Visual outcomes and prognostic factors in open-globe injuries

A multi-center analysis of visual outcomes following open globe injury

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.

Causative Activities and Prognostic Factors of Open-Globe Injury: A Registry-Based City-Wide Multicentre Study

PURPOSE

Traumatic globe injury is classified into closed-globe and open-globe injury (OGI); OGI leads to a worse prognosis. We aimed to identify causative activities and prognostic factors of OGI in a metropolitan city in South Korea.

METHODS

This retrospective observational study used a prospective eye-injury registry conducted in Daegu, South Korea, between 1 August 2016 and 31 July 2021. We identified epidemiology and visual outcomes of OGI at four tertiary hospitals. Those with the best visual acuity lower than counting fingers at the 6-month follow-up were considered to have poor visual outcome.

RESULTS

Of 9,208 patients with eye injuries, 282 had OGI. Most OGI patients were male (261, 92.6%), with the largest proportion in their 50s (76, 27.0%). The most frequent causative activity was mowing (59, 20.9%), and poor visual outcome was most seen in assault (7, 87.5%) and sports activity (9, 81.8%). Hammering, metal work, and sports activity were prevalent in those under 30, and mowing was most prevalent in those in their 50s (16, 21.1%) and 60s (29, 40.3%). In the multivariable logistic regression analysis, OGI related to traffic accident and sports activity were presented poor prognosis (adjusted odds ratio [aOR] 13.259, 95% confidence interval [CI] 1.202-146.205 for traffic accident; aOR 6.801, 95% CI 1.064-43.487 for sports activity).

CONCLUSION

We need to develop advanced vehicle safety equipment, implement public education promoting seat belt usage and hazards of OGI, establish eye protection standards for key causal activities, and provide eye protection equipment for sports activities and mowing.

Mechanism and outcomes of recreational and sports-related open globe injuries

OBJECTIVES

To describe the mechanisms and visual outcomes of recreational and sports-related open globe injuries (OGIs).

METHODS

A retrospective case series of eyes experiencing OGI secondary to recreational and sports-related activities at Memorial Hermann Hospital - Texas Medical Center (MHH-TMC) from January 1st, 2010 through March 31st, 2015 was conducted. Exclusionary criteria included no documented ophthalmologic examination upon presentation and repairs performed by services other than ophthalmology. A two-tailed t-test and Fisher's exact test were utilized to assess for statistical significance (p < 0.05).

RESULTS

A total of 20 eyes from 20 patients experiencing OGIs secondary to recreational and sports-related activities were included. Thirteen eyes (65 %) presented with OGIs from penetrating objects while seven eyes (35 %) had injuries from blunt injuries. Males comprised most of the total study group (17 of 20 patients), and zone 3 injuries were the most common location of OGI. While eyes with OGIs from blunt trauma underwent evisceration/enucleation procedures more frequently than OGIs from penetrating mechanisms (71% vs 23 %) (p = 0.10), the final visual outcomes were similarly poor between groups. Only three eyes in this series experienced an improvement from baseline VA; all three eyes had lacked initial findings consistent with severe injury.

CONCLUSIONS

Recreational and sports related OGIs most commonly occur in zone 3 and in young males, regardless of injury type. OGIs due to both penetrating and blunt trauma mechanisms implicate poor functional outcomes, but the absence of certain presenting injury features may indicate possibility of eventual visual recovery.

Diabetes Distress Among Patients Undergoing Surgery for Diabetic Retinopathy and Associated Factors: A Cross-Sectional Survey

Background

Diabetes distress (DD) is a negative emotion related to diabetes management and a predictor of depression; it affects diabetic retinopathy (DR) patients' quality of life and disease outcomes. The prevalence of DD was higher in patients undergoing surgery for DR. However, few studies have been conducted on DD in DR surgery patients. The present study aims to investigate the status of DD in DR surgery patients and identify factors associated with DD.

Methods

Using a convenience sampling method, 210 DR surgery patients who were admitted to 2 tertiary-level hospitals in Wenzhou City (Zhejiang Province) and Zhengzhou City (Henan Province) from February to June 2023 were selected as research subjects. A questionnaire collecting demographic and disease-related information, the Diabetes Distress Scale, the Summary of Diabetes Self-Management Activities, the Family Care Index Scale, and the Social Support Rating Scale were used to collect data. Statistical analyses included descriptive statistics, t tests, ANOVAs, Pearson's correlation analyses and stepwise multiple linear regression. This study is reported according to the STROBE guidelines.

Results

In total, 156 out of 210 (74.29%) DR surgery patients experienced DD, with an average score of 2.13±0.63. The results of the stepwise multiple regression analysis showed that residential location, employment status, self-management level, family support, and social support were significantly associated with DD. These variables accounted for 30.6% of the total variation in DD.

Conclusions

DR surgery patients exhibit moderate levels of distress. Health care professionals should pay attention to DD in DR surgery patients and develop targeted interventions to improve the self-management ability of these patients, increase their family support and social support to reduce their DD levels.

Pattern of Ocular Injuries Following Road Traffic Accidents Seen at a Tertiary Eye Hospital

INTRODUCTION

Traffic trauma can lead to ocular damage. Open globe injuries usually have a poor prognosis, which can be ameliorated by prompt diagnosis and appropriate treatment. Nonetheless, few studies have focused on the visual outcomes of patients following traffic accidents. In this study, we aimed to examine the characteristics and prognosis of ocular complications in patients following traffic accidents at a specialized tertiary eye hospital.

METHODS

We classified 44 patients from traffic accidents (88 eyes) into groups with equal or better (better group) and worse (worse group) corrected-distance visual acuity than a logarithm of the minimum angle of resolution 0 at the initial presentation. Final corrected-distance visual acuity, intraocular pressure, corneal injury, presence of traumatic cataracts, and treatment were compared between the groups. In addition, a multivariate linear regression analysis was performed to identify factors associated with the final visual acuity.

RESULTS

Globe contusion, orbital blowout fracture, traumatic iritis, and trochlear nerve palsy were observed in 14.8%, 3.4%, 2.3%, and 2.3% of the patients, respectively. Topical instillation and ophthalmological treatment/surgery were performed in 17.0% and 9.1% of the patients, respectively. The better group (68 eyes) had significantly better final visual acuity than the worse group (20 eyes) (P < 0.001). However, there was no between-group difference in demographic characteristics. Multivariate analysis demonstrated that there was a significant correlation between the initial and final visual acuities (P < 0.001).

CONCLUSIONS

Assessing visual acuity at the initial presentation is crucial for predicting the final visual acuity. Our findings will help to inform ophthalmologists aiming to improve the prognosis and treatment of ocular trauma in patients following traffic accidents.

Visual outcomes of the surgical rehabilitative process following open globe injury repair

Background

The path of rehabilitation of an eye after open globe injury (OGI) may require multiple additional secondary surgeries after the initial repair. Although much has been studied regarding the outcomes of secondary surgeries after open globe repair, it can be challenging to understand the possible implications of the surgical rehabilitative process. This retrospective study considers the benefits of the required additional secondary surgeries for a consecutive series of OGI patients.

Methods

OGI patients who had at least one additional surgery after the initial open globe repair (OGR) were studied retrospectively. Additional inclusion criteria included: follow up of at least 12 months since the initial injury and at least 3 months since their most recent surgery, and no additional planned interventions. Preoperative visual acuity was compared to final visual acuity. Additionally, the odds of achieving ambulatory vision (≥20/800) and reading vision (≥20/40) were calculated after each indicated consecutive surgery.

Results

A cohort of 74 eyes from 73 patients met our inclusion criteria. These patients underwent a mean of two additional surgeries. The mean logMAR VA improved from 2.3 (HM) at presentation to 1.4 (20/150), or a 9-line Snellen equivalent improvement. Upon reaching their final visit status, 50% of patients had achieved ambulatory vision and 30% of patients had achieved reading vision. The odds of achieving ambulatory vision after completion of all the rehabilitative surgical process compared to the vision prior to the secondary rehabilitative surgery were higher (OR: 19.1, 95% CI: 7.9 - 30.4, p = 0.0008) as were the odds of achieving reading vision (OR: 4.6, 95% CI: 0.2 - 9.0, p = 0.04). With subsequent second, third, and fourth additional surgeries, the odds of achieving either ambulatory or reading vision at the final visit compared to their preoperative visual acuities were not significant (p > 0.05) but the visual acuity continued to trend toward visual improvement.

Conclusion

Approximately 50% of individuals who required additional surgery at UMN achieved ambulatory vision and 30% achieved reading vision. The odds of visual improvement through the surgical rehabilitative process were very high, with the greatest gains generally achieved after the first surgery.

Zone 1 trauma: wound dehiscence compared to primary trauma

PURPOSE

The study aims to assess if Zone 1 globe injuries hold a favorable prognosis for all situations, including wound dehiscence, or just primary traumatic injuries.

METHODS

Retrospective cross-sectional chart review of patients who underwent open globe repair from 1/1/2019 to 12/1/2020 at an urban hospital setting was evaluated for final visual outcomes, associated ocular pathology, long-term complications, and need for further surgeries.

