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Bashir MT, Bouamra O, Kirwan JF, Lecky FE, Bourne RRA. Ocular injuries among patients with major trauma in England and Wales from 2004 to 2021. Eye (Lond) 2024; 38:2761-2767. [PMID: 38789787 PMCID: PMC11427661 DOI: 10.1038/s41433-024-03116-y] [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: 11/19/2023] [Revised: 04/08/2024] [Accepted: 04/25/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND Ocular trauma is a significant cause of blindness and is often missed in polytrauma. No contemporary studies report eye injuries in the setting of severe trauma in the UK. We investigated ocular injury epidemiology and trends among patients suffering major trauma in England and Wales from 2004 to 2021. METHODS We conducted a retrospective study utilising the Trauma Audit and Research Network (TARN) registry. Major trauma cases with concomitant eye injuries were included. Major trauma was defined as Injury Severity Score >15. Ocular injuries included globe, cranial nerve II, III, IV, and VI, and tear duct injuries. Orbital fractures and adnexal and lid injuries were not included. Demographics, injury profiles, and outcomes were extracted. We report descriptive statistics and 3-yearly trends. RESULTS Of 287 267 major trauma cases, 2368 (0.82%) had ocular injuries: prevalence decreased from 1.87% to 0.66% over the 2004-2021 period (P < 0.0001). Males comprised 72.2% of ocular injury cases, median age was 34.5 years. The proportion of ocular injuries from road traffic collisions fell from 43.1% to 25.3% while fall-related injuries increased and predominated (37.6% in 2019/21). Concomitant head injury occurred in 86.6%. The most common site of ocular injury was the conjunctiva (29.3%). Compared to previous TARN data (1989-2004), retinal injuries were threefold more prevalent (5.9% vs 18.5%), while corneal injuries were less (31.0% vs 6.6%). CONCLUSIONS Whilst identifying eye injuries in major trauma is challenging, it appears ocular injury epidemiology in this setting has shifted, though overall prevalence is low. These findings may inform prevention strategies, guideline development and resource allocation.
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Affiliation(s)
| | - Omar Bouamra
- The Trauma Audit & Research Network, University of Manchester, Manchester, UK
| | - James F Kirwan
- Department of Ophthalmology, Queen Alexandra Hospital, Portsmouth, UK
| | - Fiona E Lecky
- The Trauma Audit & Research Network, University of Manchester, Manchester, UK
- Centre for Urgent and Emergency Care Research (CURE), School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Rupert R A Bourne
- Department of Ophthalmology, Cambridge University Hospitals, Cambridge, UK
- Vision & Eye Research Institute, School of Medicine, Anglia Ruskin University, Cambridge, UK
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Ali M, Khan MJ, Dun C, Justin G, Makary MA, Woreta FA. Open Globe Injury Repairs Among Medicare Beneficiaries from 2011 to 2020. Ophthalmic Epidemiol 2024:1-7. [PMID: 39083566 DOI: 10.1080/09286586.2024.2371458] [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: 12/15/2023] [Revised: 05/19/2024] [Accepted: 06/18/2024] [Indexed: 08/02/2024]
Abstract
PURPOSE To explore patient and surgeon characteristics for open globe injury repairs (OGRs) and rates of subsequent operations. METHODS Using a retrospective cohort design, eyes of patients ≥18 years who underwent OGR among 100% Medicare Fee-For-Service dataset from 2011 to 2020 were included. Current Procedural Terminology (CPT®) codes were used to identify OGR. Patient characteristics were reported, and surgeon characteristics were stratified by sex and compared using Chi-square and Student's t-test. Overall rate of subsequent operations was reported, and trends of subsequent operations over time were assessed using Cochrane-Armitage trend test. RESULTS A total of 16,576 patients with a mean age of 73.89 years (±12.89) underwent OGR. Most patients were White (79.68%, n = 13,207) and 49.44% (n = 8196) were female. More patients resided in a rural area (18.71%; n = 3102) relative to surgeon location (4.51%, n = 748; p < 0.001). A total of 5,898 surgeons performed these OGRs with 77.33% (n = 4,561) male and 22.67% (n = 1,337) female surgeons. Male surgeons performed most of the OGRs (76.35%, n = 12,655; p < 0.001). On average, a surgeon performed a single OGR annually (Mean: 1.08 ± 1.04; Range: 0.11-40). Among all OGRs, 51% (8,452/16,576) had ≥1 subsequent operations in median 29 days (IQR: 10-86), which increased during the last decade from 47% to 51% (p = 0.008). CONCLUSION Geographic and workforce disparities in ocular trauma warrant future investigation. Further studies can also assess the reasons for increase in the incidence of subsequent procedures after OGR over time.
