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Shariati MM, Eslami S, Shoeibi N, Eslampoor A, Sedaghat M, Gharaei H, Zarei-Ghanavati S, Derakhshan A, Abrishami M, Abrishami M, Hosseini SM, Rad SS, Astaneh MA, Farimani RM. Development, comparison, and internal validation of prediction models to determine the visual prognosis of patients with open globe injuries using machine learning approaches. BMC Med Inform Decis Mak 2024; 24:131. [PMID: 38773484 PMCID: PMC11106970 DOI: 10.1186/s12911-024-02520-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 04/24/2024] [Indexed: 05/23/2024] Open
Abstract
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.
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Affiliation(s)
| | - Saeid Eslami
- Department of Medical Informatics, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Nasser Shoeibi
- Eye Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Alireza Eslampoor
- Eye Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Hamid Gharaei
- Eye Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Akbar Derakhshan
- Eye Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Majid Abrishami
- Eye Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mojtaba Abrishami
- Eye Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Saeed Shokuhi Rad
- Eye Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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Ciavarra BM, Stenz EC, Barke MR, Gross AW, Chuang AZ, Crowell EL. Mechanism and outcomes of recreational and sports-related open globe injuries. Injury 2024; 55:111504. [PMID: 38508982 DOI: 10.1016/j.injury.2024.111504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 02/14/2024] [Accepted: 03/11/2024] [Indexed: 03/22/2024]
Abstract
OBJECTIVES To describe the mechanisms and visual outcomes of recreational and sports-related open globe injuries (OGIs). METHODS A retrospective case series of eyes experiencing OGI secondary to recreational and sports-related activities at Memorial Hermann Hospital - Texas Medical Center (MHH-TMC) from January 1st, 2010 through March 31st, 2015 was conducted. Exclusionary criteria included no documented ophthalmologic examination upon presentation and repairs performed by services other than ophthalmology. A two-tailed t-test and Fisher's exact test were utilized to assess for statistical significance (p < 0.05). RESULTS A total of 20 eyes from 20 patients experiencing OGIs secondary to recreational and sports-related activities were included. Thirteen eyes (65 %) presented with OGIs from penetrating objects while seven eyes (35 %) had injuries from blunt injuries. Males comprised most of the total study group (17 of 20 patients), and zone 3 injuries were the most common location of OGI. While eyes with OGIs from blunt trauma underwent evisceration/enucleation procedures more frequently than OGIs from penetrating mechanisms (71% vs 23 %) (p = 0.10), the final visual outcomes were similarly poor between groups. Only three eyes in this series experienced an improvement from baseline VA; all three eyes had lacked initial findings consistent with severe injury. CONCLUSIONS Recreational and sports related OGIs most commonly occur in zone 3 and in young males, regardless of injury type. OGIs due to both penetrating and blunt trauma mechanisms implicate poor functional outcomes, but the absence of certain presenting injury features may indicate possibility of eventual visual recovery.
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Affiliation(s)
- Bronson M Ciavarra
- Ruiz Department of Ophthalmology and Visual Science, McGovern Medical School at the University of Texas Health Science Center at Houston, 6400 Fannin Street, Suite 1800, Houston, TX 77030, United States
| | - Emma C Stenz
- Ruiz Department of Ophthalmology and Visual Science, McGovern Medical School at the University of Texas Health Science Center at Houston, 6400 Fannin Street, Suite 1800, Houston, TX 77030, United States
| | - Matthew R Barke
- Ruiz Department of Ophthalmology and Visual Science, McGovern Medical School at the University of Texas Health Science Center at Houston, 6400 Fannin Street, Suite 1800, Houston, TX 77030, United States
| | - Andrew W Gross
- Ruiz Department of Ophthalmology and Visual Science, McGovern Medical School at the University of Texas Health Science Center at Houston, 6400 Fannin Street, Suite 1800, Houston, TX 77030, United States
| | - Alice Z Chuang
- Ruiz Department of Ophthalmology and Visual Science, McGovern Medical School at the University of Texas Health Science Center at Houston, 6400 Fannin Street, Suite 1800, Houston, TX 77030, United States
| | - Eric L Crowell
- Ruiz Department of Ophthalmology and Visual Science, McGovern Medical School at the University of Texas Health Science Center at Houston, 6400 Fannin Street, Suite 1800, Houston, TX 77030, United States.
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Lu Y, Armstrong GW. Prognostic Factors for Visual Outcomes in Open Globe Injury. Int Ophthalmol Clin 2024; 64:175-185. [PMID: 38525990 DOI: 10.1097/iio.0000000000000496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
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Varas J, Campos MÁ, Tapia E, Sanhueza JL, Salazar C, Vergara N, Tapia N, Mantero G, Bustamante P. Visual-functional impact of people affected by severe ocular trauma during social protests in Chile in 2019. Int Ophthalmol 2024; 44:77. [PMID: 38351240 DOI: 10.1007/s10792-024-02969-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 12/04/2023] [Indexed: 02/16/2024]
Abstract
PURPOSE To determine the impact on the functionality associated with visual loss (VFIP) in people with severe ocular trauma (SOT) caused by kinetic impact projectiles used in police crowd control through a prioritization tool in people admitted to a rehabilitation program in Santiago de Chile from December 02, 2019, to November 13, 2020. METHODS A cross-sectional descriptive study of SOT victims (N = 85), average age 31.4 ± 11.9. The data were recorded through a new 9-item screening instrument for assessment and prioritization of rehabilitation created for this emergency scenario. RESULTS The impact of the use of kinetic weapons resulted in monocular blindness in the majority of those affected (n = 68; 80.0%). The highest VFIP observed was among young men from lower social strata. There were extreme difficulties in the performance of productive tasks (occupational and/or educational) (n = 42; 49.4%) and the pursuit of hobbies and pastimes (n = 23; 27.1%), as well as a high difficulty in adapting to changes in brightness (n = 29; 34.1%) and handling objects accurately (n = 22; 25.9%). CONCLUSION The use of kinetic weapons for crowd control resulted in high and extreme VFIP and, in most cases, monocular blindness, causing major difficulties in work, study, and development of hobbies and pastimes in the affected population, highlighting the urgent need for effective rehabilitative care, which requires special attention in order to generate an adequate rehabilitation program. The use of kinetic weapons for crowd control contravenes international goals, policies, and plans set by the WHO and the International Agency for the Prevention of Blindness on strategies to prevent avoidable blindness worldwide until 2020. It is essential to ban the use of these weapons in Chile and worldwide, as well as to revise police protocols for crowd control.
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Affiliation(s)
- Joaquín Varas
- Department of Occupational Therapy and Occupational Science, Faculty of Medicine, Universidad de Chile, Independencia 1027, Santiago, Chile
| | - Miguel Ángel Campos
- Department of Medical Technology, Faculty of Medicine, Universidad de Chile, Independencia 1027, 8380453, Santiago, Chile
- Department of Ophthalmology, Hospital Del Salvador, Avenida Salvador 364, Santiago, Chile
| | - Eric Tapia
- Department of Medical Technology, Faculty of Medicine, Universidad de Chile, Independencia 1027, 8380453, Santiago, Chile
- Instituto de Investigación y Postgrado, Facultad de Medicina y Ciencias de la Salud, Universidad Central de Chile, Lord Cochrane 416, Santiago, Chile
| | - José Luis Sanhueza
- Department of Ophthalmology, Hospital Del Salvador, Avenida Salvador 364, Santiago, Chile
| | - Claudia Salazar
- School of Medical Technology, Faculty of Medicine, Universidad de Chile, Independencia 1027, Santiago, Chile
| | - Nayadet Vergara
- School of Medical Technology, Faculty of Medicine, Universidad de Chile, Independencia 1027, Santiago, Chile
| | - Nicole Tapia
- Department of Ophthalmology, Hospital Del Salvador, Avenida Salvador 364, Santiago, Chile
| | - Gianinna Mantero
- Department of Ophthalmology, Hospital Del Salvador, Avenida Salvador 364, Santiago, Chile
| | - Patricio Bustamante
- Department of Medical Technology, Faculty of Medicine, Universidad de Chile, Independencia 1027, 8380453, Santiago, Chile.
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Al Ghadeer H, Khandekar R. Characteristics, Etiological Factors, and Visual Outcomes of Pediatric Open Globe Injuries in Central Saudi Arabia: A 22-Year Retrospective Study. Clin Ophthalmol 2023; 17:2909-2917. [PMID: 37818287 PMCID: PMC10561276 DOI: 10.2147/opth.s430394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 09/25/2023] [Indexed: 10/12/2023] Open
Abstract
Purpose To discuss the characteristics, etiological factors, and visual outcomes of open globe injuries (OGIs) in children at a tertiary eye hospital in Riyadh, Central Saudi Arabia. Methods This was a hospital-based cohort study conducted in 2021. Children aged ≤16 years with OGI based on the Birmingham Eye Trauma Terminology classification were included. The age, gender, type, cause of OGI, and vision were recorded, as well as uncorrected and best corrected visual acuity (UCVA and BCVA, respectively). There was a change in the UCVA and BCVA one year after management. BCVA following management was linked to a variety of factors. Results There were 664 eyes with OGI. [median age 5.1, 461 (69.6%) boys]. UCVA at presentation was <20/400 in 525 (79%) of eyes with OGI. Injuries were mainly due to metallic objects in 195 (29.4%), glass in 102 (15.4%), and fireworks in 62 (9.4%). The Change in visual impairment grade in UCVA and BCVA after management compared to the initial presentation was significant (p < 0.001). Improvement of two lines of BCVA was noted in 345 (52%), no change in (<± 2 lines) 299 (45%) and deteriorated in 10 (1.5%). Conclusion OGI was identified as a leading cause of unilateral blindness. Children with OGIs who receive standard treatment have better outcomes. Many children could not achieve normal, functional vision despite the intervention of skilled care providers.
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Affiliation(s)
- Huda Al Ghadeer
- Emergency Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Rajiv Khandekar
- Research Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
- Department of Ophthalmology and Vision Sciences, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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Gervasio KA, Camarena J, Hampton J, Chopra N, Kalosza B, Shumate L, Wu AY. Demographic and socioeconomic disparities in receipt of ophthalmology consultation for facial trauma. BMJ Open Ophthalmol 2023; 8:e001259. [PMID: 37797981 PMCID: PMC10551933 DOI: 10.1136/bmjophth-2023-001259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 09/11/2023] [Indexed: 10/07/2023] Open
Abstract
OBJECTIVE Functional outcomes following facial and ocular trauma are time-sensitive and require prompt evaluation to minimise long-term vision loss, yet few studies have systematically evaluated disparities in the management of these cases. This study investigates whether a patient's race/ethnicity, primary language, insurance status, gender or age affects receipt of ophthalmology consultation for facial trauma. METHODS AND ANALYSIS This study was a retrospective cohort analysis of patients from the Elmhurst City Hospital Trauma Registry in Queens, New York who were seen for facial trauma including open globe injuries and orbital fractures between January 2014 and May 2016. RESULTS Of the 264 patients included, 43% reported as Hispanic, 23% white, 11% Asian, 8% black and 15% other/unknown. After controlling for confounding variables by multivariable logistic regression, neither race/ethnicity, gender, nor primary language were significantly associated with the likelihood of receiving an ophthalmology consult. However, patients with private insurance had 2.57 times greater odds of receiving an ophthalmology consultation than those with Medicaid or state corrections insurance (95% CI 1.37 to 4.95). As age increased, the likelihood of receiving an ophthalmology consultation decreased (p=0.009); patients 60 years of age and older had one-third the odds of ophthalmology consultation as younger patients (OR 0.33; 95% CI 0.16 to 0.68). CONCLUSIONS This study highlights that lack of ophthalmology consultation in patients with facial trauma is linked to age and underinsurance. Extra attention must be paid during primary assessments to ensure elderly patients and those with public insurance have equitable access to timely and appropriate care for facial trauma.
