Determinant Factors of Poor Visual Outcome After Ocular Trauma: A Retrospective Study in Central Sarawak, Malaysia

Ocular Trauma Trends during COVID-19 Pandemic

Background

The article aims to study the demographics and clinical characteristics of ocular trauma patients presenting to the Eye Casualty Clinic between COVID-19 and non-COVID-19 era in Ampang Hospital, Malaysia.

Methods

In this cross-sectional study, data of patients presented with ocular trauma injury to the Ampang Hospital during the COVID-19 era from 18 March 2020 to 17 September 2020 were retrieved and compared with the similar period of the previous non-COVID-19 era year.

Results

Among the total number of 453 patients, 76.82% (n = 348) were predominantly males. The commonest age group was between 21 years old-40 years old (49.45%, n = 224), and the commonest location of ocular trauma injury occurred at the workplace (38.19%, n = 173); welding was the commonest work-related injury (13.83% in 2019; 12.50% in 2020). Injury-to-treatment time was significantly longer during the COVID-19 era, where patients who sought treatment within a day of injury were 27.27% (n = 69) in 2019 and 18.50% (n = 37) in 2020 (P = 0.030). During the COVID-19 pandemic, patients with vision worse than 6/60 on presentation were higher at 8% compared with 3.56% before the COVID-19 pandemic (OR = 2.35; 95% CI: 1.01, 5.48; P = 0.047). Similarly, patients with a vision worse than 6/60 post-treatment during the COVID-19 period were significantly higher at 7.00% compared with 1.58% before the COVID-19 pandemic (OR = 4.72; 95% CI: 1.53, 14.62; P = 0.007).

Conclusion

The majority of ocular trauma cases in this study population were male adults between 21 years old and 40 years old, and welding was the commonest work-related injury. COVID-19 era has a higher percentage of patients presented with severe visual impairment, longer injury-to-treatment time and poorer post-treatment visual outcomes.

Clinical Characteristics, Visual Outcomes, and Prognostic Factors of Open Globe Injuries

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.

Ocular trauma in an urban Spanish population: epidemiology and visual outcome

AIM

To describe epidemiological aspects, clinical findings, and visual results in eye trauma patients requiring urgent surgery at a tertiary hospital.

METHODS

Retrospective review of adult patients requiring urgent surgery for trauma to the eyeball from January 2010 and April 2020. Data was collected relative to age, gender, mechanism of the injury, type of wound, initial and final visual acuity, number and type of surgeries carried out. Injuries were classed according to the Birmingham Eye Trauma Terminology (BETT) and the Ocular Trauma Score (OTS) categories.

RESULTS

The survey included 92 eyes. Mean age was 54.76±22.18y. The most frequent cause was domestic accidents (44.6%), followed by aggression (22.80%) and occupational accidents (17.4%). Trauma from aggression was more frequent in men (P=0.006) and accidents in the home more common in women (P=0.011). Patients over 65y presented an odds ratio (OR) of 10.71 for suffering a domestic accident. Patients between 15-45 and 46-65y were at higher risk of trauma from aggression (OR=17.52 and OR=10.94, respectively). As for the type of injury, 63.04% were open-globe lesions, Zone II being the most frequently affected (27.2%). In Logistic regression analysis, old age (P=0.05) and retinal involvement (P=0.001) were found to be associated with higher rate of unfavourable visual outcome.

CONCLUSION

The epidemiological aspects of eye trauma are highly dependent on the area of population studied. Domestic accidents are more relevant than workplace accidents in older urban areas with high socio-economic status. A better knowledge of the epidemiological characteristics is useful for implementing specific prevention measures and appropriate treatment strategies.

Changes of Patterns and Outcomes of Ocular and Facial Trauma Among Children in Jordan

Introduction

The eye is the second most common organ affected by trauma after hands and feet. Eye trauma is a common cause of visual morbidity and may result in irreversible visual impairment and blindness. Ocular and facial trauma contribute to significant proportions of visual deficits among young children. This study aimed to explore the changes in trend including the pattern and outcomes of ocular and facial trauma among children between the last twenty years. 

Methodology

A retrospective study was conducted between January 2020 and April 2021. The medical records of the patients who attended the Royal Medical Services (RMS) military hospital between January 1999 and December 2019 suffering from eye trauma which required hospitalization were enrolled in the study and reviewed regarding age, gender, mechanism of trauma, the severity of the trauma, eye structures involved, and visual outcome. The patients were divided into three groups based on the time of trauma: Group A for injuries in the period (January 1, 1999 to December 31, 2005), Group B for the period (January 1, 2006 to December 31, 2012), and Group C for the period (January 1, 2013 to December 31, 2019). The collected data was analyzed and compared to explore whether there is any change in the pattern and visual morbidity of eye injuries over time. The most frequent finding of eye injury was corneal wound in Groups A and B patients, while in Group C the most common ocular injury was ecchymosis or sub-conjunctival hemorrhage.

