Fourteen-Year Review of Open Globe Injuries in an Urban Korean Population

The clinical features and the factors affecting visual prognosis in pediatric open-globe ınjuries

PURPOSE

To investigate clinical features and factors affecting visual prognosis after pediatric open-globe injuries.

METHODS

Retrospective study of 223 children with open-globe injury was conducted. Children with final logMAR visual acuity (LVA) > 0.70 were determined as poor-vision group (group 1, n = 108) and those with final LVA ≤ 0.70 as good-vision group (group 2, n = 115). Demographic characteristics (age, gender, and damaged eye), time between trauma and surgery, ocular trauma score (OTS), follow-up time, injury size, initial and final visual acuity levels, injury type (penetrating injury, globe rupture, perforating injury, and intraocular foreign body injury), injury localization (zone 1 = within the corneal and/or limbal area, zone 2 = within the scleral area extending 5 mm back from the limbus, and zone 3 = within the area posterior to zone 2), injury cause [metal objects (fork, knife, needle), broken glass, blunt objects (ball, punch), pen-pencil, and unidentified objects], and accompanying ocular findings of the groups were detected, and comparisons were done. Additionally, effects of age, time between trauma and surgery, OTS, injury size, follow-up time, initial LVA, injury type, and injury zone on final LVA were analyzed in both groups.

RESULTS

Mean age was 9.1 ± 2.0 years. There were 151 males and 72 females. Compared to group 1, group 2 had better initial and final visions (1.21 ± 0.26 vs 0.60 ± 0.28, p < 0.001 for initial LVA; 1.00 ± 0.32 vs 0.30 ± 0.13, p < 0.001 for final LVA), greater OTS (1.72 ± 0.53 vs 3.73 ± 0.61, p = 0.025), and smaller injury size (10.4 ± 3.5 vs 5.8 ± 2.4 mm, p = 0.002). Globe rupture (p = 0.015) and relative afferent pupillary defect (RAPD) (p = 0.037) were higher in group 1, while penetrating injury (p = 0.044), zone 1 involvement (p = 0.038), and metal object injury (p = 0.041) were higher in group 2. Based on multivariate analysis, the presences of globe rupture (p = 0.024) and RAPD (p = 0.035), the involvement without zone 1 (p = 0.042), and the injury without metal object (fork, knife, needle) (p = 0.046) were associated with poor final vision. Final LVA (for group 1 and group 2) was negatively correlated with OTS (r =  - 0.398, p = 0.037; r =  - 0.369, p = 0.040), while positively correlated with injury size (r = 0.412, p = 0.031; r = 0.318, p = 0.046) and initial LVA (r = 0.335, p = 0.043; r = 0.402, p = 0.034).

CONCLUSION

In our study, poor prognostic factors affecting final vision were low OTS, poor initial vision, the presences of globe rupture and RAPD, the large injury size, the involvement without zone 1, and the injury without metal object (fork, knife, needle).

Role of Socioeconomic Status (SES) in Globe Injuries: A Review

Globe injury is a serious worldwide public health issue frequently leading to permanent vision impairment. The plethora of different types of globe injuries is classified into categories, including open and closed globe injuries. Globe injury occurs mainly in the workplace and at home, affecting predominantly middle-aged working men. Socioeconomic status (SES) is defined by income level, educational attainment, and employment status. Low socioeconomic status has been associated with a higher incidence of globe injury and can be utilized to identify at-risk populations. For managing open and closed globe injuries, different strategies are applied and the implementation of adequate globe injury prevention measures is needed for reducing the occurrence of globe injury. The following article aims to provide an overview of globe injury characteristics and their correlation with socioeconomic status and to highlight the significance of considering SES as a variable in globe injury prevention.

Open Globe Injury with Intraocular Foreign Body

Purpose

To investigate characteristics of Open Globe Injuries (OGI) that presented with Intra-Ocular Foreign Body (IOFB), along with their long-term visual outcomes, complications and need for subsequent surgeries.