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Affiliation(s)
- Kalla A Gervasio
- Wills Eye Hospital, Philadelphia, Pennsylvania, USA
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Ophthalmology & Visual Sciences, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Joab Camarena
- Stanford University School of Medicine, Stanford, California, USA
| | - Jessica Hampton
- Stanford University School of Medicine, Stanford, California, USA
| | - Nitin Chopra
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Trauma Research, Emergency Department, Elmhurst Hospital Center, Elmhurst, Queens, New York, USA
| | - Brittany Kalosza
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Lauren Shumate
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Trauma Research, Emergency Department, Elmhurst Hospital Center, Elmhurst, Queens, New York, USA
| | - Albert Y Wu
- Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, California, USA
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Abousy M, Schilling A, Qiu M, Rajaii F, Li X, Woreta FA. Ophthalmology Resident Oculofacial Surgery Case Exposure: An ACGME Case Log Analysis. Ophthalmic Plast Reconstr Surg 2023; 39:187-193. [PMID: 36700839 DOI: 10.1097/iop.0000000000002301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE The authors quantified trends in resident oculofacial surgery exposure between 2009 and 2018, reviewed specific procedure volume, and correlated procedure volume with program characteristics. METHODS The authors requested de-identified case logs of residents graduating US ophthalmology residency programs in 2018 from all 118 programs. Current Procedural Terminology codes of all oculofacial procedures were analyzed. Current Procedural Terminology codes were grouped into 25 unique categories that the authors created in addition to the 11 Accreditation Council for Graduate Medical Education categories. RESULTS One hundred and sixty-six of 488 (34%) US ophthalmology residents graduating in 2018 provided case logs (32.2% of programs). According to Accreditation Council for Graduate Medical Education case logs, residents graduating in 2018 completed significantly fewer eye removal/implant procedures, lacrimal surgeries, "other orbital" procedures, entropion/ectropion repairs, and temporal artery biopsies as primary surgeon than residents graduating in 2009, yet significantly more eyelid laceration repairs, chalazion excisions, tarsorrhaphies, ptosis repairs, and blepharoplasty/reconstruction procedures ( p < 0.05). No difference was found between the total number of oculofacial cases between 2009 and 2018 ( p = 0.051). The most frequently logged procedure per resident in the sample was blepharoplasty/reconstruction (17.2 ± 15) followed by "other oculoplastic" (12.7 ± 10.6). The least commonly performed procedures included temporal artery biopsy (1.5 ± 2.2) and "other orbital" (1.9 ± 3.1). Program size, location, and presence of oculofacial fellowship program all impacted case volume. CONCLUSIONS Oculofacial surgery has the second highest case number requirement for residents per Accreditation Council for Graduate Medical Education guidelines. However, resident exposure to oculofacial surgery cases greatly varies in each ophthalmology residency program.
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Affiliation(s)
- Mya Abousy
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Andy Schilling
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Mary Qiu
- Department of Ophthalmology, University of Chicago Medicine, Chicago, Illinois, U.S.A
| | - Fatemeh Rajaii
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ximin Li
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Fasika A Woreta
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Pelletier J, Koyfman A, Long B. High risk and low prevalence diseases: Open globe injury. Am J Emerg Med 2023; 64:113-120. [PMID: 36516669 DOI: 10.1016/j.ajem.2022.11.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 11/20/2022] [Accepted: 11/29/2022] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Open globe injury (OGI) is a rare but serious condition that carries with it a high rate of morbidity. OBJECTIVE This review highlights the pearls and pitfalls of OGI, including presentation, diagnosis, and management in the emergency department (ED) based on current evidence. DISCUSSION OGI refers to full-thickness injury to the layers of the eye. OGI can be caused by blunt or sharp trauma, and subtypes include penetration, perforation, intraocular foreign body (IOFB), globe rupture, or mixed types. OGI is more common in males and usually secondary to work-related injury, but in women it is most commonly associated with falls. Emergency clinicians should first assess for and manage other critical, life-threatening injuries. Following this assessment, a thorough eye examination is necessary. Computed tomography (CT) may suggest the disease, but it cannot definitively exclude the diagnosis. While point-of-care ultrasound (POCUS) is highly sensitive and specific for some findings in OGI, its use is controversial due to potential globe content extrusion. Management includes protecting the affected eye from further injury, preventing Valsalva maneuvers that could extrude ocular contents, updating tetanus vaccination status, administering broad-spectrum antibiotics, and ophthalmology consultation for surgical intervention to prevent the sequelae of blindness and endophthalmitis. CONCLUSION An understanding of OGI can assist emergency clinicians in diagnosing and managing this sight-threatening traumatic process.
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Affiliation(s)
- Jessica Pelletier
- Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Alex Koyfman
- Department of Emergency Medicine, UT Southwestern, Dallas, TX, USA
| | - Brit Long
- SAUSHEC, Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, TX, USA.
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Porapaktham T, Choovuthayakorn J, Nanegrungsunk O, Phinyo P, Tanasombatkul K, Watanachai N, Kunavisarut P, Chaikitmongkol V, Patikulsila D. Open Globe Injury in a Tertiary Hospital of Northern Thailand: No Vision Survival and Ocular Trauma Score. Clin Ophthalmol 2023; 17:365-373. [PMID: 36721667 PMCID: PMC9884457 DOI: 10.2147/opth.s401643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 01/19/2023] [Indexed: 01/26/2023] Open
Abstract
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.
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Affiliation(s)
- Tuangprot Porapaktham
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Janejit Choovuthayakorn
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand,Correspondence: Janejit Choovuthayakorn, Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, 110 Intavaroros Road, Maung, Chiang Mai, 50200, Thailand, Tel +66 53 935512, Fax +66 53 936121, Email
| | - Onnisa Nanegrungsunk
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Phichayut Phinyo
- Clinical Epidemiology and Clinical Statistics Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand,Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand,Musculoskeletal Science and Translational Research (MSTR), Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Krittai Tanasombatkul
- Clinical Epidemiology and Clinical Statistics Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand,Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Nawat Watanachai
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Paradee Kunavisarut
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Voraporn Chaikitmongkol
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Direk Patikulsila
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Prognosis of Open Globe Injuries at a Tertiary Referral Center: The Modified Florida Ocular Trauma Score. Am J Ophthalmol 2022; 244:152-165. [PMID: 36007553 DOI: 10.1016/j.ajo.2022.08.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 08/10/2022] [Accepted: 08/12/2022] [Indexed: 01/30/2023]
Abstract
PURPOSE To analyze vision outcomes after open globe injury and propose modifications to the ocular trauma score to offer more specific vision prognoses. DESIGN Validity and reliability analysis. METHODS Patients presenting to the University of Florida with a new open globe injury from October 2015 to January 2021 with subsequent follow-up were included in the study. Demographics, ophthalmic history, trauma details, timeline, imaging, operative findings, and ocular examinations were collected from the medical record. Z tests, χ2 test, Fisher exact test, receiver operating characteristic curve, and ordinal correlation were used. A weighted logistic model was optimized to predict vision outcomes. Measured outcomes included the best-corrected visual acuity, Ocular Trauma Score category, and performance of vision prognosis scores. RESULTS A total of 162 eyes were identified from chart review. Eighty percent of the Ocular Trauma Score categories were accurate. Only the absence of orbital fractures was associated with a significant weight in the logistic model, which produced more accurate prognoses for 59 patients, and less accurate prognoses for 30 patients compared to the Ocular Trauma Score. Kendall Tau-B was 0.639 for the logistic model and 0.582 for the Ocular Trauma Score. CONCLUSIONS The Ocular Trauma Score accurately estimates vision prognosis after open globe injury. We propose inclusion of orbital fracture status in our Modified Florida Ocular Trauma Score. This addended score is more correlated with final vision outcome and provides more specific prognoses for severe open globe injuries. Prospective, multicenter validation is needed to refine and confirm the use of this new scoring system.
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Sen P, Kohli GM, Shah C, Mohan A, Tiwari A, Ingale R, Shenoy P, Sen A. Risk Factors for Development of Endophthalmitis after Open Globe Injury in Children: A Case-Control Study. Ocul Immunol Inflamm 2022; 30:1633-1638. [PMID: 34241557 DOI: 10.1080/09273948.2021.1928237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
AIM To identify risk-factors for developing endophthalmitis following open globe injury (OGI) in children. METHODS Retrospective, single-center, case-control study of children aged <18 years who sustained OGI. RESULTS Our cohort of 93 eyes consisted of 30 cases (Group A- endophthalmitis) and 63 controls (Group B- no endophthalmitis). Twenty-four eyes (80%) diagnosed with endophthalmitis presented after 24 hours of injury. The presence of central corneal zone-1 injuries (Odd ratio [OR]: 6.64, p= 0.001) and vitreous in wound (OR: 3.53) were associated with the risk of developing endophthalmitis. (p= < 0.05) Additionally the presence of iris prolapse (OR: 4.76) and posterior capsular rupture (PCR) (OR: 5.80) increased the risk of developing endophthalmitis.(p <0.05) . Streptococci was isolated in 15 eyes, Pseudomonas in 3 eyes, and Candida in 1 eye. The visual outcomes at three months were significantly worse in Group A (LogMAR 1.77±1.06) compared to Group B (LogMAR 0.65±0.68)(p<0.05). CONCLUSION Central corneal involvement, vitreous/ iris incarceration and PCR were important risk factors for development of PTE in children.
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Affiliation(s)
- Pradhnya Sen
- Department of Pediatric Ophthalmology and Strabismus, Sadguru Netra Chikitsalaya, Chitrakoot, India
| | - Gaurav Mohan Kohli
- Department of Vitre-retina and Uvea, Sadguru Netra Chikitsalaya, Chitrakoot, India
| | - Chintan Shah
- Department of Pediatric Ophthalmology and Strabismus, Sadguru Netra Chikitsalaya, Chitrakoot, India
| | - Amit Mohan
- Department of Pediatric Ophthalmology and Strabismus, Sadguru Netra Chikitsalaya, Chitrakoot, India
| | - Amrita Tiwari
- Department of Pediatric Ophthalmology and Strabismus, Sadguru Netra Chikitsalaya, Chitrakoot, India
| | - Rashmi Ingale
- Department of Pediatric Ophthalmology and Strabismus, Sadguru Netra Chikitsalaya, Chitrakoot, India
| | - Pratik Shenoy
- Department of Vitre-retina and Uvea, Sadguru Netra Chikitsalaya, Chitrakoot, India
| | - Alok Sen
- Department of Vitre-retina and Uvea, Sadguru Netra Chikitsalaya, Chitrakoot, India
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12
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The Predictive Value of Computed Tomography Findings for Poor Visual Outcome in Traumatic Eye Injury. J Ophthalmol 2022; 2022:4995185. [PMID: 36091574 PMCID: PMC9458393 DOI: 10.1155/2022/4995185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 07/15/2022] [Accepted: 07/28/2022] [Indexed: 11/17/2022] Open
Abstract
Background. The prognosis of visual outcome is important for patients and healthcare providers and guides proper decision-making in traumatic eye injury. In this study, we have evaluated the predictive value of computed tomography (CT) scan findings for poor visual outcomes in patients with traumatic eye injuries. Methods. In a retrospective survey, documents of 200 patients with traumatic eye injury who underwent a diagnostic orbital CT scan were reviewed. Disorganized or collapsed globe, intraocular foreign body or gas, increased or decreased anterior chamber size, hemorrhage in the anterior or posterior chamber, crystalline or intraocular lens dislocation, posterior sclera thickening, globe borders haziness, orbital fracture, orbital hemorrhage, and foreign body, optic canal, and optic nerve injuries are the diagnostic clues for eye injury in CT scan. The predictive value of CT scan findings for poor visual outcome was calculated by sensitivity, specificity, accuracy, predictive values, hazard ratios, and binary logistic regression model. Results. The sensitivity, specificity, accuracy, and positive predictive values showed to be high. However, there was a low negative predictive value of CT findings for the prediction of poor vision. Among the investigated factors, disorganized/collapsed globe (HR 47.72, CI 6.13–371.62), increased/decreased anterior chamber size (HR 5.04, CI 2.57–9.88), hemorrhage in anterior/posterior chamber (HR 3.58, CI 1.900–6.774/3.62, CI 1.90–6.89), globe borders haziness (HR 3.06, CI 1.33–7.01), orbital foreign body (HR 3.66, CI 1.11–12.05), and optic canal/nerve injury (HR 21.62, CI 4.73–98.78) reached the statistical significance for increasing the hazard ratio for poor visual outcome in patients with a traumatic eye injury. Logistic regression analysis showed only evidence for disorganized/collapsed globe and optic canal/nerve injury in orbital CT scan as independent predictive factors for poor visual outcome. Conclusion. CT scan findings can be used as prognostic factors for visual outcomes in patients with a traumatic eye injury.