Results

Three-thousand one-hundred and thirty only patients (3130 eyes) aged between 2 and 14 years (mean 7.11 ± 3.13) were included in the study. The male to female ratio was 2:1. 1864 patients (56.6%) were at five years of age or younger. The most common place of injury in the three groups was on the street. This ratio decreased from 64.0% in Group A to 48.8% in Group C. Stone was the commonest etiology of injury in Group A (38.0%) while wood and fall were the commonest in Group B (28.5%) and Group C (37.1%) respectively. Open globe injuries constituted 67.0% of patients in Group A, 64.7% of patients in Group B, and 51.2% of patients in Group C. Normal or mild visual impairment was noted in patients of Group C (43.9%) as compared to the patients in Groups A (7.5%) and B (8.3%) at presentation. The final vision of normal or mild visual impairment was reported in 37.1%, 38.5%, and 77.5% of patients in Groups A, B, and C respectively.

Conclusion

The current study is a retrospective analysis of twenty years in Jordan and has comprehensively explored the trends and patient outcomes with respect to ocular and facial trauma among children. We revealed that over time, such injuries became less frequent and less serious than before with better patient outcomes. Furthermore, higher rates of closed globe injuries were reported in recent years. There was a dramatic increase in the rate of indoor injuries compared with outdoor ones which were mostly caused by falls with better initial and final visual outcomes. These injuries are preventable with the implementation of adequate safety measures which would significantly reduce the burden of visual impairment and cosmetic disfigurement among youngsters. 

The Epidemiological Profile of Open Globe Injuries and Prognostic Factors in a Tertiary Care Centre

Purpose

To describe the epidemiology of open globe injuries and its prognostic factors from the perspectives of a tertiary care centre in northern Malaysia.

Methods

A retrospective study of open globe injuries in a period of three years between June 2017 and May 2020. Patients presenting with open globe injuries were identified and recruited from hospital census. Case records were retrieved and analysed after recruitment.

Results

A total of 114 patients with 118 open globe injuries were included in the study. Four patients had bilateral eye involvement. Men were found to have seven and a half times higher rate of ocular injuries than women. The predominant age group of ocular trauma presentation was in younger adults between the age of 21 and 30 years old. Work-related injuries account for almost half of the globe injuries (48.7%) followed by motor vehicle accident-related, domestic accident-related, and others. The significant factors related to the visual outcome are presenting visual acuity (VA), presence of relative afferent pupillary defect (RAPD) and vitreous loss.

Conclusion

The factors related to visual outcomes in this study may aid the clinician in determining the visual prognosis of ocular injuries. Young working males were the most susceptible group to sustain penetrating ocular injuries due to their job nature. Health education and safety at workplace are essential to reduce the occurrence of ocular injuries.

Epidemiology of outpatient and inpatient eye injury in Taiwan: 2000, 2005, 2010, and 2015

Purpose

To estimate the incidence rate of eye injuries (EI) requiring inpatient and outpatient treatment in Taiwan and compare the epidemiologic characteristics of EI (age, sex, treatment setting, seasonality, occupation, external cause, diagnosis, and surgery) in the years 2000, 2005, 2010, and 2015.

Methods

We analyzed four random samples of 1,000,000 beneficiaries each from 2000, 2005, 2010, and 2015 of the Taiwan National Health Insurance Program. The direct age-standardized rate, with 95% confidence interval (CI), was used to compare EI rates for the four calendar years. The chi-square test and chi-square test for trend were used to compare data for the four calendar years.

Results

Annual EI incidence rates were between 2.57% in 2000 and 3.28% in 2015. The age-standardized rates were 2.73% (95% CI, 2.70%–2.76%) in 2000, 3.37% (95% CI, 3.33%–3.41%) in 2005, 3.31% (95% CI, 3.28%–3.35%) in 2010, and 3.02% (95% CI, 2.99%–3.06%) in 2015. Manual workers had the highest EI incidence rate, followed by non-manual workers and civil servants. The proportion of EI requiring inpatient treatment declined from 1.34% in 2000 to 0.63% in 2015 (P <0.0001). Analysis of seasonality showed a consistent decrease in February in the four sampling years; however, this decrease in EI was only seen in outpatients, not in EI requiring hospitalization. The proportion of outpatients requiring surgery significantly decreased, from 2.53% in 2000 to 1.2% in 2015 (P<0.0001). However, the proportion of inpatients requiring surgery for EI as the principal diagnosis increased from 69.32% in 2000 to 83.02% in 2015 (P = 0.29), and the proportion of inpatients requiring surgery for EI as a secondary diagnosis increased from 54.86% in 2000 to 71.6% in 2015 (P = 0.0019). Among inpatients with EI, the most common cause of EI was a traffic accident (44.79%, especially motorcycles), followed by falls (9.75%) and homicide (6.05%).