Methods

Retrospective interventional consecutive case series of OGIs with IOFBs that presented to the Eye Trauma service at the Massachusetts Eye and Ear from 2010 to 2015. Data collected included time from injury to OGI repair, location of injury and IOFB, retinal detachment (RD) rate, presenting and final visual acuity (VA) and subsequent surgeries.

Results

Fifty-seven consecutive cases of OGIs with IOFBs were included. The majority of patients were male (93%), mean age was 37 years and mean follow-up was 28 +/- 22 months. The median time from injury to OGI repair was 0 days (range: 0-16 days). Overall, 38/57 (66.7%) eyes achieved final vision of 20/40 or better and 43/57 (75.4%) vision of 20/150 or better. Zone I injuries were the most common (86%), followed by Zone II (16%), and Zone III (10%). 33 cases had IOFBs in the anterior segment only and 24 cases had posterior segment involvement. In total, 30% of cases (17/57) were complicated by an RD, 58.3% (14/24) in the posterior versus 9.1% (3/33) in the anterior IOFB group.( p<0.01). There were no cases of endophthalmitis. Posterior IOFB and higher zone of injury were found to be risk factors for RD both at presentation (all p<0.05) and post-primary repair.(all p<0.05) Posterior IOFB was associated with higher vitrectomy rates both at presentation (p<0.0001) and post-primary repair (p=0.002) and worse long-term visual outcome (p = 0.014).

Conclusion

OGIs with IOFB involving the posterior segment are associated with higher complication and re-operation rates and worse visual prognosis compared to those involving the anterior segment only.

Epidemiological Features of Pediatric Ocular Trauma in Egypt

Purpose. To review the epidemiology of serious pediatric ocular trauma presenting to Kasr El Aini Hospital, Cairo University. Methods. Children with serious ocular trauma during a six-month period were examined and their data was analyzed. Results. Eighty eyes of 75 patients were included in this study, with 64% males (P < 0.001) and average age of 5 years (5 months–15 years). There were 67 (83.75%) open globe injuries, 11 (13.75%) closed globe injuries, and 2 (2.5%) chemical injuries. Of the open globe injuries, 24 (30%) were ruptured globes and 43 (53.75%) were lacerations (31 penetrating injuries (38.75%), 6 IOFBs (7.5%), and 6 perforating injuries (7.5%)). Of the closed globe injuries, 3 had hyphema (3.75%), 5 had traumatic cataracts (6.25%), and 3 had vitreous hemorrhage with retinal detachment (3.75%). Forty-two patients (56%) presented within 24 hours, 28 patients (37.33%) presented between 24 hours and 1 week, and 5 patients (6.6%) presented after one week from the time of trauma. Seven eyes developed posttraumatic endophthalmitis (10% of open globe injuries). On leaving the hospital, 55 (68.75%) eyes had poor vision, 13 (16.25%) had moderate vision, and 12 (15%) had good vision. Conclusion. Children at a higher risk of trauma are males, >5 years, unsupervised, and involved in street activities. Immediate comprehensive primary management and secondary rehabilitation are mandatory in these cases.

OUTCOMES OF RETINAL DETACHMENT REPAIR AFTER POSTERIOR OPEN GLOBE INJURY

PURPOSE

To report outcomes of retinal detachment (RD) repair following posterior open globe injury.

METHODS

This retrospective, consecutive case series examined patients who underwent RD repair following Zone II and/or III open globe injury repair between January 1, 2007 and October 31, 2013. Patients with <3 months of follow-up since their last vitreoretinal surgery, and those who underwent pars plana vitrectomy (e.g., for intraocular foreign body) during their initial open globe injury repair were excluded.