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13
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Zhou Y, DiSclafani M, Jeang L, Shah AA. Open Globe Injuries: Review of Evaluation, Management, and Surgical Pearls. Clin Ophthalmol 2022; 16:2545-2559. [PMID: 35983163 PMCID: PMC9379121 DOI: 10.2147/opth.s372011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 07/22/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Yujia Zhou
- Department of Ophthalmology, University of Florida College of Medicine, Gainesville, FL, USA
- Correspondence: Yujia Zhou, Department of Ophthalmology, University of Florida College of Medicine, 1600 SW Archer Road, Gainesville, FL, 32608, USA, Tel +1 305 342-9166, Email
| | - Mark DiSclafani
- Department of Ophthalmology, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Lauren Jeang
- Department of Ophthalmology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Ankit A Shah
- Department of Ophthalmology, University of Florida College of Medicine, Gainesville, FL, USA
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14
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Shah S, Shah M, Gunay R, Kataria A, Makhloga S, Vaghela M. New model for the prediction of visual outcomes in young children with mechanical ocular conditions and comparison with other models. Indian J Ophthalmol 2022; 70:3045-3049. [PMID: 35918970 DOI: 10.4103/ijo.ijo_3144_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Purpose Herein, we compared the efficacy among the Ocular Trauma Score (OTS), Toddlers Ocular Trauma Score (TOTS), and Pediatric Ocular Trauma Score (POTS) for prognosis prediction in Indian children who had mechanical ocular conditions causing traumatic cataract. Methods This prospective, interventional study recruited consecutive children undergoing operation for traumatic cataracts caused by mechanical eye injuries at Drashti Netralaya. The following details were obtained from their medical files: the circumstance and time of injuries, penetrating injury type, initial and final visual acuity (VA), time of operation, and associated eye diseases. Specific variables were employed to determine the OTS, TOTS, and POTS. For all patients, the final and predicted VA determined using all scores were compared using Fischer's exact test. Accuracy, specificity, and sensitivity were evaluated for all the scores by using the area under receiver operating characteristic curve. Results We enrolled 124 eyes. Patients' mean value for age was 4.6 ± 1.29 years; 44 (35.41%) and 74 (64.5%) were female and male patients, respectively. Visual outcomes significantly improved after operation, and the outcomes did not differ between closed- and open-globe injuries (P = 0.162). The actual and predicted VA did not exhibit a statistically significant difference among the three scores. TOTS and POTS were more suitable for evaluating low-risk injuries, whereas the OTS could more efficiently examine high-risk cases. Conclusion TOTS and POTS were more accurate than the OTS in VA prediction after operation in toddlers with traumatic cataracts caused by mechanical globe injury. TOTS and POTS were more suitable for evaluating low-risk injuries, whereas the OTS could more efficiently examine high-risk cases. All the examined scores can be helpful in estimating VA following treatment.
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Affiliation(s)
- Shreya Shah
- Vitreo Retina, Drashti Netralaya, Dahod, Gujarat, India
| | - Mehul Shah
- Vitreo Retina, Drashti Netralaya, Dahod, Gujarat, India
| | - Ruhi Gunay
- Vitreo Retina, Drashti Netralaya, Dahod, Gujarat, India
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15
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Baur ID, Mayer CS, Storr J, Khoramnia R. Traumatic iridodialysis and mydriasis: Surgical reconstruction of the iris-lens-diaphragm with an iris implant and Intraocular lens. Am J Ophthalmol Case Rep 2022; 26:101545. [PMID: 35514801 PMCID: PMC9062661 DOI: 10.1016/j.ajoc.2022.101545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 03/15/2022] [Accepted: 04/15/2022] [Indexed: 11/16/2022] Open
Abstract
Purpose We present the case of a severe golf related ocular injury that affected the anterior and posterior segment. Treatment included primary surgical closure of the traumatic wound and secondary reconstruction of the iris-lens-diaphragm to correct aphakia and traumatic mydriasis and iridodialysis. Observations A 62-year-old woman presented to our clinic with severe ocular contusion after she had been hit by a golf ball in the right eye. We observed iridodialysis, traumatic mydriasis and luxation of the crystalline lens into the vitreous body as well as Berlin's edema and retinal tears. The patient underwent primary surgical closure of the traumatic wound and, 6 months later, combined Intraocular lens (IOL) and Customflex ArtificialIris (AI, HumanOptics, Erlangen, Germany) implantation. Uncorrected distance visual acuity was hand movement after primary surgical closure of the traumatic wound. After secondary reconstruction of the iris-lens-diaphragm, corrected distance visual acuity was 0.30 logMAR. Subjective impairment from glare could effectively be reduced and the patient was very satisfied with the aesthetic result. Conclusions and Importance Combined AI and IOL implantation can successfully restore visual acuity and reduce sensitivity to glare while providing an excellent aesthetic result in patients with a history of severe blunt ocular trauma, even in cases with a poor visual acuity prognosis.
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16
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The clinical features and the factors affecting visual prognosis in pediatric open-globe ınjuries. Int Ophthalmol 2022; 42:3589-3600. [PMID: 35579769 DOI: 10.1007/s10792-022-02359-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 04/24/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE To investigate clinical features and factors affecting visual prognosis after pediatric open-globe injuries. METHODS Retrospective study of 223 children with open-globe injury was conducted. Children with final logMAR visual acuity (LVA) > 0.70 were determined as poor-vision group (group 1, n = 108) and those with final LVA ≤ 0.70 as good-vision group (group 2, n = 115). Demographic characteristics (age, gender, and damaged eye), time between trauma and surgery, ocular trauma score (OTS), follow-up time, injury size, initial and final visual acuity levels, injury type (penetrating injury, globe rupture, perforating injury, and intraocular foreign body injury), injury localization (zone 1 = within the corneal and/or limbal area, zone 2 = within the scleral area extending 5 mm back from the limbus, and zone 3 = within the area posterior to zone 2), injury cause [metal objects (fork, knife, needle), broken glass, blunt objects (ball, punch), pen-pencil, and unidentified objects], and accompanying ocular findings of the groups were detected, and comparisons were done. Additionally, effects of age, time between trauma and surgery, OTS, injury size, follow-up time, initial LVA, injury type, and injury zone on final LVA were analyzed in both groups. RESULTS Mean age was 9.1 ± 2.0 years. There were 151 males and 72 females. Compared to group 1, group 2 had better initial and final visions (1.21 ± 0.26 vs 0.60 ± 0.28, p < 0.001 for initial LVA; 1.00 ± 0.32 vs 0.30 ± 0.13, p < 0.001 for final LVA), greater OTS (1.72 ± 0.53 vs 3.73 ± 0.61, p = 0.025), and smaller injury size (10.4 ± 3.5 vs 5.8 ± 2.4 mm, p = 0.002). Globe rupture (p = 0.015) and relative afferent pupillary defect (RAPD) (p = 0.037) were higher in group 1, while penetrating injury (p = 0.044), zone 1 involvement (p = 0.038), and metal object injury (p = 0.041) were higher in group 2. Based on multivariate analysis, the presences of globe rupture (p = 0.024) and RAPD (p = 0.035), the involvement without zone 1 (p = 0.042), and the injury without metal object (fork, knife, needle) (p = 0.046) were associated with poor final vision. Final LVA (for group 1 and group 2) was negatively correlated with OTS (r = - 0.398, p = 0.037; r = - 0.369, p = 0.040), while positively correlated with injury size (r = 0.412, p = 0.031; r = 0.318, p = 0.046) and initial LVA (r = 0.335, p = 0.043; r = 0.402, p = 0.034). CONCLUSION In our study, poor prognostic factors affecting final vision were low OTS, poor initial vision, the presences of globe rupture and RAPD, the large injury size, the involvement without zone 1, and the injury without metal object (fork, knife, needle).
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17
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Coelho J, Ferreira A, Kuhn F, Meireles A. Globe ruptures: outcomes and prognostic analysis of severe ocular trauma. Ophthalmologica 2022; 245:376-384. [PMID: 35196665 DOI: 10.1159/000523705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 02/16/2022] [Indexed: 11/19/2022]
Abstract
PURPOSE Eye trauma is an important causes of monocular visual loss worldwide. This study aimed to describe the structural and functional characteristics and outcomes of 281 globe ruptures. METHODS Medical records of all patients undergoing surgery for a ruptured globe at Centro Hospitalar Universitário do Porto in the last 17 years were retrospectively reviewed. RESULTS Two hundred and eighty-one eyes of 277 patients were included. The majority of them were males (71%) with a mean age of 59.7±20.5. In 38.8% of the cases the cause was a fall. At the time of admission, 29.5% of the eyes had a visual acuity greater than 20/200 and 12.5% had no light perception. The median time between trauma and primary repair was less than 8h (interquartile range 5-12 h). A primary reconstruction was always attempted. Primary evisceration was performed in 14 cases (5%). In multivariable analysis, independent predictors of vision survival were male gender, shorter wound size and absence of vitreous hemorrhage. CONCLUSION In this large, retrospective study on globe ruptures we identified male gender, short wound length, and the absence of vitreous hemorrhage or retinal detachment as predictors of improved functional outcome. We found a correlation between the presenting and final visual acuities and the Ocular Trauma Score. Our determination to reconstruct the traumatized eyes as early and as completely as possible was justified by the functional results: despite the severity of the injuries, one out of four eyes reached a final visual acuity greater than 20/200.
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Affiliation(s)
- João Coelho
- Service of Ophthalmology, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - André Ferreira
- Service of Ophthalmology, Centro Hospitalar Universitário do Porto, Porto, Portugal,
- Unit of Anatomy, Department of Biomedicine, Faculty of Medicine of University of Porto, Porto, Portugal,
| | - Ferenc Kuhn
- Helen Keller Foundation for Research and Education, Birmingham, Alabama, USA
- Department of Ophthalmology, University of Pécs Medical School, Pécs, Hungary
| | - Angelina Meireles
- Service of Ophthalmology, Centro Hospitalar Universitário do Porto, Porto, Portugal
- Department of Ophthalmology, Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Porto, Portugal
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18
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He B, Tanya SM, Wang C, Kezouh A, Torun N, Ing E. The Incidence of Sympathetic Ophthalmia After Trauma: A Meta-analysis. Am J Ophthalmol 2022; 234:117-125. [PMID: 34283983 DOI: 10.1016/j.ajo.2021.06.036] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 06/10/2021] [Accepted: 06/29/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Sympathetic ophthalmia (SO) is a rare, bilateral panuveitis that occurs following open globe injury (OGI), with a variable incidence reported in the literature. Our objective was to determine the incidence proportion and incidence rate of SO following OGI to help guide shared physician-patient decision making. DESIGN Systematic review and meta-analysis. METHODS A systematic literature search was performed using the MEDLINE, EMBASE, and Cochrane databases from inception to November 2020 for population-based studies on OGI and SO in adults and children. Two reviewers independently screened search results. Random-effects meta-analyses were performed to calculate the incidence proportion and incidence rate. The Risk Of Bias In Non-Randomized Studies - of Interventions (ROBINS-I) tool was used to assess the risk of bias. The study was registered on PROSPERO CRD42020198920. RESULTS A total of 24 studies were utilized in the meta-analyses. After OGI, the estimated overall incidence proportion of SO was 0.19% (95% CI 0.14%-0.24%) and the incidence rate of SO was 33 per 100,000 person-years, (95% CI 19.61-56.64) with I2 of 13% and 72%, respectively. CONCLUSIONS SO after OGI is rare. The estimated incidence proportion and incidence rate are useful when counselling patients regarding management options after OGI. Further studies are needed to examine the influence of age, the extent and location of trauma, timing of repair, and prophylactic eye removal on the incidence of SO.
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Affiliation(s)
- Bonnie He
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada (B.H.)
| | - Stuti M Tanya
- Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada (S.M.T.)
| | - Chao Wang
- Faculty of Health, Social Care and Education, Kingston University London, London, England (C.W.)
| | - Abbas Kezouh
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada (A.K.)
| | - Nurhan Torun
- Department of Ophthalmology, Harvard University, Cambridge, Massachusetts, United States of America (N.T.)
| | - Edsel Ing
- Department of Ophthalmology and Visual Sciences, University of Toronto, Toronto, Ontario, Canada (E.I.).
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19
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Placide J, Ip CS, Le BHA, Ali SF, Ghergherehchi LM. An Update on the Management of Traumatic Pediatric Open Globe Repair: Prognostication and Complication Management. Int Ophthalmol Clin 2022; 62:203-218. [PMID: 34965235 DOI: 10.1097/iio.0000000000000399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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20
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Khatri A, Shrestha SM, Kuhn F, Subramanian P, Hoskin AK, Pradhan E, Agrawal R. Ophthalmic Trauma Correlation Matrix (OTCM): a potential novel tool for evaluation of concomitant ocular tissue damage in open globe injuries. Graefes Arch Clin Exp Ophthalmol 2021; 260:1773-1778. [PMID: 34792638 DOI: 10.1007/s00417-021-05491-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 10/29/2021] [Accepted: 11/04/2021] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To introduce a novel tool to investigate the correlation between concomitant injuries and primary open globe injury (OGI) in the setting of ophthalmic trauma, the "Ophthalmic Trauma Correlation Matrix" (OTCM). METHODS Retrospective cohort review, performed at a tertiary referral eye care center in Eastern Nepal, involving all eyes with OGI meeting the inclusion criteria from 2015-2018. Clinical data including details of primary injury, concurrent injuries, and clinical course were noted from hospital medical records. A correlation matrix chart was devised using matrix correlation and Pearson's correlation coefficient. This chart was then used to evaluate the association of the various injuries in the setting of OGI. RESULTS A total of 109 eyes with OGI were included. Majority of the eyes (78, 71.6%) had zone I injuries, while most of the eyes (66, 60.6%) had penetrating injury. The most frequent concomitant injuries in all zones of OGI were traumatic lens injury (77, 70.64%), followed by hyphema (48, 44.03%), and vitreous hemorrhage (35, 32.11%). The most common concomitant injury associated with zone I was hyphema (0.873), while traumatic subluxation/cataract (0.894) and vitreous hemorrhage (0.972) were commonly associated with zone II and III, respectively. CONCLUSIONS OTCM could be a useful tool to manage injuries related to the primary ocular injury. This additional information will aid in the prognostication, planning, and management of OGI and potentially prevent repeat surgeries and inadequate treatments.
