Visual outcome in open globe injuries

Epidemiology and Visual Outcome of Open Globe Injury Cases in Hospital Pulau Pinang

Objective

To describe the epidemiology and to evaluate the visual outcome of open globe injury (OGI) cases in Hospital Pulau Pinang.

Method

A three-year retrospective study on OGI cases presenting to Hospital Pulau Pinang from January 2018 until December 2020.

Result

A total of 39 OGI cases (n=39) were included in this study. The average age of the patients was 34.9 ± 21.7 (mean ± standard deviation, SD). There were 33 males (84.6%) and six females (15.4%). In this study, 27 cases (69.2%) were Malaysians, while the remaining 12 cases (30.8%) were foreigners. OGI cases were mostly caused by occupational injuries (n=17, 43.6%) and domestic-related accidents (n=17, 43.6%). The mean initial VA (visual acuity) logMAR was 1.69 ± 0.98 (mean ± SD). Overall, the final VA improved to the mean VA logMAR of 1.04 ± 1.08 (mean ± SD). There was a significant positive correlation between initial VA and final VA logMAR (Spearman’s rho = 0.6532, p <0.001). A negative linear correlation was found between calculated raw points of Ocular Trauma Score (OTS) and final VA logMAR (Spearman’s rho = -0.7067, p <0.001).

Conclusion

Young adult males, foreign nationality, occupational injuries, and domestic-related accidents are risk factors of OGI. By uncovering the risk, we can take remedial actions to ensure better public health and clinical strategies to prevent and manage ocular trauma in the future. This study also highlights that initial VA and OTS are effective in predicting visual outcomes of OGI.

Visual outcomes and prognostic factors in open-globe injuries

BACKGROUND

Ocular trauma is an important cause of visual loss worldwide. Improvements in our knowledge of the pathophysiology and management of ocular trauma during the past 30 years, in conjunction with advances in the instrumentation and techniques of ocular surgery, have improved the efficacy of vitreoretinal surgery in injured eyes. The aim of the current study was to determine the visual outcomes and prognostic factors of open-globe injuries in the Japanese population.

METHODS

Retrospective study of 59 eyes of 59 patients presented with open globe injuries between September 2008 and March 2014 at Nagasaki University Hospital was conducted. Demographic factors including age, gender, and clinical data such as cause of injury, presenting visual acuity (VA), location of injury, type of injury, lens status, presence of intraocular foreign body, types of required surgeries, and final VA were recorded. According to the classification of Ocular Trauma Classification Group, wound location was classified into three zones. Chi-square test was used to compare presented data.

RESULTS

Out of the 59 patients, 46 were placed in the Light Perception (LP) group, and 13 were placed in the No Light Perception (NLP) group. Work-related trauma was the most common cause (27 eyes) followed by falls (19eyes). Work-related trauma was common in males (P = 0.004), while falls was significantly common in females (P = 0.00001). Zone III injuries had statistically significantly poor prognostic factor compared to other zones (P = 0.04). All cases of NLP group (100%) presented with rupture globe. Poor VA at first visit (P = 0.00001), rupture globe (P = 0.026), history of penetrating keratoplasty (PK) (P = 0.017), retinal detachment (RD) (P = 0.0001), vitreous hemorrhage (VH) (P = 0.044), and dislocation of crystalline lens (P = 0.0003) were considered as poor prognostic factors.

CONCLUSION

Poor VA at first visit, rupture globe, zone III injuries, history of penetrating keratoplasty, RD, VH, and dislocation of crystalline lens were found to be poor prognostic factors. PPV had a good prognostic value in open globe injuries associated with posterior segment involvement.

Presentation and Management Outcomes of Corneal and Scleral Perforations in Geriatric Nursing Home Residents

We compared the clinical presentation and treatment outcomes of corneal and scleral perforations in geriatric nursing home residents, geriatric community residents, and non-geriatric population. The medical records of patients who were treated for corneal and scleral perforations at the Prince of Wales Hospital, Hong Kong between January 1, 2004 and May 1, 2013, were reviewed retrospectively. Of 144 cases, 53 (37%) occurred in the geriatric population, of which 16 (11%) lived in nursing homes, and 37 (26%) were community residents. There were 91 (63%) patients in the non-geriatric group. The mean age of the patients in nursing home geriatric group was 86.5 years (87.5% females). The most common etiology of perforation was trauma. Rupture due to fall was more common in geriatric patients (P < 0.001) whereas laceration due to penetrating eye injury was more common in non-geriatric patients (P < 0.001). There were more cases of infection leading to spontaneous perforation in geriatric nursing home group compared to the other groups (P = 0.001). In the geriatric nursing home group, visual acuity at presentation (P < 0.001) and postoperative visual acuity (P = 0.012) was worse compared to the other groups. Our study showed that corneal and scleral perforations in the geriatric nursing home residents carry a poor visual prognosis. The causes and anatomical outcomes of such events in geriatric age group differ from those in the general population. In our study, geriatric patients residing in nursing homes had worse baseline as well as posttreatment visual acuity, compared to community residents.

Two kinds of ocular trauma score for paediatric traumatic cataract in penetrating eye injuries

PURPOSE

To compare the ocular trauma score (OTS) and the paediatric penetrating ocular trauma score (POTS) as prognostic model for visual outcome in paediatric traumatic cataract cases after penetrating eye injuries.

METHODS

All children younger than 16 years with unilateral traumatic cataract following penetrating trauma between 2007 and 2012 were retrospectively reviewed. Univariate chi-square analysis was conducted to identify the variables associated with profound visual loss. The area under the receiver-operating characteristic curves (AUROC) was used to assess the predictive ability of the two models.

RESULTS

The study group comprised 65 boys and 37 girls. The variables associated with profound visual loss were: a relative afferent papillary defect (RAPD) (P<0.001), poor initial vision (P=0.01), vitreous haemorrhage (P<0.001), retinal detachment (P<0.001), posterior penetrating site (P<0.001), hyphema (P<0.001), no intraocular len implantation (P<0.001) and endophthalmitis (P=0.001). OTS could not be calculated in 21 patients (20.6%) without clinical data on initial visual acuity and RAPD. For the patients with complete clinical data, POTS was similar to OTS in predicting poor vision (AUROC 0.904 vs 0.924) and in predicting good vision (AUROC 0.766 vs 0.736). For all the samples, POTS was a robust predictor of poor vision (AUROC 0.910) and had a moderate ability to predict good vision (AUROC 0.764).

CONCLUSION

OTS has high ability to predict visual outcome for paediatric traumatic cataract following penetrating ocular trauma. POTS is also a reliable prognostic model for very young child without initial vision or RAPD, but is only for penetrating eye injuries.