RESULTS

Fifty-eight eyes were identified-38 primary trauma and 20 dehisced wounds (11 penetrating keratoplasties, five clear corneal incisions, one laceration, one extracapsular cataract extraction, one radial keratotomy, and one tectonic graft). Dehisced wounds had more posterior segment pathology vs primary trauma, i.e., hemorrhagic choroidal, vitreous hemorrhage, retinal detachment, choroidal effusion (all 20% vs 2.63%, 5.26%, 5.26%, and 0%, respectively), vitreous prolapse (20% vs 2.63%), and uveal prolapse (80% vs 36.84%). Dehisced wounds had more traumatic aphakia (40% vs 0%) and dislocated lenses (15% vs 0%). Primary trauma was more likely to have traumatic cataracts (55.26% vs 10%) or no lens changes (44.74% vs 25%). About 10% dehisced wounds required enucleation (0% primary trauma). Cataract/secondary intraocular lens surgery was performed in 34% of the primary traumas (10% in dehisced wounds). Primary traumas achieved 20/40 vision or better in 44.74% (10% dehisced wounds). About 7.89% of patients with wound dehiscence ended with no light perception (none in primary trauma).

CONCLUSION

Zone 1 open globe injuries due to wound dehiscence may exhibit worse prognosis compared to primary trauma open globe injury. More important than the zone of injury may be the source.

Epidemiological and clinical characteristics of open globe injuries in Southwest China

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.

The Epidemiology and Risk Factors for the Progression of Sympathetic Ophthalmia in the United States: An IRIS Registry Analysis

PURPOSE

To investigate the demographic and clinical characteristics of patients with sympathetic ophthalmia (SO) and define the risk factors for its incidence following trauma and ophthalmic procedures.

DESIGN

Retrospective cohort study.

PARTICIPANTS

Patients in the American Academy of Ophthalmology's (Academy) IRIS Registry (Intelligent Research in Sight) who were (n=1523) or were not diagnosed with SO following a documented procedure or trauma between January 1, 2013, and December 31, 2019.

METHODS

Multiple demographic and clinical factors were collected, descriptive statistics and prevalence were calculated, and multivariate linear regression models were fit to the data.

MAIN OUTCOME MEASURES

Prevalence of SO, demographic and clinical characteristics, and beta coefficient (β) estimates of demographic and clinical characteristics impacting time to SO onset after procedure (Procedure Only cohort) or trauma (Trauma cohort).

RESULTS

Of 65,348,409 distinct IRIS Registry patients, 1523 (0.0023%) were diagnosed with SO between 2013 and 2019, and also had a documented preceding trauma or procedure. Of these, 927 (60.87%) were female, 1336 (87.72%) belonged to the Procedure Only cohort, and 187 (12.28%) belonged to the Trauma cohort. The prevalence of SO after trauma was 0.0207%, whereas after procedures it was 0.0124%. The highest risk of procedure-related SO was seen in patients with history of "other anterior segment" (0.122%) followed by glaucoma (0.066%) procedures, whereas the lowest prevalence was noted with cataract surgeries (0.011%). The average time to onset of SO across both cohorts combined was 527.44 (±715.60) days, with statistically significant differences between the 2 cohorts (P < .001). On average, the time to onset from inciting event to SO was shorter with increasing age, by 9.02 (95% CI: -11.96, -6.08) days for every 1-year increase.

CONCLUSIONS

SO following trauma and ophthalmic procedure is potentially rarer than previously reported, as measured in this large ophthalmic medical record database. Female sex may be a risk factor for SO. Older age may be a risk factor for quicker onset. These findings can guide clinical decision-making and management.

Prognostic factors of open-globe injuries: A review

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.

Use of Yamane technique for secondary intraocular lens implantation following open globe injury

A woman in her 50s presented with suspected open globe injury (OGI) of the right eye after being hit with a high velocity piece of plastic. Visual acuity at the time of presentation was counting fingers in the affected eye. Slit lamp examination revealed a full thickness laceration of the cornea and a traumatic cataract. Primary corneal repair was performed and the patient was left aphakic after cataract removal. Secondary intraocular lens placement was deferred for 2 years, after which time a scleral-fixated intraocular lens was implanted using the Yamane technique. Postoperative visual acuity of 20/50 was achieved, with the vision limited by persistent diabetic macular oedema. Thus, this case of successful implantation of a secondary lens using the Yamane technique in a patient with prior corneal laceration and traumatic cataract highlights that the Yamane technique can result in visual improvement in patients with prior OGI.

Visual Outcomes of Traumatic Lens Dislocations and Subluxations Managed by Pars Plana Vitrectomy and Lensectomy

AIM

The aim of this study was to evaluate the visual outcome of lens dislocation and subluxation managed by pars plana vitrectomy (PPV) and lensectomy in patients with open (OGIs) or closed globe injuries (CGIs).

METHODS

Medical records of 70 consecutive patients treated by PPV and lensectomy over a period of 11 years (1 January 2010-31 December 2020) were retrospectively reviewed. We collected demographic data, best corrected visual acuity (BCVA) using a Snellen Chart pre- and postoperatively, associated ocular injuries and treatment strategy. Visual outcome was evaluated according to the final BCVA which was defined as poor <0.1 or good ≥0.1.

RESULTS

The mean age was 57.9 ± 17.6 years. CGIs were present in 49 (70.0%) cases and open OGIs in 21 (30.0%) cases. The dislocation mechanism was zonular lysis in 59 cases (84.3%) and capsular rupture in 11 cases (15.7%). The intraocular lens implant (IOL) was sutured to the sclera in 51 (72.9%) cases or positioned in the capsular bag or in the sulcus in 3 (4.3%) cases and 1 (1.4%) case, respectively, whereas 15 (21.4%) patients remained aphakic. A good BCVA ≥ 0.1 was achieved in 45.71% of the eyes. The presence of retinal detachment (RD) (p = 0.014), iridodonesis (p = 0.011) and initial BCVA (p = 0.000) achieved statistical significance in predicting visual outcome. After treatment, 45.71% of patients achieved a final BCVA ≥ 0.1.

CONCLUSION

RD, iridodonesis and initial BCVA were risk factors for poor visual outcome in our series.

Intraocular foreign body: Characteristics, visual outcomes, and predictive values of ocular trauma score

Introduction

Retained intraocular foreign body (IOFB) remains an important cause of acquired visual impairment. The visual prognosis following treatments for eyes with retained IOFB was observed to be distinct from other mechanisms of open globe injury due to the specific nature and associated circumstances. This study evaluated the risk behaviors, visual results, and predictive values of Ocular Trauma Score (OTS) in determining visual outcomes in patients with IOFB that were not related to terrorism.

Methods

Medical records of patients who underwent surgical interventions between January 2015 and December 2020 were retrospectively reviewed.

Results

A total of one hundred and sixty-one patients (162 eyes) were recruited. The patients had a mean (standard deviation) age of 47.6 (14.0) years with working male predominance (93.2%). The majority of patients were injured by activities related to grass trimming (63.4%) and metallic objects were the main materials causing injuries (75.7%). Following treatments, the proportion of eyes having vision worse than 20/400 decreased from 126 eyes (77.8%) to 55 eyes (33.9%) at final visit. Ocular trauma score (OTS) had a high potential prediction for final vision in eyes in OTS categories 4 and 5. However, the discordance of final visual acuity distribution was observed in some subgroups of eyes in OTS categories 1 to 3.

Conclusion

This study highlights the significance of IOFB related eye injuries in a tertiary care setting. Decision making on treatments should be carefully considered, particularly in eyes in lower OTS categories, in light of a rise in the proportion of patients who experience improved vision after IOFB removal.

Improved Visual Outcomes after Severe Open-Globe Injuries Associated with Perioperative Vitreoretinal Evaluation

PURPOSE

To investigate the impact of perioperative evaluation by a vitreoretinal surgeon on outcomes after severe open-globe injury (OGI).

DESIGN

Retrospective, comparative study.

SUBJECTS

Open-globe injury cohorts from 2 academic United States ophthalmology departments with disparate OGI management protocols and vitreoretinal referral patterns.

METHODS

Patients with severe OGI (presenting visual acuity [VA] of counting fingers or worse) from the University of Iowa Hospitals and Clinics (UIHC) were compared with patients with severe OGI from the Bascom Palmer Eye Institute (BPEI). At UIHC, almost all cases of OGI were repaired by anterior segment surgeons, with postoperative vitreoretinal referral at the surgeon's discretion. In contrast, at BPEI, all OGIs were both repaired and managed postoperatively by a vitreoretinal surgeon.

MAIN OUTCOME MEASURES

Rate of vitreoretinal surgeon evaluation, rate of pars plana vitrectomy (PPV) (either primary or secondary), and VA at the last follow-up.