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Affiliation(s)
- Anadi Khatri
- Department of Vitreoretinal Services, Birat Eye Hospital, Biratnagar, Nepal. .,Department of Ophthalmology, Birat Medical College and Teaching Hospital, Biratnagar, Nepal.
| | | | - Ferenc Kuhn
- Helen Keller Foundation for Research and Education, Birmingham, USA.,Department of Ophthalmology, University of Pécs Medical School, Pécs, Hungary.,International Society of Ocular Trauma, Birmingham, USA
| | - Prem Subramanian
- Colorado School of Medicine, Aurora, CO, USA.,Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Annette K Hoskin
- Save Sight Institute, University of Sydney, Sydney, Australia.,Lions Eye Institute, University of Western Australia, Perth, Australia
| | - Eli Pradhan
- Tilganga Institute of Ophthalmology, Kathmandu, Nepal
| | - Rupesh Agrawal
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore.,Singapore Eye Research Institute, Singapore, Singapore.,Moorfields Eye Hospital, NHS Foundation Trust, London, UK
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21
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Dulz S, Dimopoulos V, Katz T, Kromer R, Bigdon E, Spitzer MS, Skevas C. Reliability of the ocular trauma score for the predictability of traumatic and post-traumatic retinal detachment after open globe injury. Int J Ophthalmol 2021; 14:1589-1594. [PMID: 34667737 DOI: 10.18240/ijo.2021.10.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 04/30/2021] [Indexed: 11/23/2022] Open
Abstract
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.
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Affiliation(s)
- Simon Dulz
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Vasilis Dimopoulos
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
| | | | - Robert Kromer
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Eileen Bigdon
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Martin Stephan Spitzer
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Christos Skevas
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
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22
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Qin ZX, He Y, Xu YF, Yu T, Liu Y, Wu N. Pediatric ocular trauma with pars plana vitrectomy in Southwest of China: clinical characteristics and outcomes. Int J Ophthalmol 2021; 14:1321-1326. [PMID: 34540606 DOI: 10.18240/ijo.2021.09.05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 02/19/2021] [Indexed: 11/23/2022] Open
Abstract
AIM To investigate the clinical characteristics and predictive factors of pediatric ocular trauma patients with vitrectomy. METHODS Pediatric ocular trauma patients (aged 14y or younger) who received vitrectomy in Southwest Hospital between January 2007 and December 2017 were reviewed retrospectively. Age, gender, mechanism of injury, final visual acuity (VA), and prognostic factors were analyzed. RESULTS A total of 139 eyes in 139 pediatric patients were included in the study. The mean age was 7.4±3.7 years old and the male-to-female ratio was 5:1. There were 104 (74.8%) open globe injuries and 35 (25.2%) closed globe injuries. The top one traumatic eye injuries were penetrating injuries occur through sharp metal objects (43.9%). After vitrectomy, 116 patients had favorable anatomic outcome at the last follow-up, and 30 eyes (21.6%) achieved VA of 20/200 or better. Following univariate analysis, we found zone III injuries (P=0.021), poor initial VA (P=0.005), endophthalmitis (P=0.024), and recurrent retinal detachment (P<0.001) were poor prognostic factors for pediatric ocular trauma. After Logistic regression analysis, the poor initial VA (odds ratio: 8.276, 95%CI: 1.597-42.897, P=0.012) and recurrent retinal detachment (odds ratio: 6.455, 95%CI: 2.372-17.562, P<0.001) were significantly correlated with unfavorable vision outcome in pediatric ocular trauma. CONCLUSION The treatment of vitrectomy for severe ocular trauma results in favorable anatomic outcomes, but VA improvement is not as good as anatomic outcomes. Initial VA and recurrent retinal detachment are the independent prognostic indicators for unfavorable visual outcome of severe pediatric ocular trauma.
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Affiliation(s)
- Zuo-Xin Qin
- Southwest Hospital/Southwest Eye Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China.,Key Lab of Visual Damage and Regeneration & Restoration of Chongqing, Chongqing 400038, China
| | - Yan He
- Southwest Hospital/Southwest Eye Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China.,Key Lab of Visual Damage and Regeneration & Restoration of Chongqing, Chongqing 400038, China
| | - Yu-Fei Xu
- Southwest Hospital/Southwest Eye Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China.,Key Lab of Visual Damage and Regeneration & Restoration of Chongqing, Chongqing 400038, China
| | - Tao Yu
- Southwest Hospital/Southwest Eye Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China.,Key Lab of Visual Damage and Regeneration & Restoration of Chongqing, Chongqing 400038, China
| | - Yong Liu
- Southwest Hospital/Southwest Eye Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China.,Key Lab of Visual Damage and Regeneration & Restoration of Chongqing, Chongqing 400038, China
| | - Nan Wu
- Southwest Hospital/Southwest Eye Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China.,Key Lab of Visual Damage and Regeneration & Restoration of Chongqing, Chongqing 400038, China
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23
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Khatatbeh AE, Othman E, Alalawneh AM, Khraisat HA, Alawneh S, Ahmed M, Abbas K. Changes of Patterns and Outcomes of Ocular and Facial Trauma Among Children in Jordan. Cureus 2021; 13:e16833. [PMID: 34513423 PMCID: PMC8409692 DOI: 10.7759/cureus.16833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction The eye is the second most common organ affected by trauma after hands and feet. Eye trauma is a common cause of visual morbidity and may result in irreversible visual impairment and blindness. Ocular and facial trauma contribute to significant proportions of visual deficits among young children. This study aimed to explore the changes in trend including the pattern and outcomes of ocular and facial trauma among children between the last twenty years. Methodology A retrospective study was conducted between January 2020 and April 2021. The medical records of the patients who attended the Royal Medical Services (RMS) military hospital between January 1999 and December 2019 suffering from eye trauma which required hospitalization were enrolled in the study and reviewed regarding age, gender, mechanism of trauma, the severity of the trauma, eye structures involved, and visual outcome. The patients were divided into three groups based on the time of trauma: Group A for injuries in the period (January 1, 1999 to December 31, 2005), Group B for the period (January 1, 2006 to December 31, 2012), and Group C for the period (January 1, 2013 to December 31, 2019). The collected data was analyzed and compared to explore whether there is any change in the pattern and visual morbidity of eye injuries over time. The most frequent finding of eye injury was corneal wound in Groups A and B patients, while in Group C the most common ocular injury was ecchymosis or sub-conjunctival hemorrhage. Results Three-thousand one-hundred and thirty only patients (3130 eyes) aged between 2 and 14 years (mean 7.11 ± 3.13) were included in the study. The male to female ratio was 2:1. 1864 patients (56.6%) were at five years of age or younger. The most common place of injury in the three groups was on the street. This ratio decreased from 64.0% in Group A to 48.8% in Group C. Stone was the commonest etiology of injury in Group A (38.0%) while wood and fall were the commonest in Group B (28.5%) and Group C (37.1%) respectively. Open globe injuries constituted 67.0% of patients in Group A, 64.7% of patients in Group B, and 51.2% of patients in Group C. Normal or mild visual impairment was noted in patients of Group C (43.9%) as compared to the patients in Groups A (7.5%) and B (8.3%) at presentation. The final vision of normal or mild visual impairment was reported in 37.1%, 38.5%, and 77.5% of patients in Groups A, B, and C respectively. Conclusion The current study is a retrospective analysis of twenty years in Jordan and has comprehensively explored the trends and patient outcomes with respect to ocular and facial trauma among children. We revealed that over time, such injuries became less frequent and less serious than before with better patient outcomes. Furthermore, higher rates of closed globe injuries were reported in recent years. There was a dramatic increase in the rate of indoor injuries compared with outdoor ones which were mostly caused by falls with better initial and final visual outcomes. These injuries are preventable with the implementation of adequate safety measures which would significantly reduce the burden of visual impairment and cosmetic disfigurement among youngsters.
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Affiliation(s)
| | - Enas Othman
- Dentistry, King Hussein Medical Center, Amman, JOR
| | - Ali M Alalawneh
- Medicine, Queen Rania Al Abdullah Hospital for Children, Amman, JOR
| | - Hiba A Khraisat
- Ophthalmology, Queen Rania Al Abdullah Hospital for Children, Amman, JOR
| | - Samer Alawneh
- Ophthalmology, King Hussein Medical Center, Amman, JOR
| | - Moiz Ahmed
- Medicine, Jinnah Postgraduate Medical Centre, Karachi, PAK.,Medicine and Surgery, Sindh Medical College, Karachi, PAK
| | - Kiran Abbas
- Medicine, Jinnah Postgraduate Medical Centre, Karachi, PAK
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Lee BWH, Hunter D, Robaei DS, Samarawickrama C. Open globe injuries: Epidemiology, visual and surgical predictive variables, prognostic models, and economic cost analysis. Clin Exp Ophthalmol 2021; 49:336-346. [PMID: 33982383 DOI: 10.1111/ceo.13944] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 05/03/2021] [Accepted: 05/07/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Open globe injuries (OGI) represent a visually and economically devastating cause of vision loss. We examined the epidemiology, predictive variables, prognostic models, and economic cost of surgically managed OGI. METHODS A retrospective tertiary centre study from 2008 to 2018 of 155 consecutive OGI in individuals aged 16 and older was performed. Medical records review, application of Ocular Trauma Score (OTS) and Classification and Regression Tree Analysis (CART) and cost analysis were undertaken. Key outcomes measured were visual acuity, number of operating theatre visits, prognostication using OTS and CART and estimated costs. RESULTS Younger males at work with inadequate protective eyewear (89.1%) and falls in the elderly were overrepresented. Inferior visual outcomes were associated with a more severe OTS score, a larger injury zone, increasing age, the presence of retinal detachment, extraocular muscle involvement, intraocular foreign body, and globe rupture (R2 = 0.723, p < 0.001). Multiple operating theatre visits were required in the presence of retinal detachment, lens or orbit involvement, work-related injury, globe rupture, and a history of previous intraocular surgery (R2 = 0.0423, p < 0.001). Both OTS and CART prognosticated outcomes (p < 0.001). The OTS predicted for no vision (no light perception/enucleation/evisceration) and profound visual loss (worse than 6/120; specificity: both 100%, sensitivity: 88.2% and 88%) whereas the CART predicted for visual survival (light perception or better) and minimal-to-severe visual loss (6/120 or better; specificity: 88.5% and 81.7% , sensitivity: 97.7% and 100%). Estimated annual OGI cost for Australia was AUD48.1-60.5 million (USD37.3-47.0 million). CONCLUSIONS The total cost of OGI is immense with young males and the elderly being disproportionately affected. Implementation of targeted government legislation and public health preventative measures may be cost-effective in ameliorating the significant burden.
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Affiliation(s)
- Brendon W H Lee
- University of Sydney School of Medicine, Sydney, Australia.,Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Damien Hunter
- Westmead Institute for Medical Research, Sydney, Australia
| | - Dana S Robaei
- University of Sydney School of Medicine, Sydney, Australia
| | - Chameen Samarawickrama
- University of Sydney School of Medicine, Sydney, Australia.,Faculty of Medicine, University of New South Wales, Sydney, Australia.,Westmead Institute for Medical Research, Sydney, Australia
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Prognostic factors and epidemiology of adult open globe injuries from Western Sydney: a twelve-year review. BMC Ophthalmol 2021; 21:173. [PMID: 33838650 PMCID: PMC8037828 DOI: 10.1186/s12886-021-01929-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 03/29/2021] [Indexed: 12/02/2022] Open
Abstract
Background To identify prognostic factors determining final visual outcome following open globe injuries. Methods Retrospective case series of patients presenting to Westmead Hospital, Sydney, Australia with open globe injuries from 1st January 2005 to 31st December 2017. Data collected included demographic information, ocular injury details, management and initial and final visual acuities. Results A total of 104 cases were identified. Predictors of poor final visual outcomes included poor presenting visual acuity (p < 0.001), globe rupture (p < 0.001), retinal detachment (p < 0.001), Zone III wounds (p < 0.001), hyphema (p = 0.003), lens expulsion (p = 0.003) and vitreous hemorrhage (p < 0.001). Multivariate analysis demonstrated presenting visual acuity (p < 0.001), globe rupture (p = 0.013) and retinal detachment (p = 0.011) as being statistically significant for predicting poor visual outcomes. The presence of lid laceration (p = 0.197) and uveal prolapse (p = 0.667) were not significantly associated with the final visual acuity. Conclusions Poor presenting visual acuity, globe rupture and retinal detachment are the most important prognostic factors determining final visual acuity following open globe injury.
