Retinal Detachments after Open-Globe Injury: Risk Factors and Outcomes

Bandage Contact Lens as an Alternative to a Temporary Keratoprosthesis for Vitrectomy With Concurrent Corneal Opacity

Purpose: To present a case of a bandage contact lens being used as an alternative to a temporary keratoprosthesis for urgent vitreoretinal surgery. Methods: A single case was evaluated. Results: A 72-year-old man with monocular vision presented with a retinal detachment (RD) after repair of a traumatic globe rupture. His ocular history included previous penetrating keratoplasty (PKP) and RD surgery in the eye that had visual ability. The previous corneal graft was opacified and a conventional temporary keratoprosthesis was unavailable. After removal of the corneal graft, a bandage contact lens was used as an alternative to a temporary keratoprosthesis. Subsequently, pars plana vitrectomy and a PKP were performed. The bandage contact lens provided excellent visualization for the vitrectomy and resulted in a successful final outcome. Conclusions: When corneal opacity precludes vitrectomy and a temporary keratoprosthesis is unavailable, a bandage contact lens is a viable option.

Diagnostic Accuracy of B-Scan Ultrasonography in Detecting Vitreoretinal Pathology after Open-Globe Injury

PURPOSE

To assess the diagnostic accuracy of B-scan ultrasonography (echography) after open-globe injury (OGI) repair in detecting vitreoretinal pathology, as confirmed by intraoperative inspection during subsequent pars plana vitrectomy (PPV).

DESIGN

Retrospective, single-center, consecutive case series.

PARTICIPANTS

Patients with OGI treated at the University of Iowa Hospitals and Clinics from February 2018 through December 2023 who underwent OGI repair and had at least 1 B-scan performed postrepair but before subsequent PPV.

METHODS

B-scans were performed by an experienced echographer and reviewed by the managing vitreoretinal surgeon for the presence of vitreous hemorrhage (VH), retinal tear (RT), retinal detachment (RD), choroidal detachment, and vitreoretinal incarceration. B-scan findings were compared with findings on direct inspection during PPV, which served as the gold standard.

MAIN OUTCOME MEASURES

Sensitivity, specificity, and positive/negative predictive value of B-scan findings.

RESULTS

The study included 62 eyes of 61 patients, predominantly with severe OGIs (mean presenting logarithm of the minimum angle of resolution visual acuity of 2.52 ± 0.41; 75% with an Ocular Trauma Score of 1 or 2). B-scan had excellent diagnostic accuracy for VH, but, for every other type of vitreoretinal pathology, there were significant false positives, false negatives, or both. B-scan sensitivity was particularly low for vitreoretinal incarceration (11%), RT (32%), and RD (78%).

CONCLUSIONS

This study identified much lower diagnostic accuracy of B-scan ultrasonography after OGI for all vitreoretinal pathologies except VH compared with previous, smaller studies that reported perfect accuracy (100% sensitivity and specificity). Ultrasonography provides useful clinical information but should not be solely relied upon to diagnose or rule out severe vitreoretinal pathology that may prompt vitreoretinal referral or PPV after OGI.

FINANCIAL DISCLOSURE(S)

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

EARLY RETINAL DETACHMENTS AFTER OPEN GLOBE REPAIR: Incidence and Risk Factors

PURPOSE

Risk factors for the development of rhegmatogenous retinal detachments (RRDs) in the early postoperative period after open globe repair are not well understood. RRDs are often diagnosed late after open globe injuries, which can negatively affect visual prognosis. The authors assessed the incidence and risk factors that predict the development of this complication.

METHODS

The authors conducted a retrospective case-control study of all open globe injuries at a single ocular trauma center from January 2016 to September 2021 where at baseline the retina was attached. Cases were defined as postoperative RRDs that developed within 90 days of open globe repair.

