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

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.

Development, comparison, and internal validation of prediction models to determine the visual prognosis of patients with open globe injuries using machine learning approaches

INTRODUCTION

Open globe injuries (OGI) represent a main preventable reason for blindness and visual impairment, particularly in developing countries. The goal of this study is evaluating key variables affecting the prognosis of open globe injuries and validating internally and comparing different machine learning models to estimate final visual acuity.

MATERIALS AND METHODS

We reviewed three hundred patients with open globe injuries receiving treatment at Khatam-Al-Anbia Hospital in Iran from 2020 to 2022. Age, sex, type of trauma, initial VA grade, relative afferent pupillary defect (RAPD), zone of trauma, traumatic cataract, traumatic optic neuropathy (TON), intraocular foreign body (IOFB), retinal detachment (RD), endophthalmitis, and ocular trauma score (OTS) grade were the input features. We calculated univariate and multivariate regression models to assess the association of different features with visual acuity (VA) outcomes. We predicted visual acuity using ten supervised machine learning algorithms including multinomial logistic regression (MLR), support vector machines (SVM), K-nearest neighbors (KNN), naïve bayes (NB), decision tree (DT), random forest (RF), bagging (BG), adaptive boosting (ADA), artificial neural networks (ANN), and extreme gradient boosting (XGB). Accuracy, positive predictive value (PPV), recall, F-score, brier score (BS), Matthew correlation coefficient (MCC), receiver operating characteristic (AUC-ROC), and calibration plot were used to assess how well machine learning algorithms performed in predicting the final VA.

RESULTS

The artificial neural network (ANN) model had the best accuracy to predict the final VA. The sensitivity, F1 score, PPV, accuracy, and MCC of the ANN model were 0.81, 0.85, 0.89, 0.93, and 0.81, respectively. In addition, the estimated AUC-ROC and AUR-PRC of the ANN model for OGI patients were 0.96 and 0.91, respectively. The brier score and calibration log-loss for the ANN model was 0.201 and 0.232, respectively.

CONCLUSION

As classic and ensemble ML models were compared, results shows that the ANN model was the best. As a result, the framework that has been presented may be regarded as a good substitute for predicting the final VA in OGI patients. Excellent predictive accuracy was shown by the open globe injury model developed in this study, which should be helpful to provide clinical advice to patients and making clinical decisions concerning the management of open globe injuries.

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 outcome of ocular trauma patients at Queen Elizabeth Central Hospital in Malawi

Background

To describe the epidemiology and visual outcome of patients with ocular trauma treated at Queen Elizabeth Central hospital in Malawi.

Methods

A prospective, observational study was undertaken from September 2017 to December 2017. Data on socio-demographic features, aetiology of trauma, type of ocular injury pre-referral pathway and treatment of ocular trauma was collected as the exposure variables. The main outcome variable was best corrected visual acuity at 8 weeks following initial visit.

Results

A total of 102 patients (103 eyes) with ocular trauma were recruited with loss of follow up of 11 participants at 8 weeks following recruitment. The most affected age group were children under 11 years old (35.3%), followed by young adults of age between 21–30 years (22.5%). The male-to-female ratio for ocular injury was 2.8:1. Most participants had closed globe injuries (n = 72, 70.6%), with over half the population injured by blunt objects (n = 62, 60.8%). Furthermore, among the adult population, majority (n = 19 38%) were injured on the road during assaults (n = 24, 48%), while most paediatric injuries (n = 32, 61.5%) occurred at home during play. The incidence of monocular blindness was 25.3% at eight weeks after the first presentation. Factors that were associated with monocular blindness on multivariate analysis were living in rural areas and open globe injuries.

Conclusion

Ocular trauma led to monocular blindness in a quarter of the study population. There is need for preventive education of ocular injuries at both family and community level.

Etiology and Visual Prognosis in Open Globe Injuries: Results of A Tertiary Referral Center in Turkey

We aimed to analyse the clinical characteristics of OGI and evaluate the correlation between baseline ocular trauma score (OTS) and visual outcomes in cases with OGI. The charts of 257 OGI patients who had at least six months of follow-up were reviewed retrospectively. Demographics, data about the etiology, localization and size of the OGI, baseline and final best-corrected visual acuity (BCVA) were noted. At the time of approval OTS was calculated and compared with final BCVA. All analysis was performed in both entire study population and our pediatric subgroup. A total of 261 eyes of 257 patients with a mean age of 34.9 ± 19.8 years were enrolled. Globe injury with a mean size of 6.7 ± 4.5 mm was within zone I in 46.7% of the eyes. Older age (p < 0.001, OR = 1.029, 95% CI = 1.015-1.043), higher baseline logMAR BCVA scores (p < 0.001, OR = 4.460, 95% CI = 2.815-7.065), bigger wound size (p < 0.001, OR = 1.159, 95% CI = 1.084-1.240), relative afferent pupillary defect (RAPD) positiveness (p < 0.001, OR = 0.021 95% CI = 0.005-0.087), lower OTS (p < 0.001, OR = 27.034, 95% CI = 6.299-116.021), presence of concomitant retinal detachment (p < 0.001, OR = 0.157, 95% CI = 0.080-0.306), and endophthalmitis (p = 0.045, OR = 0.207, 95% CI = 0.044-0.962) were found to be related to poor visual prognosis. Cases with OGI caused by a sharp object (p = 0.007, OR = 0.204, 95% CI = 0.065-0.641) and those injured by a glass (p = 0.039, OR = 0.229, 95% CI = 0.056-0.931) had more favorable final vision. This study highlights that baseline BCVA, wound size, RAPD, retinal detachment, and OTS were the most significant markers for poor visual outcomes in both the entire population and pediatric subgroup. In cases with OGI, OTS was also found effective in predicting visual prognosis.