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Shrestha SM, Anthony CL, Justin GA, Thapa M, Shrestha JB, Khatri A, Hoskin AK, Agrawal R. Factors affecting final functional outcomes in open-globe injuries and use of ocular trauma score as a predictive tool in Nepalese population. BMC Ophthalmol 2021; 21:69. [PMID: 33541290 PMCID: PMC7860627 DOI: 10.1186/s12886-021-01819-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 01/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Open globe injury (OGI) is one of the most devastating form of ocular trauma. The aim of the study is to identify the epidemiology and predict visual outcomes in traumatic open globe injuries using ocular trauma score (OTS) and correlate with final visual acuity (VA) at 3 months. METHODS Patients older than 5 years, presenting to B.P. Koirala Lions Centre for Ophthalmic Studies (BPKLCOS) from March 2016- March 2017 with OGI that met inclusion criteria were evaluated. Patient profile, nature and cause of injury, and time to presentation were recorded. Patients were managed accordingly and followed up to 3 months. An OTS score for each patient was calculated and raw scores were categorized accordingly. The VA after 3 months were compared to the predicted OTS values. RESULTS Seventy-three eyes of 72 patients were examined. 76 % were male, and the mean age was 26.17 years (median, 23.5 years). The mean time from injury to presentation was < 6 hours (30 patients, 41 %). Thirty-seven eyes (51 %) had zone I trauma, followed by twenty eyes (27 %) with zone II, and sixteen eyes (22 %) with zone III trauma. Sixty-five patients (90 %) were managed surgically, and fifty (68 %) received intravitreal antibiotics with steroid. When compared, the projected VA as per OTS were able to predict actual final visual outcomes in 60 % of the eyes with OGI of various zones. CONCLUSIONS OTS can be an accurate predictive tool for final visual acuity even with a short follow up period of 3 months; with poor presenting visual acuity, delayed presentation, posterior zones of injury, need for intravitreal injections, endophthalmitis, and globe rupture associated with poorer prognosis.
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Affiliation(s)
- Saurav M Shrestha
- B.P. Koirala Lions Centre for Ophthalmic Studies, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal. .,Department of Vitreoretina, Mechi Eye Hospital, Birtamode, Nepal.
| | | | - Grant A Justin
- Department of Ophthalmology, Brooke Army Medical Center, San Antonio, TX, USA.,Department of Surgery, Uniformed Services University of the Health Science, Bethesda, MD, USA
| | - Madhu Thapa
- B.P. Koirala Lions Centre for Ophthalmic Studies, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Jyoti B Shrestha
- B.P. Koirala Lions Centre for Ophthalmic Studies, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Anadi Khatri
- Department of Vitreoretinal services, Birat Eye Hospital, Biratnagar, Nepal.,Department of Ophthalmology, Birat Medical College and Teaching Hospital, Biratngar, Nepal
| | - Annette K Hoskin
- Save Sight Institute, University of Sydney, Sydney, Australia.,Lions Eye Institute, University of Western Australia, Perth, Australia
| | - Rupesh Agrawal
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore.,Singapore Eye Research Institute, Singapore, Singapore.,Moorfields Eye Hospital, NHS Foundation Trust, London, UK
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Djalali-Talab Y, Mazinani B, Djalali-Talab Y. Traumatic open globe injury—epidemiology, risk factors and visual outcome at the University Hospital Aachen. SPEKTRUM DER AUGENHEILKUNDE 2021. [DOI: 10.1007/s00717-020-00480-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Summary
Background
Ocular trauma is still a major cause leading to enucleation. This study aims to analyze the visual outcome, epidemiology and risk factors of open globe injury (OGI) at the University Hospital Aachen, Germany.
Material and methods
A retrospective analysis of patient records involving traumatic OGI treated surgically between 2005 and 2015 was conducted. Age, gender, cause of accident, ocular trauma score, best corrected visual acuity (BCVA) at presentation and after treatment as well as location of injury were evaluated.
Results
Of 2272 eyes with trauma, 102 patients with OGI were identified, of which 65% were male and 35% were female. Women were significantly older than men (p < 0.001). The most common cause of injury was domestic syncopal episodes (47%). Work-related injuries occurred exclusively in men in 8.8%. A total of 16% had no light perception (NLP) at presentation, 69% of which improved post intervention to hand movement or better. Endophthalmitis was observed in 4% of all cases. Enucleation was needed mostly due to rupture. Location of OGI, pseudophakia and initial BCVA are risk factors for poor final BCVA. Patients’ BCVA did not improve further after three surgeries.
Conclusion
Traumatic OGI still poses a challenge in terms of treatment planning and prognostic outcome. A rise in elderly patients with multimorbidity represents a secondary obstacle to treatment. Patients with initial NLP can be treated with moderate success. Nevertheless, risk factors and ocular trauma score are unable to provide definitive therapy decisions. OGI should be assessed case by case, taking risk factors for OGI into account. Treating physicians should consider the ethical and economic reasons with regard to whether a high number of surgeries with possible comorbidities is justified.
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Park J, Yang SC, Choi HY. Epidemiology and Clinical Patterns of Ocular Trauma at a Level 1 Trauma Center in Korea. J Korean Med Sci 2021; 36:e5. [PMID: 33398942 PMCID: PMC7781856 DOI: 10.3346/jkms.2021.36.e5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 10/22/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND To evaluate the patterns of distribution and clinical manifestations of ocular injuries referred to the level 1 trauma center of Pusan National University Hospital (PNUH) in Korea. METHODS We analyzed 254 of 4,287 patients who were referred to the Department of Ophthalmology at the level 1 trauma center of the PNUH, from January 2016 through December 2018. Data on the incidence of ocular injuries, sex, age, monthly and seasonal distribution, day and time of injury, side of injury, cause, residence of patients, referral time to an ophthalmologist and subsequent examination time, final visual acuity (VA), and complications were obtained from medical records and retrospectively reviewed. The patients were grouped according to their main diagnosis using the Birmingham Eye Trauma Terminology System (BETTS) and Ocular Trauma Score (OTS). RESULTS The incidence of ocular injuries with major trauma was higher in men (n = 207, 81.5%), the median age at time of injury was 54 years, and Pusan recorded the most cases. The incidences of ocular injury were 1.47/100,000, 1.57/100,000, 1.48/100,000 in 2016, 2017 and 2018, respectively. The most common cause was by a motorbike accident, followed by a pedestrian traffic accident and falls. According to the BETTS classification, open-globe injuries represented 4% of cases, closed-globe injuries represented 12.6%, and other injuries represented 83.1%. Open-globe injuries were significantly associated with low final VA (P = 0.01). In the OTS, 79.4% of patients received 4 or 5 points and 13.7% of patients received 1 or 2 points. The patients who received 1 or 2 points in the OTS score showed final VA below hand movement (P < 0.001), except for two patients. Lid laceration and low initial VA were highly correlated with poor final VA (P < 0.001). CONCLUSION This is the first study on the epidemiology and clinical manifestations in trauma patients with ocular injuries at a level 1 trauma center. The incidences of ocular injuries with major trauma were about 1.47-1.57/100,000. BETTS, OTS, lid laceration and initial VA were associated with final VA. We expect our study to provide a basis of data for the evaluation, prevention, and management of ocular injuries in patients with systemic trauma.
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Affiliation(s)
- Jungyul Park
- Department of Ophthalmology, Pusan National University Hospital, Busan, Korea
- Biomedical Research Institute of Pusan National University Hospital, Busan, Korea
| | - Sang Cheol Yang
- Department of Ophthalmology, Pusan National University Hospital, Busan, Korea
- Biomedical Research Institute of Pusan National University Hospital, Busan, Korea
| | - Hee Young Choi
- Department of Ophthalmology, Pusan National University Hospital, Busan, Korea
- Biomedical Research Institute of Pusan National University Hospital, Busan, Korea
- Department of Ophthalmology, School of Medicine, Pusan National University, Busan, Korea.
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Pfister T, Bohnak C, Patel S. Wood-Related Open-Globe Injuries. JOURNAL OF VITREORETINAL DISEASES 2021; 5:7-14. [PMID: 37009584 PMCID: PMC9976041 DOI: 10.1177/2474126420946624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: This work evaluates the clinical characteristics, visual outcomes, and complications of patients treated for open-globe injuries (OGIs) caused by wooden objects. Methods: A retrospective review of medical records was conducted on patients presenting to a tertiary trauma center with an OGI between January 2005 and December 2017. Medical records were isolated for wounds caused by wooden objects. Patient demographics were recorded, with presenting visual acuity (VA), physical examination findings, and wound characteristics. After primary globe repair, secondary complications, need for additional surgery, and visual outcomes were noted until final examination. Main outcome measures were final VA and secondary complications. The Ocular Trauma Score (OTS) was computed and assessed for clinical relevance related to visual outcomes. Results: Thirty-two patients met the inclusion criteria, with 15 (47%) being injured by plant material. Thirty of the patients were men (94%). A large portion of patients presented with hand motion or worse vision (48%), and there were high rates of hyphema (59%), vitreous hemorrhage (31%), retinal detachment (28%), and endophthalmitis (9%). Two patients eventually required enucleation. At last follow-up, 19 patients achieved 20/100 VA or better (59.4%), which correlated with their OTS ( P < .001). Conclusions: Despite the high clinical severity of wood OGIs, the potential for visual recovery remains high. The OTS appropriately assesses the severity of injuries and the likely prognosis in this cohort of patients.
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Affiliation(s)
- Tyler Pfister
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Carisa Bohnak
- Vanderbilt University Medical Center, Department of Ophthalmology, Nashville, TN, USA
| | - Shriji Patel
- Vanderbilt University Medical Center, Department of Ophthalmology, Nashville, TN, USA
- Vanderbilt Eye Institute, Nashville, TN, USA
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Bourke L, Bourke E, Cullinane A, O'Connell E, Idrees Z. Clinical outcomes and epidemiology of intraocular foreign body injuries in Cork University Hospital, Ireland: an 11-year review. Ir J Med Sci 2020; 190:1225-1230. [PMID: 33230610 DOI: 10.1007/s11845-020-02443-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 11/18/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND/AIMS To describe the epidemiology, outcomes, and prognostic factors of intraocular foreign body (IOFB) injuries at a tertiary ophthalmic referral centre in Cork University Hospital, Ireland. METHODS A retrospective review of 23 eyes with IOFB that presented to Cork University Hospital (CUH) from January 2009 to December 2019 was performed. The mechanism and characteristics of IOFB injury were all noted. This data was collated and analysed to ascertain the epidemiology of IOFB injury in CUH and to describe the prognostic factors affecting visual outcome following IOFB injury. RESULTS There was a 100% male prevalence. The mean age was 37.4 years. The majority of IOFBs were metal in nature and were acquired by hammering, often while working and frequently in the absence of personal protective equipment (PPE). The route of entry for the IOFB was via the cornea in 70% of cases. Fifty-two percent of cases were clinically detectable and 43% of cases were only identifiable on CT (computed tomography) imaging. Eighty-seven percent of cases underwent surgery on the same day as presentation. There was no incidence (0%) of endophthalmitis. Seventeen percent of cases developed post-operative retinal detachment (RD). The mean pre-operative VA was 0.79 LogMAR (6/38 Snellen equivalent-SE) compared to a mean VA of 0.58 LogMAR (6/24 SE) following surgery. CONCLUSIONS This review provides important epidemiological data for IOFB injuries in Ireland. It also adds some useful information to the literature in relation to prognostic factors and lens status post IOFB injury.
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Affiliation(s)
- Liam Bourke
- Ophthalmology Department, Cork University Hospital, Wilton, Cork, T12DC4A, Ireland.
| | | | - Anthony Cullinane
- Ophthalmology Department, Cork University Hospital, Wilton, Cork, T12DC4A, Ireland
| | - Eamonn O'Connell
- Ophthalmology Department, Cork University Hospital, Wilton, Cork, T12DC4A, Ireland
| | - Zubair Idrees
- Ophthalmology Department, Cork University Hospital, Wilton, Cork, T12DC4A, Ireland
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Pahor D, Gracner T. Comparison of the Ocular Trauma Score and Pediatric Ocular Trauma Score as Two Prognostic Models in Pediatric Open Globe Injuries. Klin Monbl Augenheilkd 2020; 238:67-72. [PMID: 33036059 DOI: 10.1055/a-1194-5104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AIM To compare the ocular trauma score (OTS) and the pediatric ocular trauma score (POTS) as prognostic models of visual outcome after open globe injury in children during a period of 19 years. PATIENTS AND METHODS A retrospective study of 36 open globe injuries in 36 patients younger than 18 years was conducted from January 2000 to January 2019. For each case, OTS and POTS points were calculated. RESULTS Significant differences were observed in our patients using the two models regarding categories 1 to 4. One third of the cases were in categories 1 and 2 using the OTS model, and nearly 60% using the POTS model. Nearly 60% of our patients were in categories 3 and 4 using the OTS model and 30.6% using the POTS model. In category 5, no difference was observed between the two models. The comparison of distribution of the percentage of final visual acuity between OTS and POTS model in each category revealed a significant difference in category 1 in final visual acuity 20/40 or more (25 vs. 50%) as well as in final visual acuity 20/20 (0 vs. 30%). In category 2, final visual acuity was not significantly different in 20/40 or more between the two models; however, there was a significant difference in final visual acuity 20/20 - 12.5% in the OTS model and 45.5% in the POTS model. In category 3, significant differences were revealed between the two models. Using the OTS model, final visual acuity 20/40 or more was observed in more than 60% and using POTS model in 100%; final visual acuity 20/20 was observed in 36.3% using OTS model and in 50% using POTS model. In category 4 and 5, no differences were observed between OTS and POTS models. CONCLUSION Our study did not confirm the benefit of POTS. The distribution of our cases among OTS categories demonstrated a significant difference between the two models with more cases distributed in lower categories in POTS group. In the POTS group, the prognosis for final visual acuity was significantly better in the first three categories than in the OTS group, probably as a result of a lower calculation for POTS points. In our opinion, the OTS model is easier to use, has a higher prognostic accuracy, and should be further used in counselling of paediatric cases.