RESULTS

Overall, 74 subjects from UIHC and 72 subjects from BPEI met the inclusion criteria. There were no differences in preoperative VA or rates of vitreoretinal pathology. The rate of vitreoretinal surgeon evaluation was 100% at BPEI and 65% at UIHC (P < 0.001), and the rate of PPV was 71% at BPEI and 40% at UIHC (P < 0.001). Median VA at the last follow-up in the BPEI cohort was 1.35 logarithm of the minimum angle of resolution (logMAR) (interquartile range [IQR], 0.53-2.30, corresponding to a Snellen VA of ∼ 20/500) compared with a median VA of 2.70 logMAR (IQR, 0.93-2.92, corresponding to a Snellen VA of light perception) in the UIHC cohort (P = 0.031). Overall, 68% of patients in the BPEI cohort had an improvement in VA from presentation to last follow-up versus 43% in the UIHC cohort (P = 0.004).

CONCLUSIONS

Automatic perioperative evaluation by a vitreoretinal surgeon was associated with a higher rate of PPV and improved visual outcomes. Prompt evaluation by a vitreoretinal surgeon, either preoperatively or in the early postoperative period, should be considered, when logistically feasible, in severe OGIs because PPV is frequently indicated and may result in significant visual improvement.

FINANCIAL DISCLOSURE(S)

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Wound size and location affect the prognosis of penetrating ocular injury

BACKGROUND

Ocular trauma is a leading cause of vision loss. Penetrating ocular injury is a major type of open globe injury(OGI), while its epidemiology and clinical characteristics are still uncertain. The aim of this study is to reveal the prevalence and prognostic factors of penetrating ocular injury in the Shandong province.

METHODS

A retrospective study of penetrating ocular injury was performed at the Second Hospital of Shandong University, from January 2010 to December 2019. Demographic information, injury causes, ocular trauma types, and initial and final visual acuity(VA) were analyzed. To obtain more precise characteristics of penetrating injury, the eye global was divided into three zones and analyzed.

RESULTS

Among 210 OGI, there are 83 penetrating injuries which account for 39.5% of all. In addition, the final VA of 59 penetrating injuries recovered to 0.1 or better, which possesses the highest frequency among OGI. In order to research the relationship between the wound location and the final VA, we took 74 cases of penetrating injuries without retina or optic nerve damage for analysis. Results show that 62 were male and 12 were female. The average age was 36.01 ± 14.15. The most frequent occupation is the worker followed by the peasant. Statistics show that there is an obvious deviation in the Ocular trauma score (OTS) predicting the final VA and the actual final VA in the 45-65 score group (p < 0.05). Results suggest that the commonest penetrating injury zone is zone III (32 cases, 43.8%). Zone III, which is farthest from the center of the visual axis, has the largest improvement of the final VA (p = 0.0001). On the contrary, there is no statistical difference in the visual improvement in zone I and zone I + II that involves the injury of the central visual axis.

CONCLUSION

This study describes the epidemiology and clinical characteristics of patients hospitalized for penetrating ocular injury without retina damage in Shandong province. It can be concluded that larger size and closer location to the visual axis of damage are accompanied by worse prognosis improvement. The study provides a better understanding of the disease and enlightenment for the prediction of visual prognosis.

Presenting clinical characteristics of open globe injuries in ocular trauma: baseline analysis of cases in the ASCOT national clinical trial

BACKGROUND/OBJECTIVES

The Adjunctive Steroid Combination in Ocular Trauma (ASCOT) trial is a unique pragmatic, multi-centre, patient and assessor masked, randomised controlled trial. We evaluate the clinical characteristics and pathology of this large trial cohort of patients with open globe injuries undergoing vitreoretinal surgery, including the associations between patient characteristics and their baseline vision.

SUBJECTS/METHODS

We (i) summarise demographics, injury history and ocular history of the 280 participants recruited into the ASCOT trial using descriptive statistics; (ii) analyse the national and seasonal variation across England and Scotland in these participant characteristics; and (iii) explore the associations between participant demographic, trauma history, ocular history and presenting baseline visual acuity (measured using the Early Treatment Diabetic Retinopathy Study, ETDRS) using multivariable regression analyses.

RESULTS

The majority of participants with open globe penetrating injuries were of white ethnicity (233, 84%), male (246, 88%), with a median age of 43 years (IQR 30-55 years). There was considerable variability in presenting visual acuity with 75% unable to read any letters on the ETDRS chart, whilst the median ETDRS letter score was 58 (IQR 24-80) for those who could read ≥1 letter. The most common causes of injury were workplace related (31%) or interpersonal violence (24%). Previous eye surgery, visual axis corneal scar, lens status, hyphaemia and vitreous haemorrhaging were found to be associated with presenting vision as measured by the ETDRS chart.

CONCLUSION

The ASCOT trial provides valuable insights into the spectrum of pathology of patients with open globe eye injuries undergoing vitreoretinal surgery. The identified causes of injury and clinical presentation of the cases will help in training and resource planning to deal with these often challenging surgical cases.

TRIAL REGISTRATION

EudraCT No. 014-002193-37. HTA Project 12/35/64.

Outcomes of Zone 3 Open Globe Injuries by Wound Extent: Subcategorization of Zone 3 Injuries Segregates Visual and Anatomic Outcomes

PURPOSE

Open globe injuries (OGIs) are categorized by zone, with zone 3 (Z3) comprising wounds > 5 mm beyond the limbus. Outcomes of Z3 OGIs are highly heterogeneous. Open globe injuries with far posterior Z3 (pZ3) wounds were hypothesized to have worse visual and anatomic outcomes.

DESIGN

Single-center retrospective cohort study.

PARTICIPANTS

A total of 258 eyes with Z3 OGIs.

METHODS

A retrospective review of Z3 OGIs treated at a tertiary center over 12 years. Wounds ≥ 10 mm posterior to the limbus were defined as pZ3. Outcomes were compared between pZ3 and anterior Z3 (aZ3) eyes.

MAIN OUTCOME MEASURES

Visual acuity on a logarithm of the minimum angle of resolution (logMAR) scale. Secondary outcomes included anatomic outcomes, development of retinal detachment and proliferative vitreoretinopathy, and the number of secondary surgeries.

RESULTS

A total of 258 Z3 OGI eyes with > 30 days follow-up were assessed; 161 (62%) were pZ3. At 3-month follow-up, pZ3 OGIs were more likely to exhibit no light perception (pZ3: 38%; aZ3: 17%; P < 0.003), lack count fingers vision (pZ3: 72%; aZ3: 43%; P < 0.002), and fail to read a letter on the eye chart (pZ3: 83%; aZ3: 64%; P < 0.001). The visual acuity distribution at 3 months was significantly worse for pZ3 compared with aZ3 injuries (P < 0.004). Similar results were found at final follow-up. Multiple linear regression showed that pZ3 location was independently associated with worse visual acuity (β = 0.29, 95% confidence interval [CI], 0.09-0.50, P < 0.006) in addition to presenting acuity, age, vitreous hemorrhage, uveal prolapse, and afferent pupillary defect. Far posterior wounds injuries were more likely to develop retinal detachments (pZ3: 87%; aZ3: 71%; P < 0.01) and proliferative vitreoretinopathy (pZ3 66%; aZ3 47%; P < 0.03). Patients with pZ3 OGIs were significantly more likely to reach poor anatomic outcome (phthisis, enucleation, need for keratoprosthesis) compared with patients with aZ3 OGI (pZ3: 56%; aZ3: 40%; P < 0.03).

CONCLUSIONS

Posterior OGI extension independently portends worse visual and anatomic outcomes. The effect on visual outcome was durable and clinically relevant compared with established predictors of OGI outcomes. Application of these findings improves the prognostic precision and will guide future research efforts to optimize surgical decision-making in severe OGI cases.

FINANCIAL DISCLOSURE(S)

Proprietary or commercial disclosure may be found after the references.

The Ocular Trauma Score Underestimates Visual Recovery for the Most Severe Open-Globe Injuries

PURPOSE

To compare visual outcomes after open-globe injury (OGI) with those predicted by the Ocular Trauma Score (OTS), and to investigate the effect of treatment with pars plana vitrectomy (PPV).

DESIGN

Retrospective cohort study.

SUBJECTS

Patients presenting with OGI to an academic United States ophthalmology department from 2017 to 2020.

METHODS

Best-corrected visual acuity (VA) measurements at the most recent follow-up were compared with final VA predicted by the OTS, based on preoperative injury characteristics. The most recently measured VA of patients treated with PPV during initial OGI repair (primary PPV group) was compared with patients treated with PPV after initial OGI repair (secondary PPV group) and patients never treated with PPV (No PPV group).

MAIN OUTCOME MEASURES

Best-corrected VA in the injured eye at last follow-up; secondary outcome measures included the occurrence of vitreous hemorrhage at any time, occurrence of retinal detachment at any time, rates of additional surgery, and rates of enucleation.

RESULTS

One-hundred and thirty-three subjects with OGI were identified and analyzed. The overall rate of PPV was 32%. Predictors of worse VA at last follow-up included older age (P = 0.047) and worse presenting VA (P < 0.001). Visual acuity outcomes for eyes in OTS categories 2 to 5 did not significantly differ from OTS predictions. However, eyes in OTS category 1 had a higher likelihood of last follow-up VA of light perception (LP) to hand motion (46% in the study cohort vs. 15% predicted by the OTS, P = 0.004) and a lower likelihood of no LP (33% vs. 74%, P < 0.001). The secondary PPV group had the worst VA at presentation among the 3 groups (P = 0.016), but VA at last follow-up did not significantly differ between the study groups (P = 0.338).