Conclusion

In Taiwan, the annual EI incidence rate slightly increased from 2000 to 2005 and then decreased through 2015. The proportion of EI patients requiring hospitalization decreased from 1.34% in 2000 to 0.63% in 2015, but the percentage of inpatients requiring surgery increased. Traffic accidents (especially those involving motorcyclists) remained the predominant external cause of EI requiring hospitalization during the study period.

Epidemiology of ocular trauma in the Indigenous vs non-Indigenous population in the Top End

IMPORTANCE

Epidemiological data on visually significant ocular trauma in the Top End of the Northern Territory.

BACKGROUND

Our main objective is to determine whether Indigenous patients are disproportionately affected by visually significant ocular trauma as compared to non-Indigenous patients.

DESIGN

This was a retrospective audit at the Royal Darwin Hospital in the Top End of the Northern Territory during January 2013 to June 2015.

PARTICIPANTS

A total of 104 ocular trauma patients were included; 43 were Indigenous and 61 were non-Indigenous.

METHODS

Medical records of patients with ocular trauma between January 2013 and June 2015 (except simple, non-penetrating corneal foreign bodies and abrasions) were reviewed. Vision loss was defined by visual acuity: mild ≥6/18, moderate 6/18-6/60, severe ≤6/60 following World Health Organization standards.

MAIN OUTCOME MEASURES

The study included the incidence of ocular trauma patients by ethnicity (Indigenous vs non-Indigenous). Our secondary outcome included vision loss, mechanism of injury, open vs closed injury, age, remoteness and alcohol involvement.

RESULTS

A total of 104 patient charts were reviewed; 43 (41%) were Indigenous and 61 (59%) were non-Indigenous. Alleged assault was the greatest contributor to ocular trauma in both groups (74% in Indigenous vs 39% non-Indigenous). Severe vision loss was more prevalent in the Indigenous vs non-Indigenous patients (30% vs 16%).

CONCLUSIONS AND RELEVANCE

Indigenous patients were disproportionately affected by visually significant ocular trauma compared to non-Indigenous patients. This research provides important data on ocular trauma in the Northern Territory. Further prevention strategies are needed to reduce vision loss in this population.

Epidemiology and clinical characteristics of patients hospitalized for ocular trauma in South-Central China

PURPOSE

Ocular trauma is a major cause of visual loss, but little is known about its epidemiology and clinical characteristics in China. The aim of this study was to determine the prevalence and clinical characteristics of ocular trauma and assess prognostic factors in Changsha, Hunan, located in South-Central China.

METHODS

A retrospective case series (ICD codes: S05) study of ocular trauma in patients was performed at the Second Xiangya Hospital, Central South University, from 1 January 2010 to 31 December 2014. Demographic information, injury causes, ocular trauma types and initial and final visual acuity (VA) were recorded and analysed. The ocular trauma score (OTS) was calculated to assess the extent of the eye injury, prognosis and factors associated with visual impairment. All patient data were collected from the medical records system.

RESULTS

Of the 2009 patients presenting during this 5-year period, 1695 (84.4%) were males and 314 (15.6%) were females. The average age of all patients was 37.0 ± 19.3 years (range from 1 to 87 years). The age distribution showed a peak in the ocular trauma population in the 41- to 50-year age group (24%, n = 482), followed by the 51- to 60-year age group (16.9%, n = 339). Overall, open-globe injuries had a higher frequency (70.7%, n = 1420) than closed-globe injuries (28.6%, n = 575) and thermal/chemical injuries (0.7%, n = 14). Of the open-globe injuries, corneal penetration was the most common injury (32.2%, n = 646) followed by rupture (21.5%, n = 432) and an intraocular foreign body (16.2%, n = 325). Overall, the most frequent ocular trauma setting was the workplace (39.6%, n = 795), followed by the home (28.4%, n = 570), and the most frequent activity was ironwork. Firecracker- and firework-associated ocular trauma was significantly higher during the months of January and February than during other months (50.0%, n = 112, p < 0.001). In patients under 18 years, the most frequently occurring injury was open globe (84.5%, n = 349) with corneal penetration (59.3%, n = 245). Overall, an operation was performed in 1865 (92.8%) cases, and 144 cases (7.2%) were treated conservatively with medication. The average OTS score was 47.1 ± 19.5. The visual prognosis was closely correlated with the initial VA (r = 0.570, p = 0.000) and the OTS score (r = 0.603, p = 0.000).

CONCLUSION

This study describes the epidemiology and clinical characteristics of patients hospitalized for ocular trauma in South-Central China. Notably, a high rate of firework-related ocular trauma occurred during the months adjacent to the Chinese New Year festival. Specific injury prevention strategies, such as the use of protective eyewear, need to target the workplace to reduce the incidence and severity of ocular trauma.