Validation of the Ocular Trauma Score for Intraocular Foreign Bodies in Deadly Weapon-Related Open-Globe Injuries

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.

Open Globe Injury in a Tertiary Hospital of Northern Thailand: No Vision Survival and Ocular Trauma Score

Purpose

To determine characteristics and factors associated with no vision survival (included no light perception, enucleation, and evisceration) following open globe injury (OGI) and to correlate the proportion of final vision to predictive values of ocular trauma score (OTS).

Patients and Methods

The medical records of consecutive patients diagnosed as OGI between January 2015 and December 2020 were retrospectively reviewed. Data collected included demographics, mechanisms and modes of injuries, ophthalmic presentations, managements, and visual outcomes at the final visit.

Results

Three hundred and seventy-one patients with a mean (standard deviation, SD) age of 44.0 (17.4) years were included. Male with workplace injury was the most frequent scenario. High-velocity metallic objects were the predominant causative materials. Following treatments, fifty-six eyes (14.9%) obtained no vision survival. Factors associated with no vision survival following OGI were low presenting vision, globe perforation, larger wound, presence of relative afferent pupillary defect, retinal detachment, and vitreous hemorrhage. Compared to OTS predictive values, eyes in OTS categories 1 and 2 had a lower proportion of no vision survival.

Conclusion

This study identified the importance of workplace injuries. Overall, there were comparable final visions between OTS and this study. However, a reduced proportion of no vision survival among severely injured eyes signifies the challenges of OGI management.

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.

Reliability of the ocular trauma score for the predictability of traumatic and post-traumatic retinal detachment after open globe injury

AIM

To elucidate the question of whether the ocular trauma score (OTS) and the zones of injury could be used as a predictive model of traumatic and post traumatic retinal detachment (RD) in patients with open globe injury (OGI).

METHODS

A retrospective observational chart analysis of OGI patients was performed. The collected variables consisted of age, date, gender, time of injury, time until repair, mechanism of injury, zone of injury, injury associated vitreous hemorrhage, trauma associated RD, post traumatic RD, aphakia at injury, periocular trauma and OTS in cases of OGI.

RESULTS

Totally 102 patients with traumatic OGI with a minimum of 12mo follow-up and a median age at of 48.6y (range: 3-104y) were identified. Final best corrected visual acuity (BCVA) was independent from the time of repair, yet a statistically significant difference was present between the final BCVA and the zone of injury. Severe trauma presenting with an OTS score I (P<0.0001) or II (P<0.0001) revealed a significantly worse BCVA at last follow up when compared to the cohort with an OTS score >III. OGI associated RD was observed in 36/102 patients (35.3%), whereas post traumatic RD (defined as RD following 14d after OGI) occurred in 37 patients (36.3%). OGI associated RD did not correlate with the OTS and the zone of injury (P=0.193), yet post traumatic RD correlated significantly with zone III injuries (P=0.013).

CONCLUSION

The study shows a significant association between lower OTS score and zone III injury with lower final BCVA and a higher number of surgeries, but only zone III could be significantly associated with a higher rate of RD.

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.

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

Background

The prognostic value of the ocular trauma score (OTS) in patients who underwent 23-gauge pars plana vitrectomy (23-G PPV) for surgical removal of posterior segment metallic intaocular foreign bodies (IOFB) was evaluated.

Methods

Patients who underwent 23-G PPV for surgical removal of retained metallic IOFBs were retrospectively analyzed. OTS score for each patient was calculated and raw scores were converted to their corresponding OTS categories. The final VAs in study patients were compared with their respective OTS categories.

Results

Twenty-five eyes from 25 patients were examined. Twenty-four (96%) of the patients were male, and the mean age was 34 ± 12 years. The time from injury to 23-G PPV was 9 ± 4 days. Fourteen (56%) patients had zone 1 trauma, eight (32%) patients had zone 2 trauma, and three (12%) patients had zone 3 trauma. Postoperative visual acuity was ≥ 20/200 in 14 (56%) of the patients and ≥ 20/40 in seven (28%) eyes. At the final visit, anatomical success was achieved in 86% of patients with retinal detachment at presentation. No statistically significant differences were found between our final VAs and OTS scores.