RESULTS

Of 30 patients who met inclusion criteria, reattachment of the retina was achieved in 25 (83%) during the first vitreoretinal surgical procedure and 5 (17%) were deemed inoperable intraoperatively. Ten patients (30%) developed recurrent RD, and 8 underwent additional surgery. At last follow-up, reattachment was observed in 4 of these 8. The overall rate of final reattachment was 63% (19 patients). The mean number of surgeries for RD was 1.5 (range, 1-3). Fifteen patients (50%) achieved final visual acuity of counting fingers or better. Mean follow-up from the last vitreoretinal surgery was 23 months (range, 3-52).

CONCLUSION

Although RD following posterior open globe injury confers a grave prognosis, successful anatomic reattachment of the retina was achieved in the majority of patients in this series, with half achieving ambulatory vision.

Clinical characteristics and prognostic factors of scleral rupture due to blunt ocular trauma

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.

Open-globe injuries with motor vehicle accidents: a 12-year review

PURPOSE

To evaluate demographics, characteristics, and outcomes of open-globe injuries (OGIs) in motor vehicle accidents (MVAs).

METHODS

Retrospective chart review of patients with OGIs related to MVAs that presented to University Hospital, Newark, from 2000 to 2012.

RESULTS

Twenty-five patients were identified; the average age of the patients was 33.3 years old (range, 5-75). The majority of patients (64 %) were males. The 25 vehicles comprised 24 automobiles and one motorcycle. Ten patients (40 %) wore seatbelts, and five (20 %) did not wear seatbelts. The seatbelt status was not documented in the remaining cases. Ethanol was documented as a contributing factor in five of the accidents. In terms of open-globe classification, 15 OGIs (60 %) were ruptures, and five (20 %) were penetrating injuries; three (12 %) had intraocular foreign bodies. Ten eyes (40 %) had a final VA of 20/400 or worse. Fourteen eyes (56 %) achieved a final VA of 20/200 or better; seven eyes (28 %) achieved a final VA of 20/40 or better.

CONCLUSION

Fifty-six percent of eyes with an open-globe injury related to MVAs achieved a final VA of 20/200 or better in this series. No eyes developed endophthalmitis.

Retinal detachment after open globe injury

PURPOSE

To characterize the development of retinal detachment (RD) after open globe trauma.

DESIGN

Case-control study.

PARTICIPANTS

A total of 892 patients comprising 893 open globe injuries (OGIs), of whom 255 were ultimately diagnosed with RD, with the remaining eyes serving as controls.

METHODS

Retrospective chart review of patients with OGIs presenting to the Massachusetts Eye and Ear Infirmary between 1999 and 2011. Kaplan-Meier analysis was used to estimate the time to detachment, and multivariable logistic regression was used to define the clinical factors associated with RD after OGI.

MAIN OUTCOME MEASURES

Demographic and clinical characteristics at the time of presentation after OGI, date of RD diagnosis, and last date of follow-up.

RESULTS

Primary repair of the open globe was typically undertaken within hours of presentation. A total of 255 eyes were ultimately diagnosed with RD after open globe trauma, yielding an incidence of 29% (95% confidence interval, 26-32). For eyes that developed RD, 27% (69/255) detached within 24 hours of primary open globe repair, 47% (119/255) detached within 1 week, and 72% (183/255) detached within 1 month. Multivariable regression analysis revealed the presence of vitreous hemorrhage (odds ratio [OR], 7.29; P < 0.001), higher zone of injury (OR, 2.51 per integer increase in zone number; OR, 1.00-6.30; P < 0.001), and poorer logarithm of the minimum angle of resolution (logMAR) visual acuity at the time of presentation after OGI (OR, 2.41 per integer increase in logMAR visual acuity; OR, 1.00-81.30; P < 0.001) to be associated with RD. A screening tool was created: the Retinal Detachment after Open Globe Injury score.

CONCLUSIONS

Retinal detachment is common after open globe trauma, although often not appearing until days to weeks after the initial traumatic event. Several clinical variables at the time of initial presentation can predict the future risk of detachment.