RESULTS

Of 96 eyes included, 40 (41.7%) subsequently developed RRD. Univariate analysis revealed initial visual acuity of light perception or worse (odds ratio 7.64; 95% CI, 3.03-19.22; P < 0.01), Zone 3 injuries (odds ratio 7.54; 95% CI, 2.64-21.54; P < 0.01), no view of the lens (odds ratio 4.26; 95% CI, 1.77-10.26; P < 0.01), and the presence of injuries external to the globe (odds ratio 5.33; 95% CI, 2.09-13.63; P < 0.01) to be associated with early RRD development. On multivariate analysis, presenting visual acuity of light perception ( P < 0.001), the presence of external injuries ( P = 0.001), and Zone 3 injuries ( P = 0.037) remained significant. Of the 40 patients with early retinal detachment, 34 (85%) remained attached after repair, with variable visual outcomes.

CONCLUSION

Presenting visual acuity of light perception, Zone 3 injuries, and external injuries to the globe confer increased risk of early postoperative RRD after open globe repair. The majority of RRDs can be successfully repaired.

Epidemiology of Ocular Trauma and Predictive Modeling of Visual Outcomes: A 12-Year Retrospective Study at a Tertiary Hospital in China

Background

Ocular trauma is a visually and economically devastating cause of visual loss. This study investigated the prevalence and clinical characteristics of ocular trauma in central and northern China, and assessed prognostic factors.

Methods

Cases of ocular trauma that underwent surgical treatment in a tertiary hospital in China between January 1, 2012, and December 31, 2023, were reviewed. All patient data were collected, including demographic information, type of injury, cause of injury, overall condition, number of surgeries, structural damage, surgical complications, and initial and final visual acuity (VA). We constructed three models to explore the prognostic factors of final VA: linear regression, regression tree, and random forest.

Results

Over 12 years, 1019 patients (1019 eyes) with ocular trauma underwent surgery, of which 836 were open globe injuries. Patients were predominantly male (80.8%), with an average age of 31.1 years. The most at-risk age group was 41-50 years old. Farmers (33.3%) and students (20.9%) were the most common occupations. The most frequent complication was vitreous hemorrhage (95.7%). Most patients required three surgeries (42.2%). During vitrectomy, proliferative vitreoretinopathy and elevated intraocular pressure were observed in 735 patients (72.1%). The final VA ranged from 0 to 3.00 logMAR with a mean of 1.10±0.43 logMAR. Among the three models, the random forest performed the best. Ocular structural damage and surgical complications, along with the number of surgeries, were important factors affecting the visual prognosis.

Conclusion

Individuals at high risk should be given extra care, as traumatic and surgical complications are the main prognostic factors.

Epidemiological and clinical characteristics of open globe injuries in Southwest China

Background

Open globe injuries (OGIs) are one of the leading causes of monocular vision loss, and the clinical characteristics of OGIs are region specific. The features and patterns of OGIs in Southwest China are poorly known and not well studied. Our study aimed to review the epidemiological and clinical characteristics of patients hospitalized for OGIs in Southwest China.

Methods

A retrospective study of OGI patients admitted to the West China Hospital from January 1st, 2015, to December 31st, 2019, was performed. Demographic characteristics and injury details were recorded. The Birmingham Eye Trauma Terminology system and the ocular trauma score (OTS) were used.

Results

A total of 3,014 patients were included. The male-to-female ratio was 5.2:1, and the mean age was 35.6 ± 19.1 years. 15.2% of patients were from the ethnic groups. The highest-risk occupation was the farmer (30.3%), followed by the worker (28.5%). OGIs occurred more frequently in people with middle (37.0%) and primary school (33.1%) education levels. Types of injuries included 46.8% penetration, 21.2% rupture, 2.9% perforation, and 29.1% intraocular foreign body (IOFB). The injuries types differed between age and occupation groups (p < 0.001). IOFBs had a higher risk of causing endophthalmitis, retinal detachment, and traumatic cataracts (p < 0.001). The most common injuries resulted from sharp objects (72.7%). The causes of the injuries were significantly associated with age, ethnicity, and occupation (p < 0.001). Explosion injuries and attacks by animals were more common among people of Tibetan and Yi ethnicities. Blunt trauma, vehicle crashes, falls and age older than 60 years were risk factors for a lack of light perception and lower OTS scores prognosis.

Conclusion

OGIs in Southwest China mainly affected working-aged males, especially workers or farmers. Severe vision loss and IOFBs are more common findings. OGIs in older patients and ethnic minorities requires additional attention.