Conclusion

OTS, which provides prognostic information after general ocular trauma, may also provide valuable prognostic information for patients who undergo 23-G PPV for the surgical removal of metallic posterior segment IOFBs.

New classification of ocular foreign bodies

Foreign bodies (FBs) in the eye are usually classified as intraocular (IOFB) or extraocular (EOFB). In IOFB the FB is within the eye ball and in EOFB it is outside. This classification seems oversimplified. Hence a new classification is proposed on the basis of FB locations, in which adnexal FBs (in orbit, lids, con- junctiva and lacrimal apparatus) are also included. These are further classified according to their exact location. FBs can also be classified in many other ways. Besides IOFB and EOFB, another condition IMFB (intramural foreign body) is also described. The FBs are situated within cornea or sclera and are neither IOFB nor EOFB. Ocular trauma also includes trauma to ocular adnexa and hence the terms IOFB and EOFB have been replaced by IGFB (intraglobal foreign body) and EGFB (extraglobal foreign body).

Prognostic Factors for Visual Outcome in Traumatic Cataract Patients

Purpose. To investigate the prognostic factors for visual outcome in traumatic cataract patients. Methods. The demographic features of traumatic cataract patients in Central China were studied. The factors that might influence the visual outcome were analyzed. The sensitivity and specificity of OTS (ocular trauma score) in predicting VA were calculated. Results. The study enrolled 480 cases. 65.5% of patients achieved VA at >20/60. The factors associated with the final VA were initial VA, injury type, wound location, the way of cataract removal, and IOL implantation. The sensitivities of OTS in predicting the VA at NLP (nonlight perception), LP/HM (light perception/hand motion), and ≥20/40 were 100%. The specificity of OTS to predict the final VA at 1/200-19/200 and 20/200-20/50 was 100%. Conclusion. The prognostic factors were initial VA, injury type, wound location, cataract removal procedure, and the way of IOL implantation. The OTS has good sensitivity and specificity in predicting visual outcome in traumatic cataract patients in long follow-up.

Visual outcomes in patients with open globe injuries compared to predicted outcomes using the Ocular Trauma Scoring system

AIM

To determine the visual outcomes in adult patients who sustained open globe injuries and to determine whether the visual prognosis following an eye injury in an African setting differs from the predicted outcomes according to the Ocular Trauma Score (OTS) study. A secondary aim was to establish the evisceration rate for these injuries and assess how this form of intervention affected outcomes in comparison to the OTS.

METHODS

A prospective case series of all patients admitted with open globe injuries over a two-year (July 2009 to June 2011) period. Injuries were scored using the OTS and the surgical intervention was recorded. The best corrected visual acuity at three months was regarded as visual outcome.

RESULTS

There were 249 open globe injuries, of which 169 patients (169 eyes) completed the 3-month follow-up. All patients underwent primary surgery, 175 (70.3%) repairs, 61 (24.5%) eviscerations and 13 (5.2%) other procedures. Globe eviscerations were mainly done on OTS Category 1 cases, but outcomes in this category were not found to be different from OTS outcomes. Outcomes were significantly worse in Category 2, but when the entire distribution was tested, the differences were not statistically significant. The overall association between OTS outcomes and the final visual outcomes in this study was found to be a strong (P<0.005).

CONCLUSION

Reliable information regarding the expected outcomes of eye injuries will influence management decisions and patient expectations. The OTS is a valuable tool, the use of which has been validated in many parts of the world-it may also be a valid predictor in an African setting.

Impact of surgeon subspecialty training on surgical outcomes in open globe injuries

Purpose

The purpose of this study was to evaluate whether subspecialty training of the initial treating surgeon affects visual acuity and surgical outcomes in patients with open globe injuries.

Design

This study is a single-institution, retrospective case series.

Methods

The charts of adult patients with open globe injuries requiring surgical repair at the Wilmer Eye Institute between July 1, 2007 and July 1, 2012 were retrospectively reviewed. Clinical findings at presentation were recorded, and details of initial repair and follow-up surgeries were analyzed. Differences in visual acuity and surgical outcomes were compared based on subspecialty training of the initial surgeon.