Epidemiology of patients hospitalized for ocular trauma in the Chaoshan region of China, 2001-2010

BACKGROUND

The burden and pattern of ocular trauma in China are poorly known and not well studied. We aimed at studying the epidemiological characteristics of patients hospitalized for ocular trauma at major ophthalmology departments in the largest industrial base of plastic toys in China.

METHODS

A retrospective study of ocular trauma cases admitted to 3 tertiary hospitals in China from 1st January 2001 to 31st December 2010 was performed.

RESULTS

The study included a total of 3,644 injured eyes from 3,559 patients over the 10-year period: 2,008 (55.1%) open-globe injuries, 1,580 (43.4%) closed-globe injuries, 41 (1.1%) chemical injuries, 15 (0.4%) thermal injuries and 678 (18.6%) ocular adnexal injuries. The mean age of the patients was 29.0±16.8 years with a male-to-female ratio of 5.2∶1 (P = 0.007). The most frequent types of injury were work-related injuries (1,656, 46.5%) and home-related injuries (715, 20.1%). The majority of injuries in males (56.2%) and females (36.0%) occurred in the 15-44 age group and 0-14 age group, respectively. The final visual acuity correlated with the initial visual acuity (Spearman's correlation coefficient = 0.659; P<0.001). The Ocular Trauma Score also correlated with the final visual acuity (Spearman's correlation coefficient = 0.655; P<0.001).

CONCLUSIONS

This analysis provides an epidemiological study of patients who were hospitalized for ocular trauma. Preventive efforts are important for both work-related and home-related eye injuries.

A 10-year review of assault-related open-globe injuries at an urban hospital

BACKGROUND

To describe the demographics and outcomes of assault-related open-globe injuries (OGI) at University Hospital (UH), Newark, New Jersey over a ten-year period.

METHODS

The medical records of all subjects presenting to a single university referral center with an OGI were retrospectively analyzed to identify prognostic factors for enucleation and final visual acuity (VA) of no light perception (NLP).

RESULTS

One hundred and forty-eight eyes of 147 patients presented to UH with assault-related OGI. Eighty-two percent of patients were male, and the mean age was 35.9 years. The anatomic site of the wound was zone 3 in the majority (54.1 %) of eyes. Most common type of injury noted was rupture (57.4 %), followed by penetrating injury (35.1 %). Mean initial presenting and final VA in LogMAR were 2.38 ± 0.12 and 2.18 ± 0.16 respectively. Initial Snellen VA was no light perception (NLP) in 57 eyes (38.5 %); four eyes had an initial VA of ≥ 20/40 (2.7 %). Final VA was NLP in 68 eyes (45.9 %) of which 46 were enucleated (31.1 %); 18 eyes (12.2 %) had a final VA of ≥ 20/40. Fifty eyes (33.8 %) underwent pars plana vitrectomy (PPV). Significant risk factors of final VA of NLP or enucleation included initial VA of NLP, perforating or rupture type of OGI, and zone 3 injury. Eyes that sustained penetrating injuries were less likely to have final VA of NLP or require enucleation.

CONCLUSIONS

Assault-related OGIs carry an extremely poor visual prognosis and a high rate of enucleations. Only eighteen eyes (12.2 %) recovered VA ≥ 20/40. We found initial VA of NLP and zone 3 injury to be significant predictors of final VA of NLP or undergoing enucleation. Penetrating injuries were less likely to have a final VA of NLP or an enucleation.

Twelve-year review of pediatric traumatic open globe injuries in an urban U.S. population

PURPOSE

To evaluate the epidemiology, anatomical characteristics, and clinical outcomes of pediatric traumatic open globe injuries and to compare the observed final visual acuity to the expected visual acuity as predicted by the Ocular Trauma Score (OTS).

METHODS

Retrospective chart review of 89 pediatric patients (89 eyes) with open globe injury presenting between 1997 and 2008.