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Affiliation(s)
- Dusica Pahor
- Department of Ophthalmology, University Clinical Centre Maribor, Slovenia.,Department of Ophthalmology, Faculty of Medicine, University of Maribor, Slovenia
| | - Tomaz Gracner
- Department of Ophthalmology, University Clinical Centre Maribor, Slovenia
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Rodríguez Á, Peña S, Cavieres I, Vergara MJ, Pérez M, Campos M, Peredo D, Jorquera P, Palma R, Cortés D, López M, Morales S. Ocular trauma by kinetic impact projectiles during civil unrest in Chile. Eye (Lond) 2020; 35:1666-1672. [PMID: 32839560 PMCID: PMC7443815 DOI: 10.1038/s41433-020-01146-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 07/17/2020] [Accepted: 08/12/2020] [Indexed: 11/09/2022] Open
Abstract
Background The use of kinetic impact projectiles (KIPs) for crowd-control has increased worldwide. Despite having been created as non-lethal weapons, significant damage to several organs, including the eye, has been reported. In this study, we investigated cases of ocular trauma from KIPs during the civil unrest in Chile. To our knowledge, this is the largest case series recorded in international literature. Methods We included all patients who sought care or were referred to the Eye Trauma Unit, a national referral centre in Santiago, Chile, during the civil unrest from October 18 to November 30, 2019. We reviewed paper medical records and extracted data on suspected cause of trauma, type of trauma, visual acuity and sociodemographic data. Results We included 259 patients, out of which in 182 cases (70.5%) KIPs were the suspected cause. Cases by KIPs were predominantly male (86.6%), young (median age 26.3, interquartile range 22.0–31.4) and living in the Metropolitan Region. Eighty-nine patients (48.9%) had severe visual impairment or were blind at the first examination. The trauma was an open-globe injury in 20.3% of cases and 13 cases required evisceration of the ocular content. Compared to other causes of ocular trauma, KIPs were related to a more severe loss of visual acuity and a higher frequency of open-globe injuries. Conclusions The use of KIPs during a period of civil unrest in Chile resulted in severe ocular trauma, visual impairment and permanent disability. KIPs should be avoided as a method of crowd-control.
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Affiliation(s)
- Álvaro Rodríguez
- Eye Trauma Unit, Hospital del Salvador, University of Chile, Avenida Salvador 364, Santiago, Chile.
| | - Sebastián Peña
- Department of Public Health Solutions, Finnish Institute for Health and Welfare, Mannerheimintie 166, Helsinki, Finland.,Facultad de Medicina, University Diego Portales, Ejército 233, Santiago, Chile
| | - Isabel Cavieres
- Eye Trauma Unit, Hospital del Salvador, University of Chile, Avenida Salvador 364, Santiago, Chile
| | - María José Vergara
- Eye Trauma Unit, Hospital del Salvador, University of Chile, Avenida Salvador 364, Santiago, Chile
| | - Marcela Pérez
- Eye Trauma Unit, Hospital del Salvador, University of Chile, Avenida Salvador 364, Santiago, Chile
| | - Miguel Campos
- Eye Trauma Unit, Hospital del Salvador, University of Chile, Avenida Salvador 364, Santiago, Chile
| | - Daniel Peredo
- Eye Trauma Unit, Hospital del Salvador, University of Chile, Avenida Salvador 364, Santiago, Chile
| | - Patricio Jorquera
- Department of Mechanical Engineering, Faculty of Engineering, University of Chile, Blanco Encalada 2002, Santiago, Chile
| | - Rodrigo Palma
- Department of Mechanical Engineering, Faculty of Engineering, University of Chile, Blanco Encalada 2002, Santiago, Chile
| | - Dennis Cortés
- Department of Ophthalmology, Pontificia Universidad Católica de Chile, Avenida Vicuña Mackenna 4686, Santiago, Chile
| | - Mauricio López
- Eye Trauma Unit, Hospital del Salvador, University of Chile, Avenida Salvador 364, Santiago, Chile
| | - Sergio Morales
- Eye Trauma Unit, Hospital del Salvador, University of Chile, Avenida Salvador 364, Santiago, Chile
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Supreeyathitikul P, Chokesuwattanaskul S, Choovuthayakorn J, Patikulsila D, Watanachai N, Kunavisarut P, Chaikitmongkol V. Epidemiology and Outcomes Following Open Globe Injury in Agricultural Region, an 11-Year Experience. Ophthalmic Epidemiol 2020; 27:246-251. [PMID: 31994961 DOI: 10.1080/09286586.2020.1716381] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE To determine the characteristics and epidemiology of open globe injury (OGI) in a third referral centre over 11 years. METHODS The study was a retrospective observational study. The medical records of 978 OGI cases (a total of 998 eyes), admitted to Chiang Mai University Hospital, Thailand from January 2006 to December 2016, were reviewed. RESULTS The mean age (SD) of patients was 39.1 (17.5) years. Patients were predominantly male (867, 88.7%). The age with the highest incidence of injury ranged from 41 to 60 years, in both genders. Most injuries happened at the workplace (64.8%), with flying objects from electric grass trimmers (23.9%) being the major injury-related mechanism. Penetration injuries were found in 479 eyes (48.0%). In elderly group (aged >60 years), a higher proportion of a globe rupture injuries were observed (13.3%). In general, intraocular foreign body group presented with better initial visual acuity (VA) compared to other injury types (p< 0.001). In all types of injury, final VA was significantly improved after treatment. However, rupture and perforation globe injuries had significantly worse final VA outcomes, compared to penetration and intraocular foreign body injuries (p< 0.001). With multivariable regression analysis, poor initial VA (p< 0.001), type of injury (p= 0.028), positive relative afferent pupillary defect (RAPD) (p< 0.001), and endophthalmitis (p< 0.001) were associated with poor visual outcomes. CONCLUSIONS Work-related eye injury is a major cause of OGI. Poor initial VA, endophthalmitis, presence of RAPD, and rupture were the predictors for poor final visual outcomes.
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Affiliation(s)
| | | | - Janejit Choovuthayakorn
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University , Chiang Mai, Thailand
| | - Direk Patikulsila
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University , Chiang Mai, Thailand
| | - Nawat Watanachai
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University , Chiang Mai, Thailand
| | - Paradee Kunavisarut
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University , Chiang Mai, Thailand
| | - Voraporn Chaikitmongkol
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University , Chiang Mai, Thailand
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Eye injury and demographic parameters associated with poor visual outcome. J Fr Ophtalmol 2019; 42:864-873. [PMID: 31122763 DOI: 10.1016/j.jfo.2019.03.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 03/19/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Eye injuries can result in long-term disability, and healthcare providers need better tools to predict outcomes. Few prognostic models for poor visual acuity have been examined using variables usually present in very severe injuries, which creates a gap in prognosis. Therefore, a model associated with severe and less severe injuries is examined. METHODS Eye injuries hospitalized in Bosnia and Herzegovina from 2006 through 2014 were included. A total of 258 eye injuries met the inclusion criteria of being an acute mechanical, chemical or physical eye injury. Prognostic variables were grouped by patient characteristics, eye injury characteristics and eye injury diagnosis. Poor final visual acuity was the main outcome measure (vision less than 20/200). Multivariable regression analysis used stepwise selection to identify the strongest set of predictive variables. RESULTS Lens subluxation (95 % CI: 2.09-14.83), vitreous prolapse (95 % CI: 2.76-26.87), vitreous hemorrhage (95 % CI: 1.71-10.03), posterior segment intraocular foreign body (95 % CI: 1.19-39.09), and vitritis (95 % CI: 0.97-11.12) were significantly associated with poor final visual acuity. The predictive model identified the combination of age over 36, lens subluxation, vitreous prolapse and hemorrhage, vitritis, and macular hemorrhage as the combination most likely to have poor visual acuity. The final model resulted in a strong fit as measured by AIC, log likelihood, goodness-of-fit, and the c-statistic. CONCLUSIONS This model can be used in clinical practice to evaluate the severity and predict final visual acuity in both severe and less severe eye injuries. The model accounts for characteristics of the injury as well as the patient. Additional studies with larger samples could further verify this model.
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Ustaoglu M, Karapapak M, Tiryaki S, Dirim AB, Olgun A, Duzgun E, Sendul SY, Ozcan D, Guven D. Demographic characteristics and visual outcomes of open globe injuries in a tertiary hospital in Istanbul, Turkey. Eur J Trauma Emerg Surg 2018; 46:549-556. [DOI: 10.1007/s00068-018-1060-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 12/04/2018] [Indexed: 10/27/2022]
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Court JH, Lu LM, Wang N, McGhee CNJ. Visual and ocular morbidity in severe open-globe injuries presenting to a regional eye centre in New Zealand. Clin Exp Ophthalmol 2018; 47:469-477. [PMID: 30414237 DOI: 10.1111/ceo.13439] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 10/02/2018] [Accepted: 11/03/2018] [Indexed: 12/15/2022]
Abstract
IMPORTANCE Open-globe injuries (OGI) are a leading cause of monocular blindness world-wide with considerable cost to the individual and society. BACKGROUND To characterize the epidemiology, severity and outcomes of OGI treated at a major ophthalmology centre in New Zealand. DESIGN Retrospective study. PARTICIPANTS A total of 385 eyes of 381 patients over a 10-year period. METHODS Eligible patients were identified using diagnosis and surgery codes on hospital discharge summaries. Clinical notes were reviewed to determine patient demographics, injury details, treatments and outcomes. MAIN OUTCOME MEASURES Complications of injury, visual acuity at 3 months and final follow-up, and final status of the eye. RESULTS The estimated annual incidence of OGI was 2.8 per 100 000. Working-age males predominated but age at injury ranged from 9 months to 90 years. Maori and Pacific peoples were over-represented. Injuries were severe with 58.7% presenting with vision of hand movements or worse. Penetrating injuries (56.4%) were most common, followed by globe ruptures (35.6%). Major complications included retinal detachment (15.8%), enucleation/evisceration (9.1%), phthisis bulbi (9.9%), endophthalmitis (2.6%) and sympathetic ophthalmia (0.26%). Despite the injury severity, 46% of eyes achieved final BCVA of ≥6/12. The Ocular Trauma Score (OTS) was a useful prognostic tool for stratifying severity of injury and predicting visual outcome (Fisher's exact test P < 0.001). CONCLUSIONS AND RELEVANCE The incidence and severity of OGI in NZ are comparable to global statistics. Surgical repair can effectively recover vision, predicted well by the OTS. We identified at-risk groups to target with education and prevention strategies.
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Affiliation(s)
- Jennifer H Court
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.,Department of Ophthalmology, Greenlane Clinical Centre, Auckland District Health Board, Auckland, New Zealand
| | - Lucy M Lu
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.,Department of Ophthalmology, Greenlane Clinical Centre, Auckland District Health Board, Auckland, New Zealand
| | - Nancy Wang
- Department of Ophthalmology, Greenlane Clinical Centre, Auckland District Health Board, Auckland, New Zealand
| | - Charles N J McGhee
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.,Department of Ophthalmology, Greenlane Clinical Centre, Auckland District Health Board, Auckland, New Zealand
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Okamoto Y, Morikawa S, Okamoto F, Inomoto N, Ishikawa H, Ueda T, Sakamoto T, Sugitani K, Oshika T. Clinical characteristics and outcomes of open globe injuries in Japan. Jpn J Ophthalmol 2018; 63:109-118. [PMID: 30406930 DOI: 10.1007/s10384-018-0638-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Accepted: 10/22/2018] [Indexed: 12/31/2022]
Abstract
PURPOSE To describe the epidemiology and clinical outcomes of open globe injuries (OGIs) in Japan over 10 years, and examine preoperative factors influencing the visual prognosis after surgery. STUDY DESIGN Retrospective, observational, multicenter case-series study. METHODS Patients' data were entered into a computerized database for review and statistical analyses. The following parameters were assessed; age, gender, initial and final visual acuity, duration between onset and surgery, presence of lens in the eye, characteristics of injury, presence of ocular complications, and number of surgeries. RESULTS The records of 374 eyes with OGI were enrolled. The average age of the patients was 56.8 ± 22.1 years, and the majority of patients were men (73.5%). Compared to the overall cohort, work-related OGI was the most common, associated with significantly better final visual acuity, whereas patients with fall-down OGI showed significantly worse final visual acuity (P < 0.05). Among the types of injury, both the initial and final visual acuity were significantly worse in the rupture group than in the laceration group. Multiple liner regression analyses revealed that the final visual acuity was significantly associated with initial visual acuity, type of injury (rupture), retinal detachment, and proliferative vitreoretinopathy. CONCLUSION To predict the visual outcome in patients with OGI, ophthalmologists need to pay attention not only to the initial visual acuity but also to initial ocular conditions, such as the presence of ocular complications.