CONCLUSIONS

The most severe OGIs (i.e., OTS category 1) had better visual outcomes than predicted by the published OTS expectations, and secondary PPV was associated with significant visual improvement despite poor prognostic predictions. Evaluation by a vitreoretinal surgeon should be considered for all patients with severe OGI, especially those in OTS category 1.

FINANCIAL DISCLOSURE(S)

Proprietary or commercial disclosure may be found after the references.

Explosive eye injuries: characteristics, traumatic mechanisms, and prognostic factors for poor visual outcomes

BACKGROUND

Explosions can produce blast waves, high-speed medium, thermal radiation, and chemical spatter, leading to complex and compound eye injuries. However, few studies have comprehensively investigated the clinical features of different eye injury types or possible risk factors for poor prognosis.

METHODS

We retrospectively reviewed all consecutive records of explosive eye injuries (1449 eyes in 1115 inpatients) in 14 tertiary referral hospitals in China over 12 years (between January 2008 and December 2019). Data on demographics, eye injury types, ocular findings, treatments, and factors affecting visual prognosis were extracted from a standardized database of eye injuries and statistically analyzed.

RESULTS

Mechanical ocular trauma accounted for 94.00% of explosion-related eye injuries, among which intraocular foreign bodies (IOFBs) resulted in 55.17% of open globe injuries (OGIs) and contusion caused 60.22% of close globe injuries (CGIs). Proliferative vitreous retinopathy (PVR) was more common in perforating (47.06%) and IOFB (26.84%) than in penetrating (8.79%) injuries, and more common with laceration (24.25%) than rupture (9.22%, P < 0.01). However, no difference was observed between rupture and contusion. Ultimately, 9.59% of eyes were removed and the final vision was ≤ 4/200 in 45.82% of patients. Poor presenting vision [odds ratio (OR) = 5.789], full-thickness laceration of the eyeball ≥ 5 mm (OR = 3.665), vitreous hemorrhage (OR = 3.474), IOFB (OR = 3.510), non-mechanical eye injury (NMEI, OR = 2.622, P < 0.001), rupture (OR = 2.362), traumatic optic neuropathy (OR = 2.102), retinal detachment (RD, OR = 2.033), endophthalmitis (OR = 3.281, P < 0.01), contusion (OR = 1.679), ciliary body detachment (OR = 6.592), zone III OGI (OR = 1.940), and PVR (OR = 1.615, P < 0.05) were significant negative predictors for poor visual outcomes.

CONCLUSIONS

Explosion ocular trauma has complex mechanisms, with multiple eyes involved and poor prognosis. In lethal level I explosion injuries, eyeball rupture is a serious condition, whereas contusion is more likely to improve. In level II injuries, IOFBs are more harmful than penetrating injuries, and level IV represents burn-related eye injuries. PVR is more associated with penetrating mechanisms than with OGI. Identifying the risk predictors for visual prognosis can guide clinicians in the evaluation and treatment of ocular blast injuries.

Outcomes of pars plana vitrectomy following ocular trauma at varying surgical time points

Background

The optimal timing of pars plana vitrectomy (PPV) following ocular trauma is an ongoing debate. Early vitrectomy post-trauma enables the rapid assessment of retinal disease by removing the scaffold that fosters proliferative vitreoretinopathy. On the other hand, late vitrectomy is less challenging as there is a lower risk of bleeding and posterior vitreous detachment induction is easier. The purpose of this work is to report the functional and anatomical outcomes following ocular traumatic injuries in a United States-based cohort, emphasizing the time of intervention.

Methods

This was a retrospective case series of 110 patients with traumatic ocular injuries who underwent PPV between 2008 to 2020. Patients were grouped into four timing categories: same day (0 days), early (1–7 days), delayed (8–14 days), and late (> 14 days). Multivariable regression models controlling for confounding were implemented to assess the impact of vitrectomy timing on anatomical and functional outcomes. Visual acuity (VA) at baseline and after surgery, proliferative vitreoretinopathy (PVR), and enucleation for each vitrectomy timing category were recorded.

Results

Patient demographics and severity of ocular trauma were comparable across timing categories. Final VA in LogMAR was found to have a stepwise worsening as the time of ocular trauma to vitrectomy was increased (p < 0.05). For every one-step increase in the vitrectomy timing category, there was an adjusted 0.24 (CI 0.04–0.44) increase in final VA. No patient in the same day vitrectomy group had an enucleation or PVR, while patients who had late vitrectomies had the largest number of both enucleations and PVR (44.4% and 52.0%, respectively). In adjusted analysis, there was 3.11 increased odds (CI 1.03–9.42) of developing PVR for a one-step increase in vitrectomy timing (p < 0.05).

Conclusion

Vitrectomy on the same day of injury has the best final VA, and the lowest incidence rates of PVR and enucleation in comparison to other timing categories, regardless of etiology.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40942-022-00399-9.

Non-traumatic open globe injuries: presenting characteristics and visual outcomes

PURPOSE

To describe clinical characteristics and visual outcomes of non-traumatic open globe injuries.

SETTING

A level 1 trauma centre in a large urban medical centre.

DESIGN

Retrospective study.

METHODS

Charts of non-traumatic open globe patients admitted to MHH-TMC from 1/2010 to 3/2015 were reviewed for demographics, cause, clinical characteristics, visual acuity (VA) and enucleation.

RESULTS

Thirty eyes were included: 15 (50%) were males with a mean age of 47 (±28) years. All presented with zone 1 injury. Twenty-five (83%) had a perforated corneal ulcer. Presenting VA was count fingers (n = 3, 10%) to NLP (n = 6, 20%). Twenty-four (80%) involved infection, 5 (17%) congenital, 3 (10%) chemical burn and 2 (7%) neurotrophic. Conjunctival injection (n = 22, 77%), corneal opacification (n = 20, 71%) and relative afferent pupillary defect (n = 9, 44%) were common. After treatment, 23 (88%) were worse than 6/60 (20/200), 9 (35%) were NLP and 8 (27%) required enucleation.

CONCLUSIONS

Often non-traumatic open globe injuries are zone 1 and due to perforated infectious ulcers. Compared to previously reported traumatic injuries, these have higher rates of enucleation (27% vs 8%) and poorer final VA (88% vs 68% worse than 6/60 20/200).

Risk factors for globe removal after open-globe injury in agricultural regions

This study aimed to identify the prevalence and risk factors for globe removal among patients with open-globe injuries (OGIs) in agricultural regions. A retrospective chart review of patients with OGIs was performed between January 2010 and December 2019. Univariable and multivariable logistic regression models were used to identify the factors associated with globe removal in OGI. This study included 422 patients (422 eyes). The highest prevalence of OGI was observed in the middle age group (> 20 to 40 years). The most common cause of OGIs was agriculture-related injury (54.7%), followed by industry or workplace-related injury (20.4%), and assault (5.0%). Intraocular foreign bodies, endophthalmitis, and panophthalmitis were reported in 57.6%, 28.4%, and 5.7% of cases, respectively. Eight eviscerations and 43 enucleations were performed, accounting for 12.1% of OGIs. The most common indication for globe removal was panophthalmitis. Multivariable analysis revealed that the predictive factors significantly associated with globe removal were assault injuries (adjusted odds ratio (aOR) = 5.53; p = 0.026), presenting logarithm of the minimum angle of resolution visual acuity (aOR = 311.79; p < 0.001), and endophthalmitis and panophthalmitis (aOR = 3.58 and 734.94, respectively; p < 0.001). This knowledge would aid in patient counseling and encourage health promotion.

Outcome of Primary Management of Scleral Rupture without Vitrectomy Jakarta Eye Trauma Study

Introduction:

To report the outcome of primary management of scleral rupture without vitrectomy.

Methods:

Descriptive retrospective study of primary surgical management of scleral rupture located anterior to the equator. Initial and final visual acuity (FVA, intra ocular pressure, type of injury (sharp/blunt/projectile), wound length, time interval between the incident and primary repair and cause of injury were recorded. Encircling scleral buckle was placed in case of scleral laceration reaching muscle insertion. Patients who had a follow up of 3 months after the primary repair were included in the study .

Results:

There were 41 patients out of 78 who had scleral rupture anterior to the equator. The average age was 21.27 + 9.73 years (range 3-50 years). Thirty-three (80.4%) were males and eight (19.6%) were females. Rupture was located superiorly) in 28 (68.3%) patients, and inferiorly in 13 (31.7%) patients. Eight patients underwent encircling buckle. The time interval from the injury till the primary repair less than 8 hours (p 0.000) and 8-24 hours (p 0.000) were associated significantly with FVA improvements. Initial VA correlated with FVA improvement significantly (p 0.001). Two patients with initial VA of LP became NLP, and they had a wound length 11 mm and 12 mm respectively.

Conclusion:

The primary management of scleral rupture anterior to the equator, without vitrectomy, improves VA significantly. Time interval less than 24 hours and shorter wound length correlated with significant improvement of final VA.