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Affiliation(s)
- Muhammad Ali
- The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Muhammad Jehanzeb Khan
- The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Chen Dun
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Grant Justin
- Department of Surgery, Uniformed Services University of Health Sciences, Bethesda, Maryland, USA
- Department of Ophthalmology, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Martin A Makary
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Fasika A Woreta
- The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Greenfield JA, Malek DA, Anant S, Antonietti M, Jammal A, Casella A, Miller SC, Wang K, Momenaei B, Lee K, Mansour HA, Justin GA, Makhoul KG, Bitar RA, Lorch AC, Armstrong GW, Wakabayashi T, Yonekawa Y, Woreta F, Cavuoto K. A multi-center analysis of visual outcomes following open globe injury. Sci Rep 2024; 14:16638. [PMID: 39025892 PMCID: PMC11258120 DOI: 10.1038/s41598-024-67564-y] [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: 02/13/2024] [Accepted: 07/12/2024] [Indexed: 07/20/2024] Open
Abstract
The purpose of this study was to examine how demographics, etiology, and clinical examination findings are related to visual outcomes in subjects with open globe injury (OGI) across a large and generalizable sample. A retrospective cohort analysis was performed using data collected from the electronic medical records of four tertiary university centers for subjects with OGI presenting from 2018 to 2021. Demographic information, injury mechanisms, clinical exam findings, visual acuity (VA) at presentation and most recent follow-up were recorded. In subjects with bilateral OGIs, only right eyes were included. A modified ocular trauma score (OTS) using presenting VA, the presence of perforating injury, OGI, and afferent pupillary defect was calculated. The risk of subjects' demographic characteristics, ocular trauma etiology, clinical findings and modified OTS on the presence of monocular blindness at follow-up were assessed using univariable and multivariable regression models. 1426 eyes were identified. The mean age was 48.3 years (SD: ± 22.4 years) and the majority of subjects were men (N = 1069, 75.0%). Univariable analysis demonstrated that subjects of Black race were 66% (OR: 1.66 [1.25-2.20]; P < 0.001) more likely to have monocular blindness relative to White race at follow-up. OTS Class 1 was the strongest predictor of blindness (OR: 38.35 [21.33-68.93]; P < 0.001). Based on multivariable analysis, lower OTS category (OTS Class 1 OR: 23.88 [16.44-45.85]; P < 0.001) moderately predicted visual outcomes (R2 = 0.275, P < 0.001). OGI has many risks of poor visual outcome across patient groups that vary by demographic category, mechanism of injury, and clinical presentation. Our findings validate that a modified OTS remains a strong predictor of visual prognosis following OGI in a large and generalizable sample.
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Affiliation(s)
- Jason A Greenfield
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 900 NW 17Th Street, Miami, FL, 33136, USA
| | - Davina A Malek
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 900 NW 17Th Street, Miami, FL, 33136, USA
| | - Shruti Anant
- Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Michael Antonietti
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 900 NW 17Th Street, Miami, FL, 33136, USA
| | - Alessandro Jammal
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 900 NW 17Th Street, Miami, FL, 33136, USA
| | - Alicia Casella
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 900 NW 17Th Street, Miami, FL, 33136, USA
| | - Sarah C Miller
- Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Kristine Wang
- Wills Eye Hospital, Jefferson Health, Philadelphia, PA, USA
| | - Bita Momenaei
- Wills Eye Hospital, Jefferson Health, Philadelphia, PA, USA
| | - Karen Lee
- Wills Eye Hospital, Jefferson Health, Philadelphia, PA, USA
| | - Hana A Mansour
- Wills Eye Hospital, Jefferson Health, Philadelphia, PA, USA
| | - Grant A Justin
- Duke Department of Ophthalmology, Duke University, Durham, NC, USA
| | - Kevin G Makhoul
- Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
- KU Eye Center, University of Kansas Medical Center, Prairie Village, KS, USA
| | - Racquel A Bitar
- Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Alice C Lorch
- Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | | | | | | | - Fasika Woreta
- Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Kara Cavuoto
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 900 NW 17Th Street, Miami, FL, 33136, USA.