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Affiliation(s)
- Yoshifumi Okamoto
- Department of Ophthalmology, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, Ibaraki, 305-8575, Japan. .,Department of Ophthalmology, Mito Kyodo General Hospital, Mito, Ibaraki, Japan. .,Japan-Clinical Research of Study (J-CREST) Group, Tokyo, Japan.
| | - Shohei Morikawa
- Department of Ophthalmology, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, Ibaraki, 305-8575, Japan.,Japan-Clinical Research of Study (J-CREST) Group, Tokyo, Japan
| | - Fumiki Okamoto
- Department of Ophthalmology, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, Ibaraki, 305-8575, Japan.,Japan-Clinical Research of Study (J-CREST) Group, Tokyo, Japan
| | - Naoki Inomoto
- Department of Ophthalmology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan.,Japan-Clinical Research of Study (J-CREST) Group, Tokyo, Japan
| | - Hiroto Ishikawa
- Department of Ophthalmology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan.,Japan-Clinical Research of Study (J-CREST) Group, Tokyo, Japan
| | - Tetsuo Ueda
- Department of Ophthalmology, Nara Medical University, Kashihara, Nara, Japan.,Japan-Clinical Research of Study (J-CREST) Group, Tokyo, Japan
| | - Taiji Sakamoto
- Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Sakuragaoka, Kagoshima, Japan.,Japan-Clinical Research of Study (J-CREST) Group, Tokyo, Japan
| | - Kazuhiko Sugitani
- Department of Ophthalmology and Visual Science, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.,Japan-Clinical Research of Study (J-CREST) Group, Tokyo, Japan
| | - Tetsuro Oshika
- Department of Ophthalmology, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, Ibaraki, 305-8575, Japan.,Japan-Clinical Research of Study (J-CREST) Group, Tokyo, Japan
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Clinical Features and Surgical Outcomes of Posterior Segment Intraocular Foreign Bodies in Children in East China. J Ophthalmol 2018; 2018:5861043. [PMID: 30046460 PMCID: PMC6036811 DOI: 10.1155/2018/5861043] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 04/11/2018] [Indexed: 11/18/2022] Open
Abstract
Purpose To report the long-term follow-up results of posterior segment intraocular foreign body (IOFB) removal in children and to determine the prognostic factors for visual outcome. Methods Design: retrospective, noncomparative, interventional case series; a single tertiary care center study. Participants or samples: eleven eyes (11 patients) under 16 years of age with posterior segment IOFB injuries from May 2014 to November 2017. Main outcome measures: clinical features of injury, visual acuity, and complications. Results The mean age was 6.8 years, and the mean follow-up was 20.2 months. The main IOFB sources were accidental penetration of the eye by materials in the playground (6 cases) or by pencil lead at school (4 cases). The mean IOFB size was 3.8 (range 1–6) mm. At the last visit, the visual acuities were 20/40 or better in 40.0% of patients and better than 20/200 in 70.0%. Poor visual outcome was correlated with intraoperative rhegmatogenous retinal detachment (P=0.0083). Postoperative complications included elevated transient intraocular pressure, retinal redetachment, and secondary glaucoma. Conclusions The clinical features of pediatric posterior segment IOFBs suggest insufficient awareness of such injuries both on the playground and at school. Visual outcomes from surgical treatment were relatively favorable in this series.
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Godbole NJ, Seefeldt ES, Raymond WR, Karesh JW, Morgenstern A, Egan JA, Colyer MH, Mazzoli RA. Simplified Method for Rapid Field Assessment of Visual Acuity by First Responders After Ocular Injury. Mil Med 2018; 183:219-223. [DOI: 10.1093/milmed/usx175] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 12/21/2017] [Indexed: 11/12/2022] Open
Affiliation(s)
- Nikhil J Godbole
- Department of Ophthalmology, Madigan Army Medical Center, Tacoma, WA, 9040 Jackson Ave., Tacoma, WA 98431
| | - Erin S Seefeldt
- Department of Ophthalmology, Madigan Army Medical Center, Tacoma, WA, 9040 Jackson Ave., Tacoma, WA 98431
- Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD 20814
| | - William R Raymond
- Department of Ophthalmology, Madigan Army Medical Center, Tacoma, WA, 9040 Jackson Ave., Tacoma, WA 98431
| | - James W Karesh
- DoD-VA Vision Center of Excellence, 8960 Brown Drive, Bldg 2, Room 1403-A, Bethesda, MD, 20889-5629
| | - Andrew Morgenstern
- DoD-VA Vision Center of Excellence, 8960 Brown Drive, Bldg 2, Room 1403-A, Bethesda, MD, 20889-5629
| | - Jo Ann Egan
- DoD-VA Vision Center of Excellence, 8960 Brown Drive, Bldg 2, Room 1403-A, Bethesda, MD, 20889-5629
| | - Marcus H Colyer
- Department of Ophthalmology, Walter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, MD 20889
| | - Robert A Mazzoli
- Department of Ophthalmology, Madigan Army Medical Center, Tacoma, WA, 9040 Jackson Ave., Tacoma, WA 98431
- Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD 20814
- DoD-VA Vision Center of Excellence, 8960 Brown Drive, Bldg 2, Room 1403-A, Bethesda, MD, 20889-5629
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Prognostic Factors and Visual Outcomes of Ruptured and Lacerated Globe Injuries. Eur J Ophthalmol 2018; 24:273-8. [DOI: 10.5301/ejo.5000364] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2013] [Indexed: 11/20/2022]
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Ji YR, Zhu DQ, Zhou HF, Fan XQ. Epidemiologic characteristics and outcomes of open globe injury in Shanghai. Int J Ophthalmol 2017; 10:1295-1300. [PMID: 28861358 DOI: 10.18240/ijo.2017.08.18] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 03/24/2017] [Indexed: 12/27/2022] Open
Abstract
AIM To investigate the epidemiologic characteristics and outcomes of open globe injury in Shanghai. METHODS A retrospective study was conducted for 148 unilateral open globe injury cases presenting to a tertiary referral hospital of Shanghai. Electronic medical records were reviewed and phone surveys were conducted to collect and analyze 1) background of patient; 2) setting of injury and clinical signs at presentation; 3) treatment procedure and outcome; 4) quality of life after injury. RESULTS There were more male patients (77.03%) than females (22.97%), more temporary habitants (79.05%) than residents (20.95%). The subjects in this study presented a significantly lower constitutional status of education than that of the whole Shanghai population (P<0.001). Occupational injury was the first cause of injuries (39.86%), followed by home accident (20.27%), road accident (16.89%), violent behavior (16.89%) and outdoor injury (6.08%). The 143 subjects (96.62%) were not wearing spectacles at the time of injury. Of all patients, 77 subjects (52.03%) had the outcome of no vision (including enucleation). The classification and regression tree (CART) prognosis presents 59.58% sensitivity to predict visual survival correctly and 80.19% specificity to predict no vision correctly. The patients whose injured eye had no vision reported more reduction of life quality. CONCLUSION We found that male subject, temporary habitants, low educational status and no eyewear are risk factors of open globe injury in Shanghai. Occupational injury is the leading cause. CART analysis presents a certain agreement to the actual visual outcome. The injury imposes negative impact on quality of life especially in no vision cases. The education of eye protection may help to avoid the injury.
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Affiliation(s)
- Yong-Rong Ji
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Dong-Qing Zhu
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Hui-Fang Zhou
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Xian-Qun Fan
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
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Wang W, Zhou Y, Zeng J, Shi M, Chen B. Epidemiology and clinical characteristics of patients hospitalized for ocular trauma in South-Central China. Acta Ophthalmol 2017; 95:e503-e510. [PMID: 28371405 DOI: 10.1111/aos.13438] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 02/13/2017] [Indexed: 02/06/2023]
Abstract
PURPOSE Ocular trauma is a major cause of visual loss, but little is known about its epidemiology and clinical characteristics in China. The aim of this study was to determine the prevalence and clinical characteristics of ocular trauma and assess prognostic factors in Changsha, Hunan, located in South-Central China. METHODS A retrospective case series (ICD codes: S05) study of ocular trauma in patients was performed at the Second Xiangya Hospital, Central South University, from 1 January 2010 to 31 December 2014. Demographic information, injury causes, ocular trauma types and initial and final visual acuity (VA) were recorded and analysed. The ocular trauma score (OTS) was calculated to assess the extent of the eye injury, prognosis and factors associated with visual impairment. All patient data were collected from the medical records system. RESULTS Of the 2009 patients presenting during this 5-year period, 1695 (84.4%) were males and 314 (15.6%) were females. The average age of all patients was 37.0 ± 19.3 years (range from 1 to 87 years). The age distribution showed a peak in the ocular trauma population in the 41- to 50-year age group (24%, n = 482), followed by the 51- to 60-year age group (16.9%, n = 339). Overall, open-globe injuries had a higher frequency (70.7%, n = 1420) than closed-globe injuries (28.6%, n = 575) and thermal/chemical injuries (0.7%, n = 14). Of the open-globe injuries, corneal penetration was the most common injury (32.2%, n = 646) followed by rupture (21.5%, n = 432) and an intraocular foreign body (16.2%, n = 325). Overall, the most frequent ocular trauma setting was the workplace (39.6%, n = 795), followed by the home (28.4%, n = 570), and the most frequent activity was ironwork. Firecracker- and firework-associated ocular trauma was significantly higher during the months of January and February than during other months (50.0%, n = 112, p < 0.001). In patients under 18 years, the most frequently occurring injury was open globe (84.5%, n = 349) with corneal penetration (59.3%, n = 245). Overall, an operation was performed in 1865 (92.8%) cases, and 144 cases (7.2%) were treated conservatively with medication. The average OTS score was 47.1 ± 19.5. The visual prognosis was closely correlated with the initial VA (r = 0.570, p = 0.000) and the OTS score (r = 0.603, p = 0.000). CONCLUSION This study describes the epidemiology and clinical characteristics of patients hospitalized for ocular trauma in South-Central China. Notably, a high rate of firework-related ocular trauma occurred during the months adjacent to the Chinese New Year festival. Specific injury prevention strategies, such as the use of protective eyewear, need to target the workplace to reduce the incidence and severity of ocular trauma.
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Affiliation(s)
- Wanpeng Wang
- Department of Ophthalmology; The Second Xiangya Hospital of Central South University; Changsha Hunan, China
| | - Yalan Zhou
- Department of Ophthalmology; The Second Xiangya Hospital of Central South University; Changsha Hunan, China
| | - Jun Zeng
- Department of Ophthalmology; The Second Xiangya Hospital of Central South University; Changsha Hunan, China
| | - Meng Shi
- Department of Ophthalmology; The Second Xiangya Hospital of Central South University; Changsha Hunan, China
| | - Baihua Chen
- Department of Ophthalmology; The Second Xiangya Hospital of Central South University; Changsha Hunan, China
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Bodanapally UK, Addis H, Dreizin D, Reddy AK, Margo JA, Archer-Arroyo KL, Feldman S, Saboury B, Sudini K, Saeedi O. Prognostic Predictors of Visual Outcome in Open Globe Injury: Emphasis on Facial CT Findings. AJNR Am J Neuroradiol 2017; 38:1013-1018. [PMID: 28302613 DOI: 10.3174/ajnr.a5107] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 12/13/2016] [Indexed: 01/15/2023]
Abstract
BACKGROUND AND PURPOSE The present prognostic models for open globe injuries have a limited ability to predict visual outcome before a comprehensive ophthalmologic examination or operation because they depend on the data derived from the ophthalmologic examination and intraoperative findings. The purpose of our study was to determine the specific CT and preoperative clinical data that can predict the prognosis of open globe injury. MATERIALS AND METHODS We analyzed the relationship of 29 variables derived from clinical and CT data from 97 globe injuries with visual acuity at 1 month. A prediction model was derived from 49 globe injuries by regression analysis, followed by receiver operating characteristic curve analysis of the best CT predictor. RESULTS Four variables with significance on a regression model were the following: posterior segment hemorrhage (β = -0.93, P < .0001), presenting visual acuity (β = 0.28, P = .042), orbital emphysema (β = 0.46, P = .0018), and complex facial fracture (β = -0.43, P = .009). Receiver operating characteristic analysis of the posterior segment hemorrhage predicted profound vision loss (light perception or no light perception) with an area under the curve of 0.97. The receiver operating characteristic table indicated that grade III posterior segment hemorrhage has a strong positive predictive value of 100% for profound vision loss. On the other hand, the absence of posterior segment hemorrhage has a strong positive predictive value of 93% for mild-to-severe vision loss (visual acuity better than light perception). CONCLUSIONS Radiologists, with the help of CT and preoperative clinical data, can predict visual acuity after open globe injury.