Guideline for the treatment of no light perception eyes induced by mechanical ocular trauma

Severe mechanical ocular trauma with no light perception (NLP) predicts a poor prognosis of visual acuity and enucleation of the eyeball. Since the innovative treatment concept of exploratory vitreoretinal surgery has developed and treatment technology has advanced, the outcomes of severe ocular trauma treatment in NLP patients have greatly improved. However, there remains a lack of unified standards for the determination, surgical indication, and timing of vitrectomy in NLP eye treatment. To address these problems, we aimed to create evidence-based medical guidelines for the diagnosis, treatment, and prognosis of mechanical ocular trauma with NLP. Sixteen relevant recommendations for mechanical ocular trauma with NLP were obtained, and a consensus was reached. Each recommendation was explained in detail to guide the treatment of mechanical ocular trauma associated with NLP.

The Predictive Value of Computed Tomography Findings for Poor Visual Outcome in Traumatic Eye Injury

Background. The prognosis of visual outcome is important for patients and healthcare providers and guides proper decision-making in traumatic eye injury. In this study, we have evaluated the predictive value of computed tomography (CT) scan findings for poor visual outcomes in patients with traumatic eye injuries. Methods. In a retrospective survey, documents of 200 patients with traumatic eye injury who underwent a diagnostic orbital CT scan were reviewed. Disorganized or collapsed globe, intraocular foreign body or gas, increased or decreased anterior chamber size, hemorrhage in the anterior or posterior chamber, crystalline or intraocular lens dislocation, posterior sclera thickening, globe borders haziness, orbital fracture, orbital hemorrhage, and foreign body, optic canal, and optic nerve injuries are the diagnostic clues for eye injury in CT scan. The predictive value of CT scan findings for poor visual outcome was calculated by sensitivity, specificity, accuracy, predictive values, hazard ratios, and binary logistic regression model. Results. The sensitivity, specificity, accuracy, and positive predictive values showed to be high. However, there was a low negative predictive value of CT findings for the prediction of poor vision. Among the investigated factors, disorganized/collapsed globe (HR 47.72, CI 6.13–371.62), increased/decreased anterior chamber size (HR 5.04, CI 2.57–9.88), hemorrhage in anterior/posterior chamber (HR 3.58, CI 1.900–6.774/3.62, CI 1.90–6.89), globe borders haziness (HR 3.06, CI 1.33–7.01), orbital foreign body (HR 3.66, CI 1.11–12.05), and optic canal/nerve injury (HR 21.62, CI 4.73–98.78) reached the statistical significance for increasing the hazard ratio for poor visual outcome in patients with a traumatic eye injury. Logistic regression analysis showed only evidence for disorganized/collapsed globe and optic canal/nerve injury in orbital CT scan as independent predictive factors for poor visual outcome. Conclusion. CT scan findings can be used as prognostic factors for visual outcomes in patients with a traumatic eye injury.

Mild-to-Moderate Traumatic Brain Injury: A Review with Focus on the Visual System

Traumatic Brain Injury (TBI) is a major global public health problem. Neurological damage from TBI may be mild, moderate, or severe and occurs both immediately at the time of impact (primary injury) and continues to evolve afterwards (secondary injury). In mild (m)TBI, common symptoms are headaches, dizziness and fatigue. Visual impairment is especially prevalent. Insomnia, attentional deficits and memory problems often occur. Neuroimaging methods for the management of TBI include computed tomography and magnetic resonance imaging. The location and the extent of injuries determine the motor and/or sensory deficits that result. Parietal lobe damage can lead to deficits in sensorimotor function, memory, and attention span. The processing of visual information may be disrupted, with consequences such as poor hand-eye coordination and balance. TBI may cause lesions in the occipital or parietal lobe that leave the TBI patient with incomplete homonymous hemianopia. Overall, TBI can interfere with everyday life by compromising the ability to work, sleep, drive, read, communicate and perform numerous activities previously taken for granted. Treatment and rehabilitation options available to TBI sufferers are inadequate and there is a pressing need for new ways to help these patients to optimize their functioning and maintain productivity and participation in life activities, family and community.

Epidemiology and prognosis factors in open globe injuries in the Federal District of Brazil

OBJECTIVE

To identify the epidemiological profile and prognostic factors of open globe injuries that require emergency surgical treatment.

DESIGN

Retrospective cohort study.

SUBJECTS

Patients with OGI who underwent publicly funded emergency surgical treatment in the Federal District from 2014 to 2018.

METHODS

Data were collected by reviewing electronic medical records through a questionnaire and tabulated. The statistical analysis was performed in SPSS Statistics 26.0.0.0 (p ≤ 0.05).

RESULTS

A total of 359 records were included, corresponding to 336 eyes of 334 patients (294 males and 40 females). The average age was 32.7 years. The affected eye was the right eye in 165 cases, the left eye in 166 cases, and both eyes in 3 cases. The average time between injury and hospitalization was 75.7 h, and the time between injury and surgery averaged 173.7 h. The injury types were as follows: 197 penetrating; 109 rupture; 19 IOFB; 11 perforating. The injuries were in the following zones: 181 zone I; 82 zone II; 70 zone III. The OTS grades were as follows: 57 were classified as grade 1; 101 were grade 2; 142 were grade 3; 28 were grade 4; and 8 were 5. The most commonly performed surgeries were corneal suture, corneoscleral suture, and evisceration. The most common clinical features were traumatic cataract, herniated iris and hyphema. The following were risk factors for poor prognosis: zone III, time between trauma and surgery > 72 h, rupture injury, retinal detachment, disorganization of the eyeball, endophthalmitis, uveal prolapse, OTS classification 1 or 2, and low initial visual acuity. The following factors predicted a good prognosis: initial VA > 1/200, penetrating injury, OTS 4 and zone II.

CONCLUSIONS

The high frequency of many of these factors may explain the high rate of severe visual loss found. Injury localization in zone II was identified as a previously unrecognized protective factor against severe visual loss.

Characteristics and visual prognosis of pediatric open globe injury in Shanghai, China

Introduction To describe the characteristics of open globe injury and the relationship between the complications and visual outcomes in children with this type of injury. Methods This was a retrospective chart review of 1664 children, under the age of 16 years, who were hospitalized for open globe injury between January 1, 2007, and December 31, 2015. Each patient's age, sex, cause and agent of injury, complications, visual acuity, and classification of ocular trauma were collected for review and analysis. Results The mean age was 5.6 ± 3.4 years. Right eyes were particularly vulnerable to injury (right eye:left eye ratio = 1.2:1). Traumatic cataract was the most common complication. The average initial and final best-corrected visual acuity (BCVA) were logMAR 2.04 ± 0.78 and logMAR 1.74 ± 0.88, respectively. Logistic regression analysis showed that hyphema (OR = 1.850), iris prolapse (OR = 1.702), vitreous hemorrhage (OR = 9.703), retinal detachment (OR = 11.938), endophthalmia (OR = 5.377), intraocular foreign body (OR = 3.346), and initial visual acuity < 0.05 (OR = 9.017) were risk factors for visual acuity < 0.05 at hospital discharge. Conclusion Open globe injury was most frequent in preschool children and boys. Right eyes were more vulnerable than left eyes. Poor visual outcomes were associated with hyphema, iris prolapse, vitreous hemorrhage, retinal detachment, endophthalmia, intraocular foreign body, and an initial visual acuity < 0.05.

Visual outcomes of open globe injury patients with traumatic cataracts

PURPOSE

Open globe injury (OGI) is a serious form of ocular trauma that can significantly lower quality of life post-injury due to comorbidities. This study was designed to investigate how traumatic cataracts and other pre-operative variables affect visual outcomes of OGIs.

METHODS

A retrospective review was conducted for OGI patient records with presence of traumatic cataracts, visual outcomes, comorbidity data and provider training. Multivariable logistic regression analysis determined if several pre-operative variables including traumatic cataracts, retinal detachment and hyphema were predictive of final visual acuity and need for retinal surgery. Ancillary multivariable analysis was conducted to evaluate if timing of traumatic cataract extraction predicted poor final visual acuity.

RESULTS

Multivariable logistic regression analysis did not find traumatic cataract to be an independent predictor of final visual outcome in the open globe injury sample population (n = 102, p = 0.386), but did find retinal detachment (p = 0.008), hyphema (p = 0.035) and scleral laceration (p = 0.009) to be independent predictors of poor final visual acuity. In the subgroup of eyes with traumatic cataract (n = 64), delayed cataract extraction was not found to be an independent predictor of poor final visual acuity (p = 0.156).

CONCLUSION

Our results suggest that retinal detachment, hyphema, and scleral laceration influence final visual outcome while traumatic cataract does not. Within the subpopulation of patients that received lens extraction, timing of extraction was not found to independently influence final visual acuity.

Global Current Practice Patterns for the Management of Open Globe Injuries

PURPOSE

To determine global current practice patterns for the management of open globe injuries and identify areas of variation.

DESIGN

Cross-sectional survey.

METHODS

An online survey assessed global management paradigms for open globe injuries from August 2020 to January 2021. Responses were collected from experts at eye trauma centers and emergency departments worldwide who manage ≥1 open globe injury per month. The survey assessed the use/selection of antibiotics and steroids, procedural and imaging decisions, and admission practices for open globe injuries.

