Prognostic value of ocular trauma score for open globe injuries associated with metallic intraocular foreign bodies

A rare intraocular foreign body resulting from a workplace accident

A 54-year-old man presented to the ophthalmic emergency department of our center with eye pain and blurred vision in his right eye following a workplace accident. Examination revealed a penetrating corneal injury with the presence of an intraocular foreign body (IOFB) involving the corneoscleral limbus, perforating the cornea, iris, anterior lens capsule, and lens. Immediate surgical intervention was carried out with the extraction of the IOFB, identified as an 8mm mussel shell fragment, and the removal of the resulting traumatic cataract. Both preoperative and postoperative examinations showed an attached retina with no signs of retinal tears or vitreous hemorrhage. Appropriate management in this case, along with the timely identification of the agent, led to favorable outcomes despite the size of the intraocular foreign body.

Management of scleral tears with concurrent intraocular foreign bodies and factors affecting outcomes

AIM

To report the clinical settings and factors predicting outcomes in scleral tears with concurrent retained intraocular foreign bodies METHODS: All cases with scleral and corneoscleral wounds with retained intraocular foreign bodies (RIOFB) from January 2014 to January 2021 were retrospectively analysed. Favourable anatomic outcome was defined as presence of globe integrity, attached retina, absence of hypotony and active inflammation at last visit. Favourable functional outcome was defined as final visual acuity (VA) > 20/200.

RESULTS

Total 139 eyes were included. Mean age was 30.66 ± 13.32 years (median 29 years, IQR 17). Penetrating trauma accounted for 87.1%, rupture for 5.8%, perforation for 7.2%. In 5.8% of the eyes the injury involved zone I extending till Zone II while in 66.9% it involved Zone II and in 27.3% in Zone III. Snellen visual acuity at presentation was logMAR 2.97 ± 1.01 and at last visit was logMAR 2.38 ± 1.45 (p < 0.0001). Time between presentation and repair was 13.93 ± 19.56 h (median 7.6 h, IQR 17.17). Favourable functional outcome was seen in 34.5% eyes and 2/3rd achieved favourable anatomic outcome. Absence of endophthalmitis (OR = 6.25, p = 0.003) and ability to remove the foreign body (OR = 7.05, p = 0.003) were associated with a favourable anatomic outcome. Better presenting Snellen visual acuity (OR = 2.77, p = 0.003), manifest scleral tear (OR = 3.36, p = 0.04), and absence of endophthalmitis (OR = 50, p = 0.0009) were associated with a favourable functional outcome.

CONCLUSION

A third of the cases achieved favourable visual outcome while 2/3rd achieved favourable anatomic outcome. Absence of endophthalmitis is an important factor predicting both.

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.

Clinical characteristics and prognostic factors of open globe injuries in a North Spain population: a 10-year review

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.

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.

Characteristics of Grape Shelf Eye Injuries at Vineyards in Japan

We aimed to investigate the characteristics and visual outcomes of farm work-associated eye injuries at vineyards. We retrospectively reviewed medical charts of patients with farm work-associated eye injuries. The eyes were divided into two groups according to the type of farming that contributed to the eye injury: the vineyard and other farming groups. Injury types, surgical procedures, and changes in visual acuity were statistically evaluated. After initial treatment, patients were followed up at different periods. We examined 30 eyes, including 14 eye injuries in the vineyard group and 16 eye injuries in the other farming group. The mean age of the patients was 58.8 ± 16.7 years, and 83.3% were male. None of the patients wore any safety eyewear at the time of injury. After initial treatment, the mean best-corrected visual acuity significantly improved from 0.83 ± 0.94 at baseline to 0.30 ± 0.57 at the final follow-up (p = 5.8 × 10^-4). Eye injuries in the vineyard group were mostly caused by the penetration of wires of grape shelves and were frequent from winter to spring. We concluded that farm work-associated eye injuries at vineyards have characteristic properties compared with those during other farm work. The use of safety eyewear is strongly recommended to prevent eye injuries during farm work.

Analysis of ocular injury 1-year outcome in survivors of Beirut Port ammonium nitrate blast

Purpose

Ascertain the 1-year outcome of patients who sustained open eye injuries from the Beirut Port ammonium nitrate (AN) explosion, one of the most powerful non-nuclear explosions in history.

Methods

Retrospective chart review of the operated eyes in 2 major eye hospitals.