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Chen Q, Liang L, Shi Y, Lu F. Epidemiological and clinical characteristics of open globe injuries in Southwest China. Front Med (Lausanne) 2024; 11:1303683. [PMID: 38384411 PMCID: PMC10879276 DOI: 10.3389/fmed.2024.1303683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 01/23/2024] [Indexed: 02/23/2024] Open
Abstract
Background Open globe injuries (OGIs) are one of the leading causes of monocular vision loss, and the clinical characteristics of OGIs are region specific. The features and patterns of OGIs in Southwest China are poorly known and not well studied. Our study aimed to review the epidemiological and clinical characteristics of patients hospitalized for OGIs in Southwest China. Methods A retrospective study of OGI patients admitted to the West China Hospital from January 1st, 2015, to December 31st, 2019, was performed. Demographic characteristics and injury details were recorded. The Birmingham Eye Trauma Terminology system and the ocular trauma score (OTS) were used. Results A total of 3,014 patients were included. The male-to-female ratio was 5.2:1, and the mean age was 35.6 ± 19.1 years. 15.2% of patients were from the ethnic groups. The highest-risk occupation was the farmer (30.3%), followed by the worker (28.5%). OGIs occurred more frequently in people with middle (37.0%) and primary school (33.1%) education levels. Types of injuries included 46.8% penetration, 21.2% rupture, 2.9% perforation, and 29.1% intraocular foreign body (IOFB). The injuries types differed between age and occupation groups (p < 0.001). IOFBs had a higher risk of causing endophthalmitis, retinal detachment, and traumatic cataracts (p < 0.001). The most common injuries resulted from sharp objects (72.7%). The causes of the injuries were significantly associated with age, ethnicity, and occupation (p < 0.001). Explosion injuries and attacks by animals were more common among people of Tibetan and Yi ethnicities. Blunt trauma, vehicle crashes, falls and age older than 60 years were risk factors for a lack of light perception and lower OTS scores prognosis. Conclusion OGIs in Southwest China mainly affected working-aged males, especially workers or farmers. Severe vision loss and IOFBs are more common findings. OGIs in older patients and ethnic minorities requires additional attention.
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Affiliation(s)
| | | | | | - Fang Lu
- The Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China
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Li C, Fu Y, Liu S, Yu H, Yang X, Zhang M, Liu L. The global incidence and disability of eye injury: an analysis from the Global Burden of Disease Study 2019. EClinicalMedicine 2023; 62:102134. [PMID: 37599904 PMCID: PMC10432781 DOI: 10.1016/j.eclinm.2023.102134] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 07/16/2023] [Accepted: 07/18/2023] [Indexed: 08/22/2023] Open
Abstract
Background The aim of the present study was to estimate the incidence, years lived with disability (YLDs), and cause of eye injury at global, regional, and national levels by age and sex based on the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. Methods This is a retrospective demographic analysis based on aggregated data. GBD 2019 included the burden of eye injury worldwide and its temporal and spatial characteristics in the past three decades. The Bayesian meta-regression tool and DisMod-MR 2.1 were used to analyse the estimates based on a linear regression mode of the age-standardised rates (ASR). Average annual percent change (AAPC) was calculated to represent the temporal trends of the ASR. Findings Globally, there were 59,933.29 thousand (95% uncertainty interval [UI]: 45,772.34-77,084.03) incident cases and 438.4 thousand (95% UI: 132.44-898.38) YLDs of eye injury in 2019. Both the ASR of incidence and YLDs decreased from 1990 to 2019, with AAPC -0.46 (95% confidence interval [CI]: -0.52 to -0.39) and -0.45 (95% CI: -0.52 to -0.39), respectively. Males had higher rates of incidence and YLDs in all age groups. Young and middle-aged adults had higher disease burdens. Regionally, Australasia had the highest ASR of YLDs to be 9.51 (95% UI: 3.00-19.58) per 100,000. Nationally, New Zealand had the highest burden of eye injury to be 11.33 (95% UI: 3.57-23.10) per 100,000. Foreign bodies, exposure to mechanical forces, and falls were the main causes of global eye injury burden in 2019, and there was an increased worldwide burden due to road injuries and executions and police conflict compared with 1990. Interpretation Our findings suggest that the incidence and burden of eye injury have decreased over the last 30 years, while the absolute number of eye injuries has substantially increased, representing a major public health concern. Males and young adults were affected to a greater degree than females and elder individuals. More attention should be paid to road injuries and executions and police conflict in order to prevent eye injury. Funding Guangdong Provincial People's Hospital (GDPH) Supporting Fund for Talent Program (KY0120220263).
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Affiliation(s)
- Cong Li
- Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, 510080, China
- School of Medicine South China University of Technology, Guangzhou, Guangdong, 510006, China
| | - Yongyan Fu
- Department of Ophthalmology, The People's Hospital of Liaoning Province, 33 Wenyi Road, Shenhe District, Shenyang, 110016, China
| | - Shunming Liu
- Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, 510080, China
| | - Honghua Yu
- Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, 510080, China
- Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image Analysis and Application, Guangzhou, Guangdong, 510080, China
| | - Xiaohong Yang
- Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, 510080, China
| | - Meixia Zhang
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China
- Macular Disease Research Laboratory, Department of Ophthalmology, Sichuan University, West China Hospital, Chengdu, Sichuan, 610041, China
| | - Lei Liu
- Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, 510080, China
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