RESULTS

Responses were received from representatives of 36 of 42 institutions (85.7%), of which 33 (78.6%) had sufficient trauma volume to be included. Included responses were distributed across North America (n=12, 36.4%), Asia (n=12, 36.4%), South America (n=4, 12.1%), Africa (n=3, 9.1%), Europe (n=1, 3.0%), and Australia (n=1, 3.0%). Preoperative systemic antibiotics for open globe injuries were administered by 75.8% (n = 25/33) of institutions, while 30.3% (n = 10/33) administered preoperative topical antibiotics. Intraoperative ophthalmic antibiotics for open globe injuries were used by 54.5% (n = 18/33) of experts. Most institutions also administered postoperative systemic antibiotics (n = 23 [69.7%]) and topical steroids (n = 29 [87.9%]), although specific medication choices diverged. At 19 responding centers (61.3% of the 31 that had trainees), residents participated in surgical repairs. Many institutions discharged patients after repair, but 54.5% (n = 18/33) of locations routinely admitted them for observation.

CONCLUSIONS

Preferred management practices for open globe injuries vary widely. To ensure the highest standard of care for all patients, evidence-based international guidelines for the treatment of these injuries are needed.

The Incidence of Sympathetic Ophthalmia After Trauma: A Meta-analysis

PURPOSE

Sympathetic ophthalmia (SO) is a rare, bilateral panuveitis that occurs following open globe injury (OGI), with a variable incidence reported in the literature. Our objective was to determine the incidence proportion and incidence rate of SO following OGI to help guide shared physician-patient decision making.

DESIGN

Systematic review and meta-analysis.

METHODS

A systematic literature search was performed using the MEDLINE, EMBASE, and Cochrane databases from inception to November 2020 for population-based studies on OGI and SO in adults and children. Two reviewers independently screened search results. Random-effects meta-analyses were performed to calculate the incidence proportion and incidence rate. The Risk Of Bias In Non-Randomized Studies - of Interventions (ROBINS-I) tool was used to assess the risk of bias. The study was registered on PROSPERO CRD42020198920.

RESULTS

A total of 24 studies were utilized in the meta-analyses. After OGI, the estimated overall incidence proportion of SO was 0.19% (95% CI 0.14%-0.24%) and the incidence rate of SO was 33 per 100,000 person-years, (95% CI 19.61-56.64) with I² of 13% and 72%, respectively.

CONCLUSIONS

SO after OGI is rare. The estimated incidence proportion and incidence rate are useful when counselling patients regarding management options after OGI. Further studies are needed to examine the influence of age, the extent and location of trauma, timing of repair, and prophylactic eye removal on the incidence of SO.

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.

POSTERIOR SEGMENT INJURIES IN OPERATION IRAQI FREEDOM AND OPERATION ENDURING FREEDOM: 2001 to 2011

BACKGROUND/PURPOSE

To characterize the nature of posterior segment ocular injuries in combat trauma.

METHODS

Eyes in the Walter Reed Ocular Trauma Database were evaluated for the presence of posterior segment injury. Final visual outcomes in open-globe versus closed-globe injuries and by zone of injury and the types of posterior segment injuries in open-globe versus closed-globe injuries were assessed.

RESULTS

Four hundred fifty-two of 890 eyes (50.8%) had at least one posterior segment injury. The mechanism of injury was most commonly an improvised explosive device in 280 (62.0%) eyes. Sixty-one patients (13.5%) had a Zone I injury, 50 (11.1%) a Zone II injury, and 341 (75.4%) a Zone III injury. Patients with Zone I injuries were more likely to have a final visual acuity of 20/200 or better compared with patients with either a Zone II (P < 0.001) or Zone III injury (P = 0.007). Eyes with a closed-globe injury were more likely to have a final visual acuity of 20/200 or better compared with those with an open-globe injury (P < 0.001). Furthermore, closed-globe injury compared with open-globe injury had a lower risk of vitreous hemorrhage (odds ratio 0.32, P < 0.001), proliferative vitreoretinopathy (odds ratio 0.14, P < 0.001), and retinal detachment (odds ratio 0.18, P < 0.001) but a higher risk of chorioretinal rupture (odds ratio 2.82, P < 0.001) and macular hole (odds ratio 3.46, P = 0.004).

CONCLUSION

Patients with combat ophthalmic trauma had similar posterior segment injury patterns to civilian trauma in open-globe versus closed-globe injuries. Zone II and III injuries were associated with a worse visual prognosis.

Value of ocular trauma score in predicting the incidence of secondary glaucoma after closed globe injury

AIM

To analyze the visual acuity (VA) and the incidence of secondary glaucoma among patients with closed globe injury (CGI). To determine the correlations between the ocular trauma score (OTS) with surgery rate, and evaluate the applicability of OTS in secondary glaucoma prediction and treatment.

METHODS

We conducted a retrospective review of 265 patients (265 eyes) with CGI admitted to Xijing Hospital between January 2014 and December 2016. The clinical characteristics; VA, IOP, injury zone, surgery, and IOP-lowering medications were collected at the initial visit and at six months. The patients with secondary glaucoma were scored and assessed by the OTS system. The correlation of the anti-glaucoma surgery with the OTS was evaluated. The difference in the number of IOP-lowering medications between the initial visit and six months was analyzed.

RESULTS

The average age of the patients was 33.5 ± 20.7 years with 80.8% being males. The final VA outcome improved in its totality after treatment. 35 patients developed glaucoma, with an incident rate of 13.2% over six months. All glaucoma patients had an injury in zone I and II, and 12 of them had an injury in zone III. The severity of the OTS category showed a strong correlation with the anti-glaucoma surgery rate. After the surgical intervention, the number of IOP-lowering medications in OTS category 2, 3, and 4 significantly reduced.

CONCLUSIONS

The OTS has predictive value in the incidence of secondary glaucoma after CGI. A patient with a low score is more likely to develop secondary glaucoma and might require surgical intervention.

Ophthalmic Trauma Correlation Matrix (OTCM): a potential novel tool for evaluation of concomitant ocular tissue damage in open globe injuries

PURPOSE

To introduce a novel tool to investigate the correlation between concomitant injuries and primary open globe injury (OGI) in the setting of ophthalmic trauma, the "Ophthalmic Trauma Correlation Matrix" (OTCM).

METHODS

Retrospective cohort review, performed at a tertiary referral eye care center in Eastern Nepal, involving all eyes with OGI meeting the inclusion criteria from 2015-2018. Clinical data including details of primary injury, concurrent injuries, and clinical course were noted from hospital medical records. A correlation matrix chart was devised using matrix correlation and Pearson's correlation coefficient. This chart was then used to evaluate the association of the various injuries in the setting of OGI.

RESULTS

A total of 109 eyes with OGI were included. Majority of the eyes (78, 71.6%) had zone I injuries, while most of the eyes (66, 60.6%) had penetrating injury. The most frequent concomitant injuries in all zones of OGI were traumatic lens injury (77, 70.64%), followed by hyphema (48, 44.03%), and vitreous hemorrhage (35, 32.11%). The most common concomitant injury associated with zone I was hyphema (0.873), while traumatic subluxation/cataract (0.894) and vitreous hemorrhage (0.972) were commonly associated with zone II and III, respectively.

CONCLUSIONS

OTCM could be a useful tool to manage injuries related to the primary ocular injury. This additional information will aid in the prognostication, planning, and management of OGI and potentially prevent repeat surgeries and inadequate treatments.

Clinical Analysis of Adult Severe Open-Globe Injuries in Central China

Purpose: To describe the characteristics, management, and outcomes of adult severe open-globe injured (OGI) eyes. Methods: Retrospective chart review of inpatients with initial visual acuity (VA) of light perception (LP) or no light perception (NLP) associated with OGI between 2017 and 2020 at Department of Ophthalmology, Henan Eye Institute, Henan Eye Hospital, Henan provincial People's Hospital. Results: Six hundred twenty-five eyes of 622 adult patients with initial VA of LP or NLP associated with open-globe injuries (OGIs) were included. The mean age was 47.8 ± 14.1 years with the range from 18 to 91 years. Significant male predominance was noted (81.5%). The most common type of these severe OGIs was rupture (65.8%). Traffic accidents accounted for 13.5% followed by fall/tumble (10.9%) and nail/wire (10.9%) of all the severe OGIs. Almost half of the injuries happened at workplace (47.2%). Initially, 78.7% eyes just received primary debridement and wound closure, while 8.5% eyes with no possible of anatomical reconstruction received evisceration. After initial management, 350 eyes received subsequent operation, including 239 eyes underwent vitrectomy + silicone oil/(+cataract remove). Finally, over 6 months follow-up, 137 eyes (21.9%) were eviscerated, 150 eyes (24.0%) got atrophied, while 132 eyes (21.1%) retain some VA. Fifty-three eyes (8.5%) got VA of 0.3-1.5. Conclusion: Severe OGIs are most seen in the young, middle-aged, and male working population and remain a serious public health problem, resulting in significant vision loss or Evisceration of eyes. Effective preventive measures should be taken for the individuals in these groups.

