Open globe injuries: factors predictive of poor outcome

Abstract

Objective Despite advances in ocular and orbital imaging, instrumentation, materials, and surgical procedures, the management of open globe injuries continues to pose difficult management dilemmas. In this retrospective study, we identify clinical characteristics and outcome of a series of open globe injuries presenting to a major UK centre. Method Operating department records were reviewed to identify all patients who had undergone repair of an open globe injury from 1 January 1998 to 1 January 2003 at the Manchester Royal Eye Hospital. Case notes were examined to determine demographic data, mechanisms of injury, influence of alcohol/drugs, and location of injury. The Snellen visual acuity on presentation and initial clinical signs were recorded. Results In total, 115 cases of open globe injury were identified of which 107 cases notes were available for review. Injury to the eye with a sharp object accounted for 71/107 (66%) cases and blunt mechanisms for 30/107 (28%) cases. In six (6%) cases the cause of injury was unknown. The rate of secondary enucleation in our series of 107 open globe injuries was 13/107 (12%). Significant risk factors on presentation associated with eventual enucleation included relative afferent pupillary defect (Po0.001), absence of a red reflex (Po0.001), presence of a lid laceration (Po0.02), a blunt mechanism of injury (Po0.02), and an initial VA worse than 6/60 (P ¼ 0.03). Conclusion From this retrospective study, we have identified several factors that may aid the clinician in deciding on the prognostic value of primary repair. Blunt injuries associated with adnexal trauma, with poor initial visual acuity, the presence of an RAPD or retinal detachment, and the absence of a red reflex are associated with a significantly higher rate of subsequent enucleation.

A new ocular trauma score in pediatric penetrating eye injuries

“…Other studies on trauma epidemiology confirm a male predominance, with a male : female ratio varying between 1.25 and 5.5. 3,14,18,19 The male : female ratio in this study was 1.42. This may reflect the more aggressive characteristics of male behaviour even in childhood aged.…”

“…3,4 Despite public health campaigns designed to prevent eye injuries, open globe injuries still occur. Identifying the causes and the nature of these injuries in the population, and directing educational and legislative efforts towards minimizing eye injury, are the previous goals of prevention.…”

“…[1][2][3][4] Eye trauma constitutes 7% of all bodily injuries and 10-15% of all eye disease. 5,6 The severity of trauma is directly proportional to morbidity and affects the socioeconomic loss; however, this loss can be prevented if certain precautions are taken.…”

Visual outcome after open globe injury: a comparison of two prognostic models—the Ocular Trauma Score and the Classification and Regression Tree

“…1 The incidence rates of ocular trauma requiring hospitalisation are reported to be 8.1 per 100 000 persons per year in Scotland, 2 12.6 per 100 000 persons per year in Singapore, 3 13.2 per 100 000 persons per year in the United States, 4 and 15.2 per 100 000 persons per year in Australia. 5 Several studies have suggested that the factors that significantly predict visual outcome after open globe injuries are initial visual acuity, 6,7 presence of a relative afferent pupillary defect (RAPD), 7,8 mechanism of injury, 7,9,10 wound location, 7,11,12 adnexal trauma, 8,13 lens damage, 7,12 hyphaema, 14 vitreous haemorrhage, 11,15 and retinal detachment. 11,16 In 2002, Kuhn et al 17 developed a prognostic model, the ocular trauma score (OTS), to predict the visual outcome of patients after ocular trauma.…”

Perfil biopsicossocial de portadores de anoftalmia no sul de Minas Gerais - Brasil

“…Para Fonseca (7) , a exérese do globo ocular representa aproximadamente 3,1% de todas as cirurgias oftalmológicas, havendo predominância do gê-nero masculino, principalmente devido à maior exposição ao trauma. Assim, o glaucoma (8) , traumatismos (9)(10)(11) e tumores intra-oculares têm sido considerados como etiologias importantes da anoftalmia (12)(13)(14) . O objetivo deste estudo foi avaliar o perfil das causas e das conseqüências biopsicossociais da perda do globo ocular, em pacientes sob reabilitação com próteses oculares, no Centro de Tratamento de Deformidades Crânio-Faciais -"Centrinho", da Universidade de Alfenas, Minas Gerais, Brasil.…”