Results

Out of 42 patients with open globe injury that was originally sutured, 29 patients (34 eyes) were followed at the 1-year mark. The initial vision in logMAR (mean ± SD) was 2.93 ± 0.87 (hand motion equivalent) and the final vision was 1.80 ± 1.47 (counting finger 2 m equivalent). No light perception (NLP) vision was noted in 12 eyes on presentation and 10 eyes remained so, while 2 eyes reached light perception (LP) vision. Eight eyes had an intraoperative expulsive choroidal hemorrhage (7 NLP and 1 LP both pre- and postoperatively), and 6 of the 8 developed phthisis. All eyes that developed phthisis had NLP preoperatively and postoperatively. Ocular Trauma Score (OTS) correlated inversely with both initial and final vision (p < 0.001). Zone of injury inversely correlated with initial vision (p = 0.02) and positively with final vision (p < 0.001). Final vision was significantly worse in zone 3 vs. zones 1 and 2 (3.2 ± 0.5) vs. 0.9 ± 1.1) (p < 0.001) injuries, as was the initial vision (3.3 ± 0.5 vs. 2.7 ± 0.8; p = 0.002).

Conclusion

The OTS, which provides prognostic information for serious ocular trauma, also yields valuable prognostic information for AN-associated ocular injuries. Expulsive choroidal hemorrhage and NLP vision at presentation remain very poor prognostic signs.

Verification of Ocular Trauma Score for Intraocular Foreign Bodies in Lethal-Weapon-Related Ocular Injuries

INTRODUCTION

The ocular trauma score (OTS) is a widely used predictive tool in determining the visual prognosis of ocular injuries. Intraocular-foreign-body (IOFB)-type injuries comprise the leading type of open-globe injuries (OGI) in ocular combat injuries. However, there are scarce reports evaluating the efficacy of OTS in IOFB-type injuries. Only one study is available that explored the validity of OTS in combat-related IOFB injuries with a limited number of eyes. The aim of this study is to confirm the predictive value of OTS in lethal-weapon (LW)-related OGI with IOFB.

MATERIAL AND METHODS

The charts of 488 patients with IOFB-type-eye injuries between January 1998 and January 2018 were analyzed. Only the LW-related ocular injuries were included. Baseline details (patient demographics, surgeries, OTS categories, and visual acuity [VA]) were recorded. To test the validity of OTS, Fischer exact test was used to compare the likelihood of the final VAs for every OTS subgroups between OTS study group and this study.

RESULTS

The complete data of 206 eyes of 142 patients including two civilians were analyzed in the study. No subjects had ocular protection at the time of the injury. OTS study and this current study did not show an exact validation in first three OTS categories in various final VA subgroups (no light perception (NLP) subgroup (P: 0.001), light perception/hand movements subgroup (P: 0.033), 20/200 to 20/50 subgroup (P: 0.047) in OTS category 1; NLP subgroup (P: 0.000), 20/200 to 20/50 subgroup (P: 0.036), 20/40 subgroup (P: 0.018) in OTS 2; and 20/200 to 20/50 subgroup (P: 0.01), 20/40 subgroup (P: 0.003) in OTS 3, respectively). The above results indicate that in first three OTS categories, OTS study was not useful in visual prognosis prediction in the mentioned VA subgroups. The results predicted the final VA only in OTS categories 4 and 5 in which all P values were greater than 0.05.

CONCLUSIONS

Visual outcome of this type of ocular injury may be unpredictable due to more frequent discouraging results. OTS failed to predict visual outcome in first three OTS categories in this study. Therefore, OTS appears to be verified only in better (OTS categories 4 and 5) categories.

Epidemiology of pediatric eye injuries requiring hospitalization in rural areas of Wenzhou and Changsha, China: a 10-year retrospective study

BACKGROUND

The aim of this study was to review the demographic and characteristic distribution data of serious rural pediatric eye injuries in Wenzhou and Changsha, located in Zhejiang Province in East China and Hunan Province in Central China.

METHODS

This retrospective study included hospitalized pediatric patients aged < 18 years with eye injuries at the Eye Hospital of Wenzhou Medical University and Xiangya Hospital of Central South University from January 2008 to December 2017. Demographic data, injury types, injury causes, and initial and final visual acuity (VA) were recorded and analyzed. The ocular trauma score (OTS) was calculated to assess the severity of injury and evaluate the prognosis. All patient data were obtained from the medical record systems.