The Impact of Primary Treatment on Post-Traumatic Endophthalmitis in Children with Open Globe Injuries: A Study in China

Post-traumatic endophthalmitis (PTE) is considered as one of the most serious complications after open globe injuries (OGIs), especially in children. Poor prognosis of this disease can lead to a variety of socioeconomic problems. This study aimed to investigate the clinical characteristics of pediatric OGIs and the factors associated with the development of PTE in China. 131 patients under 14 years old and needed hospitalization for management of OGIs were enrolled. There were 90 males and 41 females. 44 patients were left-behind children, the majority were 3–6 years old (n = 71, 71/131, 54.2%) and living in rural area (n = 106, 106/131, 80.9%). After injury, 82 patients received primary repair within 24 h, with the remaining 49 patients receiving primary repair after 24 h. Eventually, there were 28 (28/131, 21.4%) patients presented with PTE. In those 49 patients, the frequency of PTE achieving 32.7% (16/49). Univariate analysis showed that the timing of primary repair is significantly associated with the development of PTE (p < 0.05). Moreover, left-behind children took higher risks in having delayed treatment that over 24 h after OGIs (OR = 2.466, 95% CI: 1.16–5.26). Reducing the time before primary repair is a useful strategy to prevent the development of PTE. Special supervision is needed for pre-school-aged boys living in rural areas, especially for left-behind children.

Analysis of Ocular Injury Characteristics in Survivors of the 8.12 Tianjin Port Explosion, China

Introduction

On the evening of August 12, 2015, a large chemical explosion occurred at Tianjin Port. We analyzed ocular injury characteristics in the survivors of this accident.

Methods

Twenty injured eyes of 17 hospitalized patients were included. Initial best-corrected visual acuity (BCVA), injury type, injury cause, relative afferent pupillary defect (RAPD), zone of injury (ZOI), and ocular trauma score (OTS) were evaluated. Final BCVA and enucleation were the final outcome index. The relationship between risk factors and final outcomes was analyzed.

Results

The patients comprised 14 males and 3 females (mean age, 35.24 ± 12.68 years). Eighteen eyes had open-globe and 2 had closed-globe injuries. Fifteen ocular injury types were reported. Initial visual acuity (VA) was 20/50 to 20/200, 20/200 to finger counting (FC), hand motion to light perception (HM-LP), and no light perception (NLP) in 2, 7, 7, and 4 eyes, respectively. RAPD was found in 5 eyes. Most eyes sustained severe injuries with OTSs of 1 (25%) and 2 (40%). Of the injured eyes, 50% had Zone III injuries. In 95% of the injured eyes, glass was the cause of injury. Three of 4 eyes with an initial VA of NLP had a final VA of NLP and an outcome of enucleation. In 5 eyes with RAPD, 3 had a final VA of NLP and a final outcome of enucleation. Eyes with lower OTSs generally had poorer outcomes. All eyes with a final VA of NLP and an enucleation outcome had Zone III injuries. All 3 eyes with an enucleation outcome had retinal injuries, whereas eyes with no retinal injury had a better final BCVA.

Conclusions

Explosions can inflict severe ocular trauma, even indoors; 90% of injured eyes had open-globe injuries caused by glass fragments. Initial NLP, RAPD, low OTS, posterior extended wound, and retinal injury indicate a poor final outcome.

Ocular Trauma Score as prognostic value in traumatic ocular injuries due to rotating wire brushes

PURPOSE

Rotating wire brushes are used, e.g., for rust removal. Detaching fragments can cause severe eye injuries. The purpose of this study was to investigate mechanism, severity, clinical outcome, validity of Ocular Trauma Score (OTS) and to assess the likelihood of final visual acuity.

METHODS

Twenty patients with traumatic ocular injuries by rotating wire brushes were included. Location and type of injury, grade of injury according to OTS, surgical procedure, and development of visual acuity were evaluated.

RESULTS

Eleven accidents (55%) happened at work, nine at home (45%). Eighteen injuries (90%) were penetrating, one (5%) was perforating. In one case (5%), an intraocular foreign body was present. One case each was classified OTS 1 and 2 (5%), six cases OTS 3 (30%), four cases OTS 4 (20%), and eight cases OTS 5 (40%). None of the patients was wearing safety goggles. Fourteen patients (70%) were surgically treated. Of these, five were treated at the anterior segment only, nine additionally underwent pars-plana vitrectomy. Nine patients received phacoemulsification. Mean best corrected visual acuity was logMAR 1.0 (2/20) at admission and 0.3 (10/20) at last follow-up. Our results were similar to those in the OTS study, except for OTS 1 (p = 0.046). Comparing the categorical distribution of final visual acuity in all OTS categories, no statistically significant difference was found (p = 0.119) between our results and the OTS study group.

CONCLUSIONS

OTS may provide prognostic information in traumatic ocular injuries by rotating wire brushes. The injuries could have been avoided by wearing safety goggles.