RESULTS

Sixty-five patients (73%) were male, average age was 9.7 years, and mean follow-up was 22.6 months. The most common causes of trauma were: accidents (79%), violence (10%), and motor vehicle accidents (9%). Penetrating ocular injury was the most common trauma (54%), followed by blunt rupture (34%). Zone 1 injuries represented 49% of cases, and zones 2 and 3 represented 29% and 21%, respectively. No patient developed endophthalmitis. The average presenting and final visual acuities were logarithm of the minimum angle of resolution 1.927 and 1.401, respectively. Lens trauma was noted in 44 (49%) eyes. Twenty-eight patients (31%) had retinal detachment within 6 months of presentation. Total retinal attachment was achieved in 12 (63%) of 19 eyes undergoing repair. Enucleation was performed in 9 (10%) patients. Final visual acuities were not statistically different from visual acuities predicted by OTS (P > .05).

CONCLUSIONS

The visual prognosis in pediatric open globe injury is poor. The zone of injury may correlate with poor final visual acuity, risk of retinal detachment, and subsequent need for an enucleation. The final predicted visual acuity correlated well with the observed final visual acuity in these patients.

[Open-globe injuries and intraocular foreign bodies involving the posterior segment]

Open globe injuries involving the posterior segment remain a major cause of visual loss in young adults. They occur more frequently in male than in female populations. The majority is due to domestic accidents, since work-related injuries have been decreasing due to proper education and use of safety equipment. However, leisure-related open globe injuries are on the increase. Prompt recognition and treatment of open globe injuries are essential. At presentation, it is necessary to collect etiological data such as cause, nature, time and place of injury. Anti-tetanus immunization must be confirmed. The presenting visual acuity and clinical examination data must be recorded. The lesion type is classified in accordance with the Birmingham Eye Trauma Terminology. Ocular ultrasound or computed tomography is performed for patients suspected of having an intra- or periocular foreign body. Functional prognosis is negatively influenced by a posterior or large rupture, the presence of an intraocular foreign body, the presence of retinal lacerations or retinal detachment, or the occurrence of posttraumatic infectious endophthalmitis. Recent advances in microsurgical techniques such as pars plana vitrectomy and new visualization techniques may improve the anatomical and functional prognosis for these patients. However, postoperative proliferative vitreoretinopathy remains a major concern: it is responsible for a significant rate of secondary retinal detachment with negative consequences for visual prognosis.

Influence of alcohol consumption on incidence and severity of open-globe eye injuries in adults

AIM

To investigate the influence of alcohol consumption on the occurrence of open-globe injuries in adults.

METHODS

A retrospective study was made of 100 consecutive patients (81 male, 19 female) with open-globe injuries. Of these patients, 18 exhibited alcohol intoxication (group Ai), and 82 exhibited no alcohol intoxication (group nAi). Investigated parameters were best-corrected visual acuity at day of admission and last examination (logMAR), type of injury according to BETT-classification, extraocular injuries, cause of injury, time and setting of injury, in relation to alcohol consumption and tested for statistical significance with Fisher's exact test or the Mann-Whitney U test, respectively.

RESULTS

In group Ai, 83.3% of the patients were male, and in group nAi, 80.5%. Mean logMAR at day of admission was 1.06 ± 0.63 (20/250) in group Ai and 1.08 ± 0.59 (20/250) in group nAi. At last examination, mean logMAR in group Ai was 1.11 ± 0.59 (20/250), in group nAi 0.75 ± 0.60 (20/125). This difference was statistically significant (p = 0.02). In group Ai, significantly more ruptures according to BETT classification occurred (p = 0.05). In group Ai, significantly more additional extraocular injuries occurred compared to group nAi (38.9% versus 6.1%; p = 0.0009). In group Ai, the cause of injury was significantly more often glass (44.4% versus 2.4%; p = 0.0000), in group nAi the injury was more often directly or indirectly caused by tools (74.4% versus 33.3%; p = 0.001). In group Ai, the injury was significantly more often inflicted by others (50.0% versus 9.8%; p = 0.0003). The settings in which the injuries occurred were significantly more often the street in group Ai (44.4% versus 6.1%; p = 0.0002), in group nAi the garden or tool shed (31.7% versus 5.6%; p = 0.02) or the workplace (34.2 % versus 11.1 %; p = 0.04). In group Ai, the injuries occurred significantly more often at night (p = 0.0001) and on weekends (p = 0.0000).

