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Tan SI, Hoskin AK, Khatri A, Dave VP, Bhalerao S, Romero J, Agrawal R. Prognostic factors of open-globe injuries: A review. Indian J Ophthalmol 2023; 71:3587-3594. [PMID: 37991288 PMCID: PMC10788744 DOI: 10.4103/ijo.ijo_1496_23] [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: 06/07/2023] [Revised: 10/07/2023] [Accepted: 10/27/2023] [Indexed: 11/23/2023] Open
Abstract
Open-globe injuries (OGI) can lead to significant visual impairment. The Ocular Trauma Score (OTS) is the most widely recognized tool for predicting visual outcomes. This review aimed to identify prognostic factors and assess the effectiveness of the OTS in predicting visual outcomes. Twenty-one articles published on PubMed and Google Scholar were analyzed. Initial visual acuity and the zone of injury were found to be the most significant prognostic factors for OGI. Other significant prognostic factors include retinal detachment/involvement, relative afferent pupillary defect, vitreous hemorrhage, vitreous prolapse, type of injury, hyphema, lens involvement, and duration from incidence of OGI to vitrectomy. Of the 21 studies evaluated, 11 investigated the effectiveness of OTS. Four studies concluded that OTS was effective overall, while six studies suggested that it was only useful in certain OGI categories. Thus, there is a need for further research to develop an optimized ocular trauma prognosticating system.
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Affiliation(s)
- Sze Ing Tan
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Annette K Hoskin
- Save Sight Institute, The University of Sydney, Australia
- Lions Eye Institute, The University of Western Australia, Australia
| | - Anadi Khatri
- Department of Ophthalmology, Birat Aankha Aspatal, Biratnagar, Nepal
- Department of Opthalmology, Byers Eye Institute at Stanford, Stanford University, Palo Alto, USA
| | - Vivek P Dave
- Department of Ocular Immunology, Anant Bajaj Retina Institute, Kallam Anji Reddy Campus, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Sushank Bhalerao
- Shantilal Shanghvi Cornea Institute, Kode Venkatadri Chowdary Campus, L V Prasad Eye Institute, Vijayawada, Andhra Pradesh, India
| | - Jose Romero
- Department of Ocular Trauma, Unidad Nacional de Oftalmologia de Guatemala, Guatemala, USA
| | - Rupesh Agrawal
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
- Singapore Eye Research Institute, Singapore
- Duke‐NUS Medical School, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Santamaría A, Pérez S, De Luis B, Orive A, Feijóo R, Etxebarria J. Clinical characteristics and prognostic factors of open globe injuries in a North Spain population: a 10-year review. Eye (Lond) 2023; 37:2101-2108. [PMID: 36371603 PMCID: PMC10333325 DOI: 10.1038/s41433-022-02297-8] [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: 04/15/2022] [Revised: 09/27/2022] [Accepted: 10/14/2022] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES To describe the epidemiologic and clinical characteristics of open globe injuries (OGIs) treated in a tertiary hospital and analyse predictors of visual outcome. METHODS This retrospective observational study included all patients with OGIs admitted to Cruces University Hospital between 2010 and 2020. The descriptive analysis included demographic data, type of injury classified as "rupture", "penetration", "perforation", or "intraocular foreign body", trauma mechanism and setting, injury zone, Ocular Trauma Score, delay to surgery, length of hospital stay, antibiotic prophylaxis, initial and final best corrected visual acuity (BCVA), complications and further surgery. Univariate analysis and logistic regression were performed to identify prognostic factors, based on final BCVA. RESULTS Overall, 207 OGI cases were reported. The most common type of injuries were ruptures caused by domestic falls. Notably, 44.4% of eyes developed phthisis bulbi. In the univariate analysis, the following variables were significantly linked to visual outcome: age > 60 years, "rupture", "fall", posterior and/or combined zones of injury, lens damage, retinal/choroidal detachment, initial BCVA of no light perception, and Ocular Trauma Score ≤ 2 (p < 0.001). Delay to surgery, length of stay and further surgery did not have prognostic value. In the logistic regression, initial BCVA of no light perception (p < 0.001) and injury zone III (p = 0.005) remained significant predictors of poor outcome. CONCLUSIONS In the population studied, most OGIs were caused by domestic falls usually affecting elderly patients with comorbidities. Visual outcome depended on patients´ specific characteristics and the nature of the trauma itself, whereas environmental factors failed to show any prognostic value.
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Affiliation(s)
- Alaitz Santamaría
- Department of Ophthalmology, BioCruces Bizkaia Health Research Institute, Cruces University Hospital, Begiker, Plaza de Cruces s/n, 48903, Barakaldo, Spain.