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Affiliation(s)
- U K Bodanapally
- From the Department of Radiology, R Adams Cowley Shock Trauma Center (U.K.B., D.D., K.L.A.-A., B.S.)
| | - H Addis
- University of Maryland School of Medicine (H.A., S.F.), Baltimore, Maryland
| | - D Dreizin
- From the Department of Radiology, R Adams Cowley Shock Trauma Center (U.K.B., D.D., K.L.A.-A., B.S.)
| | - A K Reddy
- University of Iowa Carver College of Medicine (A.K.R.), Iowa City, Iowa
| | - J A Margo
- Department of Ophthalmology and Visual Sciences (J.A.M., O.S.), University of Maryland Medical Center, Baltimore, Maryland
| | - K L Archer-Arroyo
- From the Department of Radiology, R Adams Cowley Shock Trauma Center (U.K.B., D.D., K.L.A.-A., B.S.)
| | - S Feldman
- University of Maryland School of Medicine (H.A., S.F.), Baltimore, Maryland
| | - B Saboury
- From the Department of Radiology, R Adams Cowley Shock Trauma Center (U.K.B., D.D., K.L.A.-A., B.S.)
| | - K Sudini
- Department of Environmental Health Sciences (K.S.), Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - O Saeedi
- Department of Ophthalmology and Visual Sciences (J.A.M., O.S.), University of Maryland Medical Center, Baltimore, Maryland
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A Retrospective Study on Clinical Features and Visual Outcome of Patients Hospitalized for Ocular Trauma in Cangzhou, China. J Ophthalmol 2017; 2017:7694913. [PMID: 28386477 PMCID: PMC5366229 DOI: 10.1155/2017/7694913] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 01/26/2017] [Accepted: 02/06/2017] [Indexed: 11/18/2022] Open
Abstract
Purpose. To describe clinical features and to analyze visual outcome of ocular trauma in Cangzhou in 2012–2015, China. Methods. A retrospective study of ocular trauma cases admitted to Cangzhou Central Hospital from January 2012 till December 2015 was performed. Results. This study included a total of 507 eyes from 478 patients. Four hundred (83.7%) patients were male, with a male-to-female ratio of 5.1 : 1. Mean age was 43.6 ± 18.3 years (5–95 years). The largest age group was 45–59 years old, followed by 30–44 years old, presenting two peaks of the age distribution and accounting for 28.5% and 27.2%, respectively. The most frequent type of injuries was work-related (194, 40.6%) followed by home-related (123, 25.7%). Initial visual acuity (VA) correlated with final VA (Spearman's test, r = 0.703, p = 0.001). The Ocular Trauma Score also correlated with the final VA significantly (Spearman's test, r = 0.802, p = 0.001). Conclusions. Susceptible population of eye injuries were middle- and young-aged working groups, and the proportion of males was higher. The leading two types of ocular trauma were work-related and home-related. Initial VA was a significant predictor of the final VA and the OTS possibly had predictive value in the final VA.
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Shah MA, Agrawal R, Teoh R, Shah SM, Patel K, Gupta S, Gosai S. Pediatric ocular trauma score as a prognostic tool in the management of pediatric traumatic cataracts. Graefes Arch Clin Exp Ophthalmol 2017; 255:1027-1036. [PMID: 28224290 DOI: 10.1007/s00417-017-3616-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 12/22/2016] [Accepted: 02/08/2017] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE To introduce and validate the pediatric ocular trauma score (POTS) - a mathematical model to predict visual outcome trauma in children with traumatic cataract METHODS: In this retrospective cohort study, medical records of consecutive children with traumatic cataracts aged 18 and below were retrieved and analysed. Data collected included age, gender, visual acuity, anterior segment and posterior segment findings, nature of surgery, treatment for amblyopia, follow-up, and final outcome was recorded on a precoded data information sheet. POTS was derived based on the ocular trauma score (OTS), adjusting for age of patient and location of the injury. Visual outcome was predicted using the OTS and the POTS and using receiver operating characteristic (ROC) curves. RESULTS POTS predicted outcomes were more accurate compared to that of OTS (p = 0.014). CONCLUSION POTS is a more sensitive and specific score with more accurate predicted outcomes compared to OTS, and is a viable tool to predict visual outcomes of pediatric ocular trauma with traumatic cataract.
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Affiliation(s)
- Mehul A Shah
- Drashti Netralaya, Nr. GIDC, Chakalia Road, Dahod, 389151, Gujarat, India.
| | - Rupesh Agrawal
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Tan Tock Seng, Singapore
| | - Ryan Teoh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore
| | - Shreya M Shah
- Drashti Netralaya, Nr. GIDC, Chakalia Road, Dahod, 389151, Gujarat, India
| | - Kashyap Patel
- Drashti Netralaya, Nr. GIDC, Chakalia Road, Dahod, 389151, Gujarat, India
| | - Satyam Gupta
- Drashti Netralaya, Nr. GIDC, Chakalia Road, Dahod, 389151, Gujarat, India
| | - Siddharth Gosai
- Drashti Netralaya, Nr. GIDC, Chakalia Road, Dahod, 389151, Gujarat, India
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Xia T, Bauza A, Soni NG, Zarbin MA, Langer PD, Bhagat N. Surgical Management and Outcome of Open Globe Injuries with Posterior Segment Complications: A 10-Year Review. Semin Ophthalmol 2016; 33:351-356. [DOI: 10.1080/08820538.2016.1242634] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Tian Xia
- Institute of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Alain Bauza
- Institute of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Nishant G. Soni
- Institute of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Marco A. Zarbin
- Institute of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Paul D. Langer
- Institute of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Neelakshi Bhagat
- Institute of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, NJ, USA
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Jovanovic N, Peek-Asa C, Swanton A, Young T, Alajbegovic-Halimic J, Cavaljuga S, Nisic F. Prevalence and risk factors associated with work-related eye injuries in Bosnia and Herzegovina. INTERNATIONAL JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HEALTH 2016; 22:325-332. [PMID: 27813453 PMCID: PMC5137557 DOI: 10.1080/10773525.2016.1243081] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Eye injuries are a prevalent workplace injury and cause substantial disability when vision is impaired. OBJECTIVE To examine work-relatedness of demographic, injury, and clinical characteristics of eye injuries in a large clinic in Bosnia and Herzegovina. METHODS We performed a nine-year retrospective study of patients admitted with an eye injury to the Canton Hospital in Zenica, Bosnia and Herzeogvina. Controlling for age and sex, we used logistic regression to examine the influence of work-relatedness on patient and injury characteristics and clinical outcomes. RESULTS Of 258 patients, 71 (27.5%) had work-related and 180 (69.8%) had non-work-related eye injuries. Work-related eye injury was associated with age, education, occupation, and injury type. Agricultural workers were eight times more likely to experience work-related eye injury (95%CI = 1.21-152.0) compared to manual workers. Work-relatedness of injury did not predict final visual acuity or length of hospital stay. CONCLUSION Promotion of eye safety is needed countrywide. Occupational eye protection is a priority due to the relatively proportion of eye injuries and the workplace being a relatively controlled environment.
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Affiliation(s)
- Nina Jovanovic
- a Department of Ophthalmology , Canton Hospital Zenica , Zenica , Bosnia and Herzegovina.,b Injury Prevention Research Center (IPRC), College of Public Health , University of Iowa , Iowa City , IA , USA
| | - Corinne Peek-Asa
- b Injury Prevention Research Center (IPRC), College of Public Health , University of Iowa , Iowa City , IA , USA
| | - Amanda Swanton
- b Injury Prevention Research Center (IPRC), College of Public Health , University of Iowa , Iowa City , IA , USA
| | - Tracy Young
- b Injury Prevention Research Center (IPRC), College of Public Health , University of Iowa , Iowa City , IA , USA
| | | | - Semra Cavaljuga
- d Department of Epidemiology and Biostatistics , School of Medicine, University of Sarajevo , Sarajevo , Bosnia and Herzegovina
| | - Faruk Nisic
- c Eye Clinic , Clinical Center University of Sarajevo , Sarajevo , Bosnia and Herzegovina
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Yucel OE, Demir S, Niyaz L, Sayin O, Gul A, Ariturk N. Clinical characteristics and prognostic factors of scleral rupture due to blunt ocular trauma. Eye (Lond) 2016; 30:1606-1613. [PMID: 27589050 DOI: 10.1038/eye.2016.194] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 07/11/2016] [Indexed: 11/09/2022] Open
Abstract
PurposeTo describe and identify ocular and wound characteristics, and prognostic factors associated with final visual acuity (VA) in patients with scleral rupture due to blunt ocular trauma.MethodsThe medical records of 61 patients with globe rupture due to blunt ocular trauma who underwent primary repair were reviewed retrospectively. The data recorded included demographic characteristics, initial and final VA, ocular signs, wound characteristics, and surgeries. Initial VA, ocular signs, wound characteristics, and surgeries were analyzed to determine the association with the final VA.ResultsForty three women and 18 men with a mean age of 43.6±23.5 years were included in the study. The locations of scleral wounds were mostly in the superonasal quadrant (41.0%) and zone 2 (75.4%). In eyes with hyphema (P=0.009), vitreous hemorrhage (P=0.001), and retinal detachment (P=0.004), final VA was statistically worse than eyes without these signs. A moderate positive correlation was found between the initial and final VA (P<0.001). Final VA was statistically worse in eyes with horizontal midline wounds than in eyes with vertical midline wounds (P=0.002). A moderate negative correlation was found between scleral wound length and final VA (P<0.001). Patients who underwent cataract surgery had statistically better final VA (P=0.002).ConclusionsScleral rupture was detected mostly in females, superonasal quadrant and zone 2. Poor final VA was significantly associated with poor initial VA, longer wound length, horizontal midline wound, presence of hyphema, vitreous hemorrhage and retinal detachment at presentation, and cataract surgery not performed during follow-up period. Scleral ruptures have different demographic, ocular and wound characteristics than other open globe injuries.
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Affiliation(s)
- O E Yucel
- Department of Ophthalmology, Medical Faculty, Ondokuz Mayis University, Samsun, Turkey
| | - S Demir
- Department of Ophthalmology, Medical Faculty, Gaziosmanpasa University, Tokat, Turkey
| | - L Niyaz
- Department of Ophthalmology, Medical Faculty, Ondokuz Mayis University, Samsun, Turkey
| | - O Sayin
- Clinic of ophthalmology, Develi Hatice Muammer Kocaturk State Hospital, Kayseri, Turkey
| | - A Gul
- Department of Ophthalmology, Medical Faculty, Ondokuz Mayis University, Samsun, Turkey
| | - N Ariturk
- Department of Ophthalmology, Medical Faculty, Ondokuz Mayis University, Samsun, Turkey
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Page RD, Gupta SK, Jenkins TL, Karcioglu ZA. Risk factors for poor outcomes in patients with open-globe injuries. Clin Ophthalmol 2016; 10:1461-6. [PMID: 27536059 PMCID: PMC4975575 DOI: 10.2147/opth.s108901] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose The aim of this study was to identify the risk factors that are predictive of poor outcomes in penetrating globe trauma. Patients and methods This retrospective case series evaluated 103 eyes that had been surgically treated for an open-globe injury from 2007 to 2010 at the eye clinic of the University of Virginia. A total of 64 eyes with complete medical records and at least 6 months of follow-up were included in the study. Four risk factors (preoperative best-corrected visual acuity [pre-op BCVA], ocular trauma score [OTS], zone of injury [ZOI], and time lapse [TL] between injury and primary repair) and three outcomes (final BCVA, monthly rate of additional surgeries [MRAS], and enucleation) were identified for analysis. Results Pre-op BCVA was positively associated with MRAS, final BCVA, and enucleation. Calculated OTS was negatively associated with the outcome variables. No association was found between TL and ZOI with the outcome variables. Further, age and predictor variable-adjusted analyses showed pre-op BCVA to be independently positively associated with MRAS (P=0.008) and with final BCVA (P<0.001), while the calculated OTS was independently negatively associated with final BCVA (P<0.001), but not uniquely associated with MRAS (P=0.530). Conclusion Pre-op BCVA and OTS are best correlated with prognosis in open-globe injuries. However, no conventional features reliably predict the outcome of traumatized eyes.
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Affiliation(s)
| | | | | | - Zeynel A Karcioglu
- Department of Ophthalmology; Department of Pathology, University of Virginia, Charlottesville, VA, USA
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Lin H, Lema GMC, Yoganathan P. PROGNOSTIC INDICATORS OF VISUAL ACUITY AFTER OPEN GLOBE INJURY AND RETINAL DETACHMENT REPAIR. Retina 2016; 36:750-7. [DOI: 10.1097/iae.0000000000000798] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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