CONCLUSIONS

Open-globe eye injuries under alcohol intoxication are more often caused by a third party and have a worse prognosis. Open-globe injuries under alcohol intoxication occur in a different spatio-temporal setting and exhibit a more severe type of injury. Risk behavior combined with alcohol consumption therefore seems to be an independent factor for the incidence of open-globe eye injuries.

Comparison of the clinical presentation and visual outcome in open globe injuries in adults and children over 30 months

PURPOSE

To compare the clinical presentation and final visual outcome of open globe injuries in children and adults in a referral hospital over a 30-month period.

METHODS

This is an institutional-based prospective study of open globe injuries cases presenting in the emergency department between July 2003 and December 2005. Patients were divided in 2 groups: group 1, children (2-15 years), and group 2, adults (>15 years). All the patients were admitted and emergency surgical interventions were undertaken. The clinical features at presentation and the final visual acuity are compared. Chi-square and Fisher exact tests were used for statistical analysis.

RESULTS

Ninety and 84 patients were included in group 1 and group 2, respectively. The most common places of injuries were home or while playing outdoor games in group 1 (67%) and workplace in group 2 (53.5%). The presenting features were significantly more grave in group 2. These included poor presenting visual acuity (p=0.012), vitreous prolapse (p=0.002), presence of relative afferent pupillary defect (p=0.001), and incidence of endophthalmitis (p=0.004). Time interval between injury and surgical intervention (p=0.018) was better in group 2. Other features, such as presence of hyphema, uveal tissue prolapse, cataract, intraocular foreign body, and length or location of laceration were similar in both groups. The final visual outcome was similar in the groups (p = 0.21), with approximately half of the patients achieving vision of 20/60 or better in each group.

CONCLUSIONS

The majority of injuries in children and adults occurred in their homes or workplaces, respectively. Although the clinical presentations of open globe injuries were significantly more grave in adults than in children, the final visual outcomes were similar.

Eye injury (ocular trauma) in southern Turkey: epidemiology, ocular survival, and visual outcome

PURPOSE

To evaluate the epidemiology and outcome of ocular trauma in southern Turkey.

METHODS

Patients referred to the University of Cukurova, School of Medicine, Department of Ophthalmology, with ocular trauma during the last two years were reviewed retrospectively. Age and gender of patients, type of injury, cause of injury, place where injury occurred, initial and final visual acuities, and final outcome were analyzed.

RESULTS

Medical records of 250 patients (four bilateral injuries), aged between three months and ninety years were reviewed. Ocular trauma mostly occurred between 0 and 15 years and a male preponderance (76.8%) was evident. There were 72% open-globe injuries, corneal and/or scleral penetration being the most common injury type. Metallic objects were the main cause of injury (32.4%). Fifty percent of injuries happened in streets. Closed-globe and self-sealing corneal injuries were found to have the best prognosis in terms of final outcome (57.6% and 57.9%, respectively; P < 0.001 for both). Initial visual acuity was found to be a significant predictor of final visual acuity (P < 0.001). Endophthalmitis was significantly associated with metallic objects (P < 0.005).

CONCLUSION

Eye injury is still a common and avoidable cause of blindness. Our findings suggest that any person in the population can be subject to ocular trauma at any time. Prognosis might be challenging. Education, attention, and safety precautions would help in reducing ocular morbidity.

Visual outcomes of vitreoretinal surgery in eyes with severe open-globe injury presenting with no-light-perception vision

BACKGROUND

Severe ocular trauma causing no light perception (NLP) typically carries a dismal prognosis, and implies no further therapeutic intervention. We have identified a cohort of patients with verified NLP following open-globe injury who have recovered vision of light perception (LP) or better. We evaluated the outcomes of vitreoretinal surgery performed on eyes that were NLP post open-globe injury.