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.

Health-seeking behavior and the initial economic impact of patients with open globe injuries seeking treatment in a tertiary care center in India

Purpose:

The aim of this study was to assess the health-seeking behavior and the costs of primary treatment in the immediate aftermath of open globe trauma among patients seeking care at a tertiary eye care center in South India.

Methods:

This prospective observational study was carried out from June to December 2019. Details of the patient’s demographic profile, health-seeking behavior immediately following the trauma and total cost incurred till the completion of primary treatment were collected.

Results:

Eighty-five patients were recruited. Majority of patients were men (53, 82.8%), came from rural areas (65, 76.4%) and were the main breadwinners (44, 68%) of their family. After the initial trauma, a vast majority of the patients (68, 80%) visited the nearest eye care provider to obtain treatment and a majority of them (47, 69.1%) reached there within 3 h. The remaining patients (17, 20%) came directly to our center, the base hospital (BH). The mean distance travelled to the BH was 113.6 km. The mean total cost incurred was INR 20107.6 ± 10441.3. Approximately 84.8% of the patients reported a monthly income less than this amount.

Conclusion:

The economic impact of receiving primary definitive care following open globe injuries is higher than the average monthly income of more than 2/3^rd of the patients. To replicate the success stories like the cataract outreach programs, there is a need to implement an integrated program encompassing workplace safety, legal protection to primary eye care providers and providing economic support for definitive treatment for the vulnerable population.

Outcomes Following Pars Plana Vitrectomy for Severe Ocular Trauma

Purpose

To investigate outcomes and presenting characteristics for subjects undergoing pars plana vitrectomy for ocular trauma.

Methods

Retrospective study of 113 patients who underwent pars plana vitrectomy for severe ocular trauma at [name deleted to maintain the integrity of the review process] between 1999 and 2018. Data were collected on age, gender, initial and final visual acuity (LogMAR), mode of injury, type of injury, number of surgeries performed, follow-up duration, type of tamponade, presence of phthisis, and retinal detachment. The Birmingham Eye Trauma Terminology System (BETTS) was employed.

Results

We identified assault and contusion injuries to be the most common mode and type of ocular injury in our cohort. Furthermore, through follow-up we noted a varied number of operations required by patients presenting with ocular trauma and a statistically significant improvement in visual acuity from 1.73 ( ± 0.86) LogMAR to 1.17 ( ± 1.03; p < 0.01) LogMAR. A statistically significant difference in final visual acuity was also noted between BETTS classified type of injury groups (p < 0.01). Notably, only 7.3% and 8.2% of patients developed phthisis or a persisting retinal detachment, respectively, during follow-up.

Conclusion

Our study demonstrates that ocular trauma requiring pars plana vitrectomy can require a varied number of operations with a guarded visual prognosis. However, a small percentage will proceed to develop phthisis following intervention.

Risk factors and outcomes of post-traumatic endophthalmitis: a retrospective single-center study

Background

To describe the epidemiology, characteristics, risk factors, and outcomes of post-traumatic endophthalmitis.

Main body

Medical records of consecutive open globe injury patients admitted and primarily treated between January 2006 and December 2016 were retrospectively reviewed. Patients were defined as having or not having associated endophthalmitis. Data of demographics, injury characteristics, clinical presentations, and visual outcomes were collected. The potential risks and significant factors for visual outcomes of post-traumatic endophthalmitis were determined. There were 591 patients included in this study. Among these, 118 patients were clinically diagnosed as having accompanied endophthalmitis. Higher proportions of intraocular foreign body (IOFB) (55.1% vs. 27.3%) and injury related to high-velocity objects (55.9% vs. 32.6%) were noted in patients with endophthalmitis compared to patients without endophthalmitis. Anterior wound location (odds ratio [OR], 2.0; 95% confidence interval [CI], 1.1 to 3.7; P = 0.020), presence of IOFB (OR, 1.9; 95% CI 1.2 to 3.0; P = 0.005), and delayed presentation of > 24 h (OR, 3.9; 95% CI 2.3 to 6.4; P < 0.001) were significant risk factors for associated endophthalmitis. Final visual acuity (VA) of the overall population improved significantly from 2.4 (0.6) logMAR to 1.4 (0.1) logMAR, P < 0.001, however, patients in the endophthalmitis group achieved a worse final VA than the non-endophthalmitis group (66.1% vs. 43.5%, P < 0.001).

Conclusion

High proportions of post-traumatic endophthalmitis patients had subsequent poor visual outcomes. Therefore, safety and protective measurements, especially when performing activities related to high-velocity objects, and the institution of prophylactic antibiotics in high-risk groups should be promptly considered to reduce the incidence.

Prognostic factors and epidemiology of adult open globe injuries from Western Sydney: a twelve-year review

Background

To identify prognostic factors determining final visual outcome following open globe injuries.

Methods

Retrospective case series of patients presenting to Westmead Hospital, Sydney, Australia with open globe injuries from 1st January 2005 to 31st December 2017. Data collected included demographic information, ocular injury details, management and initial and final visual acuities.

Results

A total of 104 cases were identified. Predictors of poor final visual outcomes included poor presenting visual acuity (p < 0.001), globe rupture (p < 0.001), retinal detachment (p < 0.001), Zone III wounds (p < 0.001), hyphema (p = 0.003), lens expulsion (p = 0.003) and vitreous hemorrhage (p < 0.001). Multivariate analysis demonstrated presenting visual acuity (p < 0.001), globe rupture (p = 0.013) and retinal detachment (p = 0.011) as being statistically significant for predicting poor visual outcomes. The presence of lid laceration (p = 0.197) and uveal prolapse (p = 0.667) were not significantly associated with the final visual acuity.

Conclusions

Poor presenting visual acuity, globe rupture and retinal detachment are the most important prognostic factors determining final visual acuity following open globe injury.

Factors Associated with Visual Outcome after Primary Repair of Open-Globe Injury by Ophthalmology Residents in Training in a Tertiary Eye Center

Purpose

To assess factors associated with visual outcome after open-globe injury (OGI) repair by trainees.

Methods

In this observational study, charts of OGIs repaired by trainees at King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok were retrospectively reviewed. Preoperative, intraoperative, and postoperative outcomes (day 1, month 1, and month 6 postoperation) were analyzed.

Results

A total of 78 OGIs presented in a 10-year period. A biphasic pattern was found among the young and the elderly. Approximately 73.6% of the cases had had surgical repair outside office hours. A majority of cases had been caused by machinery and hammers, and had visual acuity (VA) <20/200. Three cases were reported as having been unsuccessful intraoperatively for globe repair. A fifth of the cases required evisceration/enucleation within 2 weeks of presentation. Presenting VA worse than hand motion was associated with the risk of evisceration/enucleation (OR 14.5, P=0.013). VA improved at 6 months postoperation to the range of counting fingers and 20/200 (OR 15.6, P<0.01). High ocular trauma scores (OTSs) was associated with lower risk of evisceration/enucleation, and 12% retinal detachment (RD) was discovered, of which 90% occurred within 1 month after OGI repair.

Conclusion

Most OGIs were efficiently managed by the trainees, seldomly requiring assistance from subspecialists. Poor initial VA was associated with high risk of visual loss, whereas higher OTSs were inversely related to lower risk of evisceration or enucleation. There was a higher percentage of participants with final VA of 20/100-20/20 than the preoperative period. Precaution and careful evaluation of RD in the early postoperative period is recommended.

Trans-scleral plugs scleral fixation IOL and penetrating keratoplasty to restore vision in vitrectomized eyes

PURPOSE

To report the surgical outcomes of penetrating keratoplasty (PKP) and sutureless scleral fixation (SSF) using Carlevale Lens (Soleko) combined procedure to solve corneal failure and aphakia in vitrectomized eyes and discuss eventual advantages of this new approach.

METHODS

Two patients underwent primary wound repair and pars plana vitrectomy after a penetrating ocular trauma and were referred to the author's clinic. The PKP and SSF-Carlevale lens implantation were performed under retrobulbar anesthesia. Intraoperative and postoperative complications were recorded, intraocular lens positioning was evaluated using anterior segment optical coherence tomography (AS-OCT) and endothelial cell density was determined using an endothelial microscope. Both patients completed 12 months follow-up.

RESULTS

The surgery was performed without intraoperative complications. After 1 month, the lens was fixed well, and the graft showed no sign of rejection. At the last visit after 12 months, the corneal graft remained transparent with good endothelial cell density in both cases; conjunctival scarring or inflammation and plugs externalization did not occur during follow-ups. Best-corrected visual acuity was 4/10 Snellen in the first case, while in the second case, we witnessed a limited visual recovery of 1/20 Snellen due to retinal issues.

CONCLUSION

We report the feasibility of secondary IOL implantation using Carlevale with penetrating keratoplasty. The relative of ease of Carlevale lens implantation through the transscleral plugs reduces the open globe length resulting in a safer procedure, especially for vitrectomized eyes.

Open Globe Injuries Related to Traffic Accidents: A Retrospective Study

Purpose

To evaluate epidemiology, clinical characteristics and outcomes of patients sustained traffic-related open globe injury (OGI).