| | - Silvia Pérez
- Scientific Coordination Facility, BioCruces Bizkaia Health Research Institute, Cruces University Hospital, Plaza de Cruces s/n, 48903, Barakaldo, Spain
| | - Beatriz De Luis
- Department of Ophthalmology, BioCruces Bizkaia Health Research Institute, Cruces University Hospital, Begiker, Plaza de Cruces s/n, 48903, Barakaldo, Spain
| | - Ana Orive
- Department of Ophthalmology, BioCruces Bizkaia Health Research Institute, Cruces University Hospital, Begiker, Plaza de Cruces s/n, 48903, Barakaldo, Spain
| | - Raquel Feijóo
- Department of Ophthalmology, BioCruces Bizkaia Health Research Institute, Cruces University Hospital, Begiker, Plaza de Cruces s/n, 48903, Barakaldo, Spain
| | - Jaime Etxebarria
- Department of Ophthalmology, BioCruces Bizkaia Health Research Institute, Cruces University Hospital, Begiker, Plaza de Cruces s/n, 48903, Barakaldo, Spain
- Department of Cell Biology and Histology, School of Medicine and Nursing, University of the Basque Country (UPV/ EHU), Barrio Sarriena s/n, 48940, Leioa, Spain
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Pelletier J, Koyfman A, Long B. High risk and low prevalence diseases: Open globe injury. Am J Emerg Med 2023; 64:113-120. [PMID: 36516669 DOI: 10.1016/j.ajem.2022.11.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 11/20/2022] [Accepted: 11/29/2022] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Open globe injury (OGI) is a rare but serious condition that carries with it a high rate of morbidity. OBJECTIVE This review highlights the pearls and pitfalls of OGI, including presentation, diagnosis, and management in the emergency department (ED) based on current evidence. DISCUSSION OGI refers to full-thickness injury to the layers of the eye. OGI can be caused by blunt or sharp trauma, and subtypes include penetration, perforation, intraocular foreign body (IOFB), globe rupture, or mixed types. OGI is more common in males and usually secondary to work-related injury, but in women it is most commonly associated with falls. Emergency clinicians should first assess for and manage other critical, life-threatening injuries. Following this assessment, a thorough eye examination is necessary. Computed tomography (CT) may suggest the disease, but it cannot definitively exclude the diagnosis. While point-of-care ultrasound (POCUS) is highly sensitive and specific for some findings in OGI, its use is controversial due to potential globe content extrusion. Management includes protecting the affected eye from further injury, preventing Valsalva maneuvers that could extrude ocular contents, updating tetanus vaccination status, administering broad-spectrum antibiotics, and ophthalmology consultation for surgical intervention to prevent the sequelae of blindness and endophthalmitis. CONCLUSION An understanding of OGI can assist emergency clinicians in diagnosing and managing this sight-threatening traumatic process.
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Affiliation(s)
- Jessica Pelletier
- Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Alex Koyfman
- Department of Emergency Medicine, UT Southwestern, Dallas, TX, USA
| | - Brit Long
- SAUSHEC, Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, TX, USA.
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Carrell SM, Anderson S, Benson MD, Pietrosanu M, Chen SH. A 10-year analysis of traumatic open-globe injuries in Edmonton, Canada, from 2009-2018. Can J Ophthalmol 2022:S0008-4182(22)00118-1. [PMID: 35483430 DOI: 10.1016/j.jcjo.2022.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 03/22/2022] [Accepted: 03/30/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE To identify and characterize the incidence and correlates of open-globe injuries documented at the Eye Institute of Alberta (EIA) at the Royal Alexandra Hospital in Edmonton. STUDY DESIGN A 10-year single-centre retrospective chart review. METHODS All patients who underwent traumatic open-globe injury repair at EIA from January 2009-December 2018 were identified using key search terms. Charts were individually assessed for key demographic variables, including mechanism and location of injury. Patterns in open-globe injury incidence over the 10-year period and across demographics were assessed using Poisson regression. Associations between key demographic variables also were analyzed. RESULTS In total, 551 traumatic open-globe injuries were treated at the EIA from January 2009-December 2018, resulting in an average of 4.63 injuries per month over the 10-year period. Mean patient age was 42 ± 21.56 years. The number of males (n = 442) presenting for open-globe injury repair was 3.9 times higher than that for females (n = 114). Among patients for whom use of eye protection was recorded (n = 186), only 11% reported using eye protection at the time of the trauma. The incidence rate of injuries with zone 3 involvement was significantly higher in males (41.4%) than in females (29.8%). CONCLUSION Open-globe injuries remain a significant source of ocular morbidity at EIA, averaging just over 1 emergency case a week. Given the strong association with sex and the infrequent use of eye protection, targeted public health strategies are necessary to mitigate the risk of these sight-threatening injuries.
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Affiliation(s)
- Stephen M Carrell
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alb
| | - Scott Anderson
- Department of Ophthalmology and Visual Sciences, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alb
| | - Matthew D Benson
- Department of Ophthalmology and Visual Sciences, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alb
| | - Matthew Pietrosanu
- Department of Mathematical and Statistical Sciences, University of Alberta, Edmonton, Alb
| | - Sylvia H Chen
- Department of Ophthalmology and Visual Sciences, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alb..
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Description of Main Predictors for Taking Sick Leave Associated with Work-Related Eye Injuries in Spain. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18105157. [PMID: 34067993 PMCID: PMC8152250 DOI: 10.3390/ijerph18105157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 05/06/2021] [Accepted: 05/07/2021] [Indexed: 11/17/2022]
Abstract
Recent studies in Spain have shown that males, younger workers, and people involved in manual jobs had the highest risk of suffering a work-related eye injury (WREI). This study aims to assess the predictors of sick leave associated with WREI and to compare them with risk factors of initial injury. A retrospective and descriptive study of WREI that causes sick leave of one or more days among workers from an insurance labor mutual company in Spain was conducted over a period from 2008 to 2018. The variables of the study were sex, age, occupation, and type of injury. A total of 9352 (18.6% of 50,265 WREI) cases and 113,395 total days of sick leave were observed, with an estimated EUR 4,994,009.59 of associated labor cost. The main predictors of sick leave related to WREI were found to be female (highest incidence; 25.9 (95% CI (24.8–27.1))), >55 years of age (highest incidence; 20.5 (95% CI (19.3–21.7))), not working in the industry (lowest incidence; 13.8 (95% CI (13.3–14.2))), and not suffering “other disorders of conjunctiva” (lowest incidence; 5.7 (95% CI (4.7–6.8))). The consequences associated with WREI are worse for female and older workers, despite the main risk of suffering WREI being observed in males and younger workers.
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