METHODS

Retrospective review of outcomes of secondary vitreoretinal surgery performed at Massachusetts Eye and Ear Infirmary from 1 January 2001 to 31 December 2006 on all cases of open-globe repair (OGR) that had NLP prior to OGR or on the first post-operative day.

RESULTS

A total of 648 cases of OGR were performed in the study period. Eighty-eight patients had NLP prior to OGR or on the first post-operative day after OGR. Twenty-three patients from the above group (26.1%) spontaneously recovered a vision of light perception (LP) or better. Eight of the 23 patients had a secondary vitreoretinal surgery. All eyes that did not undergo vitreoretinal surgery returned to NLP or became phthisical within 7 months. Among the eight eyes that underwent surgery, five had improvement, with vision ranging from hand motion to 20/70. Prognostic indicators for successful surgical outcome were hand motion or better vision prior to vitreoretinal surgery, recovery of vision within 5 days of OGR, and vitreoretinal intervention within 5 weeks of the initial open-globe injury.

CONCLUSION

Patients with severe open-globe injury and NLP occasionally recover LP or better vision. These patients may regain useful vision after vitreoretinal surgery if prompt referral and intervention is attempted and if the spontaneous visual recovery occurs within the first week after OGR.

Pattern of ocular trauma in Egypt

PURPOSE

To review the epidemiology of serious ocular trauma presenting to Kasr El Aini Hospital, Cairo University.

METHODS

This is a prospective epidemiological and clinical study of ocular trauma patients admitted to Kasr El Aini hospital during a 6-month period; January-June 2000. Cases were analyzed with respect to: (1) demographics, (2) time, place and nature of trauma, (3) type of injury, (4) time to receive care, and (5) management and visual outcomes following primary repair.

RESULTS

One hundred and fifty three eyes of 147 patients (six bilateral injuries) sustaining serious ocular injury requiring hospitalization were included during the study period. Eighty percent of ocular trauma occurred in men (P < 0.001 chi-square test) with an average age of 22 years (ranging from 2 months to 76 years). There were 123 (80.4%) open globe injuries and 30 (19.6%) closed globe injuries. Of the open globe injuries, 48 eyes (31.4% of all eyes) were ruptured globes and 75 eyes (49% of all eyes) were lacerated globes (37 intraocular foreign bodies, 35 penetrating injuries and three perforating injuries, that is 24%, 23%, and 2% respectively of all injured eyes). Of the closed globe injuries, 5.9% had hyphema (33% of all patients), 4% lamellar lacerations, and 2.5% vitreous hemorrhage with retinal detachment. Most of the injuries occurred (39.5%) and presented (36.7%) between 12:00-5:59 PM: . Eighteen patients (12%) presented after 24 hours, and nine patients (6%) 1 week after the time of trauma. Presenting visual acuity in 123 patients (123 eyes) was as follows: 98 (80%), ten (8%) and 15 (12%) patients had poor, moderate and good visual acuity respectively. Ten eyes developed posttraumatic endophthalmitis (8% of open globe injuries). On leaving the hospital, 77.1% eyes had a visual acuity of less then 1/60 (poor), 3.9% were between 1/60 and 6/60 (moderate), and 19% were 6/36 and/or better (good). Fifty-two (35%) patients were lost in follow-up: at 1 month, 60%, 7% and 33% of the rest had poor, moderate and good visual acuity respectively.

CONCLUSION

The majority of ocular trauma in our population was due to assaultive injuries occurring mainly in males. Open globe injuries were more common than closed globe injuries, and globe lacerations were more common than ruptured globes. Open globe injuries, especially ruptured globes, had the worst visual outcomes. The initial visual acuity correlated well with the final visual acuity. Immediate and comprehensive medical care is mandatory for ocular trauma patients. Educating the public is essential if we wish to prevent eye injuries.