Clinical characteristics and visual outcomes of work-related open globe injuries in Japanese patients

Effect of time to operative repair within twenty-four hours on visual acuity outcomes for open globe injuries

PURPOSE

Convention is to perform open globe injury (OGI) repair within 24 h to minimize risk of endophthalmitis. However, there are limited data assessing how time to operative repair (OR) within 24 h impacts postoperative visual acuity (VA).

METHODS

Manual retrospective chart review of 633 eyes at Massachusetts Eye and Ear (MEE) with a diagnosis of OGI between 2012 and 2022. Inclusion criteria were primary repair ≤ 24 h after injury and ≥1 month follow-up. Multivariate regression analysis was conducted with postoperative VA as primary outcome.

RESULTS

Of the subjects, 489 (77.3%) were male and 496 (78.4%) were white. Demographics of OGI wounds included 320 (50.6%) rupture and 313 (49.4%) laceration; 126 (19.9%) with rAPD, 189 (29.9%) zone 3 injuries, 449 (71.2%) uveal prolapse, and 110 (17.4%) intraocular foreign body. Final postoperative LogMAR VAs consisted of 31% with a VA < 1.7, 9% with a VA of 1.9, 18% with a VA of 2.3, 27% with a VA of 2.7, and 11% with a VA of 3.0. Multivariate analysis showed no significant correlation between time to OR and postoperative VA (p = 0.800) [95%CI: -0.01,0.01]. Older age (p < 0.001) [95%CI: 0.00,0.01], worse presenting VA (p < 0.001) [95%CI: 0.17,0.32], rAPD (p < 0.001) [95%CI: 0.65,1.0], mechanism of rupture (p < 0.001) [95%CI: 0.19,0.54], higher zone of injury (p < 0.001) [95%CI: 0.25,0.45], and uveal prolapse (p = 0.003) [95%CI: 0.09,0.42] were significantly associated with worse final VA.

CONCLUSIONS

Time to repair of OGIs within 24 h does not influence final VA. Optimization of surgical and patient factors may contribute more significantly to final VA than prioritizing more rapid time to OR.

Relationship between the use and type of eye protection and work-related corneal and conjunctival foreign body injuries

OBJECTIVE

This study was designed to reveal the relationship between the use and type of eye protection and the occurrence of work-related corneal and conjunctival foreign body injuries.

METHODS

This is a retrospective cohort study of patients with work-related corneal and/or conjunctival foreign body injuries between 1 August 2017 and 31 July 2018. They were all diagnosed and treated at Jia Ding Hospital affiliated to the Shanghai University of Medicine and Health Sciences in Shanghai, China. All patients received a comprehensive eye examination and a face-to-face interview using a structured questionnaire by ophthalmologists.

RESULTS

A total of 426 consecutive patients were included in the study. The majority of work-related eye injuries occurred in men (94.17%). Summer was the season that had the highest incidence of eye injuries, especially in July and August (38.03%). There were 290 patients (68.08%) that were injured more than once. The ratio of eye protection use to non-protection was 1:7 at the first time of eye injury. The ratio improved to 1:3 on subsequent injury. A majority of employers (79.11%) provided eye protection to employees. However, 19.95% of the workers were injured despite wearing a pair of protective spectacles. The causes of work-related eye injury were as follows: no eye protections provided (20.89%); unawareness of work safety (30.99%); defect of spectacles (47.18%).

CONCLUSIONS

Protection use at work effectively prevents work-related eye injuries. Both employers and employees require improved awareness of workplace hazards and personal protection. Eye protection should be selected appropriately according to the work environment.

Trends in occupational-related open globe injury presenting to a tertiary referral centre of Northern Thailand

PURPOSE

To determine characteristics of occupational-related open globe injury (OGI) in a tertiary referral centre within an agricultural activity endemic area.

METHODS

The medical records of patients diagnosed as open globe injury received during work and admitted to Chiang Mai University Hospital, Thailand from January 2006 to December 2016, were retrospectively reviewed.

RESULTS

Six hundred and fifteen patients were included in this analysis with a mean (SD) age of 44.6 (14.1) years and a median (IQR) follow-up of 6.5 (2.5 to 17) months. Males were predominant (92%). The highest risk groups were patients in the age range of 40 to 59 years (52%). The common locations of injuries were gardening/farming (52%) followed by work at construction/industrial site (32%). Over the study period, there was an increasing proportion of intraocular foreign body (IOFB), while the proportion of penetrating injuries decreased (p = 0.001). An increasing frequency of injuries from mowing were noted (p = 0.003). Types of injury also varied in different working settings as follows: while higher proportion of penetrating OGI occurred at the office (86%), IOFB occurred more frequently at gardening/farming site (59%). Work setting did not influence either the initial visual acuity (VA) (p = 0.53) or the final VA (p = 0.73). Significant improvements in final VA were demonstrated across all work settings, but 46% of patients still had a final visual acuity worse than 20/400.

CONCLUSIONS

The majority of occupational-related OGI in this study were related to agricultural work. A high incidence of injuries during mowing and a high frequency of IOFB should be considered when discussing guidelines and public recognition should be raised regarding safety protective measures at work.