Methods

The medical records of all OGI patients who were admitted in a tertiary referral center from January 2006 to December 2016 were retrospectively evaluated. Then, the records of injuries related to traffic accidents were identified and reviewed in detail.

Results

Among the overall causes of OGI, traffic-related accidents comprised 92/978 (9%) of cases. Nearly half of the injuries (51%) occurred in the 20–39-year-old group and 59% involved automobile transportation. Globe rupture occurred in 48 (47%) eyes. Following treatments, LogMAR visual acuity (VA) significantly improved from a median (interquartile range) of 2.3 (1.9–2.3) to 1.7 (0.3–3.0), at the final appointment. Presence of relative afferent pupillary defect and presence of retinal detachment were predictors for poor final visual outcomes.

Conclusions

Traffic-related OGI had a high prevalence in the young. The risky transportation modes were motorcycles in teenagers and automobiles in young adults. Despite treatment, there was a considerable proportion of impaired final VA. This information could help establish effective safety education and encourage regular adherence to road safety behaviors in the high-risk groups.

Factors affecting final functional outcomes in open-globe injuries and use of ocular trauma score as a predictive tool in Nepalese population

BACKGROUND

Open globe injury (OGI) is one of the most devastating form of ocular trauma. The aim of the study is to identify the epidemiology and predict visual outcomes in traumatic open globe injuries using ocular trauma score (OTS) and correlate with final visual acuity (VA) at 3 months.

METHODS

Patients older than 5 years, presenting to B.P. Koirala Lions Centre for Ophthalmic Studies (BPKLCOS) from March 2016- March 2017 with OGI that met inclusion criteria were evaluated. Patient profile, nature and cause of injury, and time to presentation were recorded. Patients were managed accordingly and followed up to 3 months. An OTS score for each patient was calculated and raw scores were categorized accordingly. The VA after 3 months were compared to the predicted OTS values.

RESULTS

Seventy-three eyes of 72 patients were examined. 76 % were male, and the mean age was 26.17 years (median, 23.5 years). The mean time from injury to presentation was < 6 hours (30 patients, 41 %). Thirty-seven eyes (51 %) had zone I trauma, followed by twenty eyes (27 %) with zone II, and sixteen eyes (22 %) with zone III trauma. Sixty-five patients (90 %) were managed surgically, and fifty (68 %) received intravitreal antibiotics with steroid. When compared, the projected VA as per OTS were able to predict actual final visual outcomes in 60 % of the eyes with OGI of various zones.

CONCLUSIONS

OTS can be an accurate predictive tool for final visual acuity even with a short follow up period of 3 months; with poor presenting visual acuity, delayed presentation, posterior zones of injury, need for intravitreal injections, endophthalmitis, and globe rupture associated with poorer prognosis.

Epidemiology of United States Inpatient Open Globe Injuries from 2009-2015

PURPOSE

To study the epidemiology of inpatient open globe injuries (OGI) in the United States (US).

METHODS

This was a retrospective cohort study of patients with a primary diagnosis of OGI in the National Inpatient Sample (NIS) from 2009 to 2015. Sociodemographic characteristics, including age, gender, race, ethnicity, insurance, and income were stratified for comparison. Annual prevalence rates were calculated using 2010 US Census data. Statistical analysis included Chi-square tests, ANCOVA, and Tukey tests.

RESULTS

A total of 6,821 US inpatient hospital discharge records met inclusion/exclusion criteria. The estimated national prevalence of OGI during the 5-year period from 2009 to 2015 was 34,061 (95% confidence interval [CI] 31,445-36,677). The overall annual prevalence rate was 1.58 per 100,000 per year (CI 1.56-1.59). Overall, average annual prevalence rates were highest among patients 85 years or older (7.72, CI 6.95-8.49), on Medicare (3.92, CI 3.84-4.00), males (2.28, CI 2.25-2.30), African Americans (2.38, CI 2.32-2.44), and Native Americans (1.80, CI 1.62-2.00). OGI rates were lowest among Whites (1.21, CI 1.19-1.22), females (0.89, CI 0.87-0.91), those with private insurance (0.84, CI 0.82-0.86), and Asians (0.69, CI 0.64-0.74). Being in the lowest income quartile was a risk factor for OGI (p < .05).

CONCLUSIONS

Inpatient OGIs disproportionately affected those over 85, young males, elderly females, patients of African-American descent, on Medicare, and in the lowest income quartile. Additionally, children and young children had lower rates of OGI compared to adolescents. Further studies should delineate causes for socioeconomic differences in OGI rates to guide future public health measures.

Traumatic open globe injury—epidemiology, risk factors and visual outcome at the University Hospital Aachen

Background

Ocular trauma is still a major cause leading to enucleation. This study aims to analyze the visual outcome, epidemiology and risk factors of open globe injury (OGI) at the University Hospital Aachen, Germany.

Material and methods

A retrospective analysis of patient records involving traumatic OGI treated surgically between 2005 and 2015 was conducted. Age, gender, cause of accident, ocular trauma score, best corrected visual acuity (BCVA) at presentation and after treatment as well as location of injury were evaluated.

Results

Of 2272 eyes with trauma, 102 patients with OGI were identified, of which 65% were male and 35% were female. Women were significantly older than men (p < 0.001). The most common cause of injury was domestic syncopal episodes (47%). Work-related injuries occurred exclusively in men in 8.8%. A total of 16% had no light perception (NLP) at presentation, 69% of which improved post intervention to hand movement or better. Endophthalmitis was observed in 4% of all cases. Enucleation was needed mostly due to rupture. Location of OGI, pseudophakia and initial BCVA are risk factors for poor final BCVA. Patients’ BCVA did not improve further after three surgeries.

Conclusion

Traumatic OGI still poses a challenge in terms of treatment planning and prognostic outcome. A rise in elderly patients with multimorbidity represents a secondary obstacle to treatment. Patients with initial NLP can be treated with moderate success. Nevertheless, risk factors and ocular trauma score are unable to provide definitive therapy decisions. OGI should be assessed case by case, taking risk factors for OGI into account. Treating physicians should consider the ethical and economic reasons with regard to whether a high number of surgeries with possible comorbidities is justified.

Predictors of traumatic eye injuries at high-risk for ophthalmic complications in children

Eye injuries are important cause of ocular morbidity in children. There is lack of data regarding predictors for high-risk injuries that will result in ophthalmic complications. Most cases are managed by the emergency department (ED) physicians without immediate ophthalmologist evaluation. Our aim was to identify predictors for ophthalmological complications and to imply indications for early ophthalmologic consultation in the ED. A retrospective chart review of 834 patients ages 0-18 years who presented to the emergency department at Tel Aviv Medical Center between 2015 and 2018 following traumatic eye injuries was performed. All cases which later needed ophthalmological care were considered as high-risk for ophthalmic complications. An increased rate of eye injury was revealed over the years, but high-risk injury rate was stable. High-velocity mechanism, sport injury, orbital, anterior chamber, and retinal involvement were all significantly more common in the high-risk group compared to the low risk group. Only 10 patients, which represent 1.2% of all the patients, had decreased visual acuity on the last follow up, with significantly more injuries of high-velocity mechanism and anterior chamber involvement, in comparison to patients with normal visual acuity on the last follow up.Conclusion: High-velocity mechanism by itself, even with normal visual acuity and eye examination by the ED physician, should prompt to consider an urgent ophthalmologist consult. What is Known: •Traumatic eye injuries are an important cause of ocular morbidity in children. • Most injuries can be handled by a trained ED physician, but there are indications for an urgent ophthalmologist consultation. • It is crucial to discriminate between low and high-risk ocular injuries. What is New: • High-velocity mechanisms stand out as the most likely risk factor for final impaired visual acuity. • Normal visual acuity on presentation is not reassuring. • We recommend urgent ophthalmologist consultation in cases of high-velocity injury, even if visual acuity is preserved at presentation.

Globe rupture: a single-center retrospective study of demographic patterns and outcomes

Globe rupture is one of the severe mechanisms of eye injury. This study aimed to describe an epidemiologic patterns and visual outcomes of the open globe injury from globe rupture at a tertiary referral centre. Medical records of 167 patients (173 eyes) were retrospectively reviewed. Overall, males were predominant (82%). Road traffic- (26.3%) and work- (23.4%) were the major contributors. However, falling was the main mechanism in the elderly aged over 60 years. At presentation, 91.4% of eyes had initial visual acuity (VA) of worse than 20/200. The mean (SD) VA in logarithm of the minimum angle of resolution (LogMAR) unit at final [1.8 (1.1)] was significantly improved from presenting VA [2.4 (0.6)] (p ˂ 0.001). Predictors for final VA of worse than 20/400 included poor initial VA, presence of relative afferent pupillary defect, and endophthalmitis. In conclusion, this study observed the peak incidence of globe rupture in young teen to early adult patients, with unique characteristics in each age group. Even with significant visual improvement following the treatments, profound visual loss was still a common consequence. Thus, the role of effective prevention along with a multidisciplinary team together with timely and prompt ophthalmic management should be emphasised.