| | - Ron A Adelman
- Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, CT, USA
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Feng K, Wang CG, Hu YT, Yao Y, Jiang YR, Shen LJ, Pang XQ, Nie HP, Ma ZZ. Clinical features and prognosis of eyeball rupture: eye injury vitrectomy study. Clin Exp Ophthalmol 2015; 43:629-36. [PMID: 25855007 DOI: 10.1111/ceo.12534] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Accepted: 03/31/2015] [Indexed: 12/31/2022]
Affiliation(s)
- Kang Feng
- Department of Ophthalmology; Ministry of Education's Key Laboratory of Vision Loss and Restoration; Peking University Third Hospital; Beijing China
| | - Chang-guan Wang
- Department of Ophthalmology; Ministry of Education's Key Laboratory of Vision Loss and Restoration; Peking University Third Hospital; Beijing China
| | - Yun-tao Hu
- Department of Ophthalmology; Ministry of Education's Key Laboratory of Vision Loss and Restoration; Peking University Third Hospital; Beijing China
| | - Yi Yao
- Department of Ophthalmology; Chinese PLA General Hospital; Beijing China
| | - Yan-rong Jiang
- Department of Ophthalmology; Peking University People's Hospital; Beijing China
| | - Li-jun Shen
- Hospital of Optometry and Ophthalmology; Wenzhou Medical College; Zhejiang Province China
| | - Xiu-qin Pang
- Department of Ophthalmology; Tongren Hospital; Capital University of Medical Sciences; Beijing China
| | - Hong-ping Nie
- Department of Ophthalmology; Peking University First Hospital; Beijing China
| | - Zhi-zhong Ma
- Department of Ophthalmology; Ministry of Education's Key Laboratory of Vision Loss and Restoration; Peking University Third Hospital; Beijing China
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Anatomical outcome of vitreoretinal surgery using temporary keratoprosthesis and replacement of the trephined corneal button for severe open globe injuries: one-year result. J Ophthalmol 2014; 2014:794039. [PMID: 25105021 PMCID: PMC4106123 DOI: 10.1155/2014/794039] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Revised: 06/01/2014] [Accepted: 06/12/2014] [Indexed: 11/18/2022] Open
Abstract
In this case series of 74 patients with coexisting vitreoretinal injury and severe corneal opacification, after temporary keratoprosthesis (TKP) assisted pars plana vitrectomy (PPV), an allograft corneal transplant was not performed at the same time; instead, the patient's trephined corneal button was sutured back. One year after the surgery, if intraocular pressure of the injured eyes was above 8 mmHg, removing silicone oil was attempted, and penetrating keratoplasty could be performed. Finally, 10 eyes (13.5%) were enucleated due to atrophia bulbi; 46 eyes (62.2%) were silicone-oil sustained; 15 eyes (20.3%) were anatomically restored; and 3 eyes (4.0%) experienced recurrent retinal detachment. These figures only demonstrate a small percentage of the injured eyes in our series, which have PKP indications. It is a practical option to suture back the patient's trephined cornea following a TKP assisted PPV; keratoplasty was reserved for selected cases.
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Gupta B, Sian I, Agrawal R. Ophthalmic trauma: risk and management update. EXPERT REVIEW OF OPHTHALMOLOGY 2014. [DOI: 10.1586/17469899.2014.931808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Dharmasena A, Park DY, Vishwanath M. Does high intraocular pressure exclude an open globe injury? Int J Ophthalmol 2014; 7:389-90. [PMID: 24790891 DOI: 10.3980/j.issn.2222-3959.2014.02.36] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Accepted: 11/25/2013] [Indexed: 11/02/2022] Open
Affiliation(s)
- Aruna Dharmasena
- Manchester Royal Eye Hospital, Manchester M13 9WH, United Kingdom
| | - Dong Young Park
- Manchester Royal Eye Hospital, Manchester M13 9WH, United Kingdom
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Schörkhuber MM, Wackernagel W, Riedl R, Schneider MR, Wedrich A. Ocular Trauma Scores in paediatric open globe injuries. Br J Ophthalmol 2014; 98:664-8. [DOI: 10.1136/bjophthalmol-2013-304469] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Pimolrat W, Choovuthayakorn J, Watanachai N, Patikulsila D, Kunavisarut P, Chaikitmongkol V, Ittipunkul N. Predictive factors of open globe injury in patients requiring vitrectomy. Injury 2014; 45:212-6. [PMID: 23830208 DOI: 10.1016/j.injury.2013.06.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Revised: 05/13/2013] [Accepted: 06/01/2013] [Indexed: 02/02/2023]
Abstract
BACKGROUND To determine the outcomes and predictive factors of patients with open globe injury requiring pars plana vitrectomy (PPV). METHODS The medical records of 114 patients age 10 years or older who had undergone PPV due to ocular trauma, with at least 6 months follow up, were retrospectively reviewed. RESULTS The mean age of the patients was 42 (SD14) years, with males accounting for 89% of the cases. Penetrating eye injury was the most common injury mechanism (43%) with most injuries occurring secondary to work related incidents (54%). After surgical interventions, 78% of the patients had visual improvement of one or more Snellen lines, while no light perception occurred in 10%. Anatomical attachment was achieved in 87% of eyes at the final follow up. Logistic regression analysis showed that the presence of a relative afferent pupillary defect (RAPD) was a significant predictive factor of visual outcome, while initial retinal detachment was a significant predictor of anatomical outcome. CONCLUSIONS Pupillary reaction is an important presenting ocular sign in estimating the post-vitrectomy poor visual outcome for open globe injury. Vision was restored and improved in more than half of the patients in this study; however, long-term sequelae should be monitored.
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Affiliation(s)
- Weeraya Pimolrat
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Thailand
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