Predictive factors for final outcome of severely traumatized eyes with no light perception

Abstract

BackgroundAn eye injury that causes no light perception (NLP) typically carries an unfavorable prognosis, and NLP because of trauma is a common indication for enucleation. With advances in vitreoretinal surgical techniques, however, the indication for enucleation is no longer determined by posttrauma NLP vision alone. There are limited studies in the literature to analyse the outcome of NLP eyes following open globe injury. The current study was aimed to evaluate the outcome of surgical repair of severely traumatized eyes with no light perception vision as preoperative visual acuity. Secondary objective was to possibly predict the factors affecting the final vision outcome in this eyes.MethodsRetrospective case analysis of patients with surgical repair of open globe injury over last ten years at a tertiary referral eye care centre in Singapore.ResultsOut of one hundred and seventy two eyes with open globe injury 27 (15.7%) eyes had no light perception (NLP). After surgical repair, final visual acuity remained NLP in 18 (66.7%) eyes. Final vision improved to Light perception/ Hand movement (LP/HM) in 2(7.4%) eyes, 1/200 to 19/200(11.1%) in 3 eyes and 20/50-20/200(14.8%) in 4 eyes. The median follow up was 18.9 months (range: 4–60 months). The factors contributing to poor postoperative outcome were presence of RAPD (p = 0.014), wound extending into zone III (p = 0.023) and associated vitreoretinal trauma (p = 0.008).ConclusionsOne third of eyes had ambulatory vision or better though two third of eyes still remained NLP. Pre-operative visual acuity of NLP should not be an indication for primary enucleation or evisceration for severely traumatized eyes. Presence of afferent papillary defect, wound extending posterior to rectus insertion and associated vitreoretinal trauma can adversely affect the outcome in severely traumatized eyes with NLP. Timely intervention and state of art surgery may restore useful vision in severely traumatized eyes.

Clinical characteristics and prognostic factors of scleral rupture due to blunt ocular trauma

“…This rate was reported to be 20.1 to 100% in severe OGIs in the literature. 5,7,8,10,13,14 Hyphema was a prognostic factor for poor final VA (P = 0.009) in our study. Rofail et al 3 reported hyphema was a predictor of poorer visual outcome.…”

“…Open globe injuries occur most frequently in males. 3,[5][6][7][8][9]12 In contrast to the literature, a significant female predominance was found in our scleral rupture series. Emami-Naeini et al 14 reported a female predominance in fall-related OGIs.…”

“…Sixteen (26.2%) patients underwent cataract surgery. In the literature, there are studies that have reported similar rates of lens injury and traumatic cataract 8,17 and studies that have reported higher rates of lens injury and traumatic cataract. 4,6,12 Patients who underwent cataract surgery had statistically better final VA (P = 0.002) in our study.…”

“…In contrast, some studies detected no association between lens injury or traumatic cataract and visual outcome. 6,8,12 Uveal tissue prolapse or damage was seen in 52.4% of patients. In contrast to the results of some studies, uveal tissue prolapse or damage was not a predictor of visual outcome in our series.…”

“…1 A globe rupture is a type of OGI caused by blunt ocular trauma and has poor visual outcome. 2 Several studies have suggested that the factors that significantly predict visual outcome after OGIs are presenting visual acuity (VA), [3][4][5][6] presence of a relative afferent pupillary defect (RAPD), 3,7-9 mechanism of injury, 4,6,7,10,11 wound location, 8,10,[12][13][14] wound size and extension, 10,11,15,16 adnexal trauma, 7,9,12,17 lens damage, 4,11 hyphema, 3,11 vitreous hemorrhage, 3,4,8,10,12 and retinal detachment. 4,5,7,12,17 The major signs of scleral rupture are VA with light perception or less, conjunctival edema and subconjunctival hemorrhage, hyphema, ocular hypotony, impairment or dislocation of the lens, vitreous hemorrhage, and retinal detachment.…”