Results

The charts of 282 adult patients were analyzed, and 193 eyes had at least 6 months of follow-up for analysis. Eighty-six eyes (44.6%) required follow-up surgery within the first year, and 39 eyes (20.2%) were enucleated. Eyes initially treated by a vitreoretinal (VR) surgeon were 2.3 times (P=0.003) more likely to improve by one Ocular Trauma Score (OTS) visual acuity category and 1.9 times (P=0.027) more likely to have at least one more follow-up surgery at 6 months compared to eyes treated by non-VR surgeons. Patients with more anterior injuries treated by a VR surgeon were more likely to improve by one OTS visual acuity category compared to those treated by non-VR surgeons (P=0.004 and 0.016 for Zones I and II, respectively). There was no difference in visual acuity outcomes for eyes with posterior injuries (P=0.515 for Zone III).

Conclusion

Eyes initially treated by a VR surgeon are more likely to improve by one OTS visual acuity category than those initially treated by a non-VR surgeon. However, patients initially treated by a VR surgeon also undergo more follow-up surgical rehabilitation, and improvement in visual acuity is more likely for anterior (Zone I and II injuries) than posterior (Zone III) injuries.

Post-Traumatic Endophthalmitis: A Mini-Review

Post-traumatic endophthalmitis comprises 25-30% of all endophthalmitis cases. Post-traumatic endophthalmitis is an important clinical condition that may have serious anatomical and functional consequences. The type of pathogenic microorganism, nature of the injury, the presence of a foreign body, and the geographical region in which the trauma occurred are all important factors influencing both treatment and prognosis. Unlike postoperative endophthalmitis, there is not a confirmed treatment protocol recommended by the Endophthalmitis-Vitrectomy Study Group in traumatic cases. In this study, we examine the incidence, risk factors, diagnosis, microbiological features, and treatment principles of post-traumatic endophthalmitis in order to guide clinicians who often encounter eye trauma related to this potential complication.

Prospective validation of the Ocular Trauma Score as a prognostic model to predict vision survival in injured adult patients from a developing country

PURPOSE

To assess the prognostic value of the Ocular Trauma Score (OTS) in patients with eye injury treated in a University Hospital in South America.

METHODS

One hundred and ninety subjects who were victims of eye trauma with different degrees of severity were evaluated and treated accordingly. Initial OTS categories were calculated for each patient and compared to the final visual result by transforming the achieved best-corrected visual acuity (BCVA) after treatment into OTS values.

RESULTS

OTS visual acuity showed good correlation with the final BCVA after treatment [Spearman's ρ = 0.857, 95 % confidence interval (CI) 0.813-0.891, P < 0.0001). No difference between the predicted BCVA and achieved BCVA was noticed (P < 0.0001, Chi-square test).

CONCLUSION

The OTS provided useful information on outcomes treatment after eye trauma and can be used as a prognostic model to predict vision survival in injured adult patients from a developing country.

Visual outcome after open globe injury and its predictive factors in Korea

BACKGROUND

To determine visual outcomes and prognostic factors of open globe injury in Korea and to assess the prognostic power of Ocular Trauma Score (OTS) model.

METHODS

The medical records of 194 consecutive patients (194 eyes) with open globe injury were reviewed. Data including demographics, mechanisms of injuries, wound sizes and locations, initial visual acuities, presence of intraocular damage and adjacent tissue injuries, and final visual acuities, which was defined as visual acuities at 1 year, after injury were collected and analyzed. Comparison of final visual acuities with those of the OTS study was also performed.

RESULTS

The study group consisted of 160 (82.5%) male and 34 (17.5%) female subjects. The average age was 38.2 ± 17.8 years (range, 2-91 years). One year after injury, visual acuity of light perception or better was attained in 78.4% of the patients, and 20/200 or better in 58.2%. In multivariate analysis, poor initial visual acuity, presence of retinal detachment and relative afferent papillary defect, and larger wound (>10 mm) were related to poor final visual acuities. Final visual acuities assessed using OTS categories were similar to those of OTS study in OTS category 3, 4, and 5, and more favorable in OTS category 1 and 2.

CONCLUSION

We have identified prognostic factors of open globe injury including initial visual acuity, presence of retinal detachment, relative afferent papillary defect, and wound length. OTS may have prognostic value in open globe injuries in Asian patients.