RESULTS

In total, 1125 children were hospitalized during the 10-year period; 830 (73.8%) were males and 295 (26.2%) were females. The majority of the patients were aged 3 to 8 years (57.4%, n = 646). Among mechanical injuries (n = 1007), penetrating injury was the most common (68.4%, n = 689), followed by contusion (17.2%, n = 173) and rupture (8.1%, n = 82). Overall, the top three injury causes were sharp objects (n = 544, 48.4%), blunt objects (n = 209, 18.6%) and fireworks (n = 121, 10.8%). In Wenzhou, eye injuries occurred mostly in summer (n = 136, 29.1%), and sharp object-related eye injuries accounted for the highest proportion (n = 98, 72.1%). In Changsha, eye injuries occurred mostly in winter (n = 272, 41.3%), and firecracker- and fireworks-associated eye injury accounted for the highest proportion (n = 73, 26.8%). The final VA was positively correlated with the initial VA (r = 0.641, P < 0.001) and the OTS (r = 0.582, P < 0.001).

CONCLUSION

The age range of the susceptible pediatric population from rural areas was 3-8 years. Most eye injuries were penetrating, and the main cause of injury was a sharp object. Notably, the differences in the characteristics of eye injuries in the two areas were related to regional features.

Visual Outcomes and Prognostic Factors of Intralenticular Foreign Bodies in a Tertiary Hospital in North China

Purpose

The aim of this study is to describe the epidemiological and visual outcomes and to identify the main prognostic factors of intralenticular foreign body (ILFB) injuries.

Methods

We performed a retrospective review of 21 patients (21 eyes) referred to Hebei Eye Hospital in North China from January 2012 to December 2017, who underwent surgical removal of ILFBs and associated ocular trauma repairs. Data regarding the patient demographics, cause of the injury, nature of the ILFB, clinical features, time interval between the injury and the ILFB removal, time interval between the presentation and the surgery, and the initial and final best-corrected visual acuities (BCVAs) were analyzed, and the main prognostic factors were identified.

Results

Male adults were most affected by ILFBs (90.5%). The mean age of the patients was 41.5 years (median: 46 years, range: 21 to 60 years). None of the patients were wearing goggles at the time of the injury. The most common ILFB cause was hammering the metal (57.1%), and most of the ILFBs were metallic (71.4%). After medical treatment, the final BCVA was improved significantly (Z = 2.49, P=0.015). There was a significant association between the ILFBs with posterior segment injuries and the final BCVA (χ² = 10.03, P=0.01). Those factors showing no statistical association with the final BCVA included the age (χ² = 0.36, P=1.0), gender (χ² = 0.52, P=1.0), nature of the ILFB (χ² = 1.11, P=0.54), entrance wound location (χ² = 2.85, P=0.25), and time interval between the injury and the ILFB removal (χ² = 1.87, P=0.23).

Conclusion

This is the first local study to explore the epidemiology of ILFB injuries and to identify the main prognostic factors. There was a significant association between the ILFBs with posterior segment injuries and the final BCVA. Improved public awareness and strengthened education regarding safety are the key approaches to reduce the incidence of eye injuries.

Intraocular Foreign Bodies: Clinical Characteristics and Prognostic Factors Influencing Visual Outcome and Globe Survival in 373 Eyes

Aim

To describe epidemiologic and clinical characteristics and prognostic factors influencing visual outcome after intraocular foreign bodies (IOFBs) injury.

Methods

Medical records of 370 patients (373 eyes) with IOFBs were reviewed to identify the factors influencing visual acuity by univariate and multivariate analyses.

Results

The majority of patients (97.0%) were men, with a mean age of 38.1 years. The most common cause of ocular injury was hammering (52.6%); magnetic IOFBs occurred in 84.7% of these cases. Factors associated with poor visual outcome (defined as <1.3 logMAR) included the following: age ≥50 years (P=0.046); worse presenting visual acuity (P < 0.001); complications of retinal breaks (P=0.006) and endophthalmitis (P=0.032); vitrectomy (P=0.035); and intraocular C₃F₈ gas tamponade (P=0.038). Excellent visual outcome (defined as ≥0.5 logMAR) was associated with age <50 years (P=0.003); better presenting visual acuity (PVA) (P < 0.001); wound length <4 mm (P=0.005); absence of vitreous hemorrhage (P=0.026) and retinal breaks (P < 0.001); nonvitrectomy surgery (P=0.043); and use of balanced saline (P=0.029).

Conclusions

Multiple prognostic factors were identified that may predict visual outcome and globe survival after IOFBs injury. Age, initial presenting visual acuity, wound length, complications (vitreous hemorrhage, retinal breaks, and endophthalmitis), surgical approach, and intraocular tamponade were significant predictors of visual outcome.