Ocular Trauma Trends in Indonesia: Poor Initial Uncorrected Visual Acuity Associated with Mechanism of Injury

Objectives: To identify ocular trauma trends and to analyze how initial uncorrected visual acuity (VA) is associated with mechanism of injury (MOI) in a referral hospital in Indonesia. Methods: A five-year medical chart review at the Ophthalmology Emergency Department (OED) Dr. Soetomo General Academic Hospital (DSGAH). The information retrieved included sex, age, laterality involvement, initial uncorrected VA, MOI and management. Sex- and age- adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were calculated to evaluate the relationship between poor initial uncorrected VA and MOI, using multivariate logistic regression analysis. Results: A total of 953 patients consisted of 80.3% males and 19.9% females. Ocular trauma predominantly occurred in 21–30 years age group (20.9%). May and November were found to have the highest average number of monthly patients. Closed globe injuries (80.3%) were more prevalent than open globe injuries (17.7%). The most frequent MOIs were sharp objects (311; 32.6%), followed by blunt objects (236; 24.8%). Most cases (89.2%) displayed unilateral involvement and 54.3% cases showed an initial uncorrected VA of better than 6/18. Compared to road dust, blunt object, sharp object and traffic accident were significantly associated with poor initial VA, with adjusted ORs (95% CIs) of 5.24 (2.27-12.10), 4.03 (1.76-9.25) and 8.17 (3.31-20.15), respectively. Conclusions: Initial uncorrected VA and MOI provide earlier information regarding the prognosis. Traffic accident showed a greater tendency to cause a poor initial uncorrected VA. Most ocular trauma is preventable by educating people at risk to avoid common MOIs and to use protection.

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Visual Outcome of Ocular Trauma Presenting in a Tertiary Care Hospital in Sahiwal

Pakistan Journal of Ophthalmology ◽

10.36351/pjo.v36i2.987 ◽

2020 ◽

Vol 36 (2) ◽

Author(s):

Ahmad Zeeshan Jamil ◽

Muhammad Luqman Ali Bahoo

Keyword(s):

Visual Acuity ◽

Ocular Trauma ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Sampling Technique ◽

Visual Outcome ◽

P Value ◽

Care Hospital ◽

Open Globe ◽

Patient Reported

Purpose: To find the visual outcome of ocular trauma presenting in a tertiary care hospital in Sahiwal. Study Design: Descriptive observational study. Place and Duration of Study: This study was conducted at District Headquarter Teaching Hospital affiliated with Sahiwal Medical College, Sahiwal from January 2016 to June 2019. Material and Methods: Four hundred and thirty five patients were included in the study by convenient sampling technique. Patient’s age, gender, occupation, activity at the time of injury, nature of object causing trauma, duration of trauma, visual acuity at the time when patient reported to hospital, the time delay before coming to the hospital were recorded. Ocular injuries were classified according to Birmingham ocular trauma terminology. Detailed ocular examination was performed. Patients were managed and post-management visual acuity at three months was recorded. Results: Mean age of patients was 29.07 ± 12.53 years. There were 219 (50.3%) closed globe and 216 (49.7%) open globe injuries. In 59 (13.6%) cases, cause of injury was metal object. In 146 (33.6%) cases injury was classified as contusion. In 164 (37.7%) cases cornea was involved. Majority of the patients were male. Eighty-seven patients presented within 1 day after trauma. In 154 (35.4%) patients, visual acuity at the time of presentation was 6/12 or better while in 171 (39.3%) cases it was less than 6/60. Chi-square test was used to calculate the difference between pre and post-management visual acuity. This difference was statistically significant with p-value less than 0.05 Conclusion: Ocular trauma cases, if properly and timely managed, have a statistically significant increase in visual acuity.

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Bungee cord related ocular trauma: An avoidable cause of ocular morbidity

Panacea Journal of Medical Sciences ◽

10.18231/j.pjms.2021.060 ◽

2021 ◽

Vol 11 (2) ◽

pp. 297-300

Author(s):

Nazia Imam ◽

Mobashir Sarfraz Ali ◽

Bibhuti Prassan Sinha ◽

Gyan Bhaskar ◽

Rakhi Kusumesh

Keyword(s):

Visual Acuity ◽

Clinical Features ◽

Medical Records ◽

Tertiary Care ◽

Final Visual Acuity ◽

Ocular Injury ◽

Age Group ◽

Mechanism Of Injury ◽

Open Globe Injury ◽

Open Globe

To study the mechanism and clinical features of ocular injury and its outcome associated with bungee cord related eye trauma. A retrospective review of medical records was performed at our tertiary care centre to identify patients presented with bungee cord related eye injury between March 2016 to February 2017. Data collected from medical records were age, sex, mechanism of injury, clinical features, therapeutic intervention, presenting visual acuity, final visual acuity and length of follow up. Total of thirteen patients with bungee cord related trauma were identified. Ten (77%) patients presented with closed globe injury and 3(23%) presented with open globe injury. All patients were male with mean age group of 30.15±7.38 years. Presenting visual acuity ranges from 6/12 to NPL. Only seven (54%) of patients were having final visual acuity of better than or equal to 6/18 in injured eye. Three patients (23.1%) with open globe injury had final visual acuity of counting fingers or worse. Main mechanism of injury being combination of blunt and high speed projectile injury due to slippage of metal or plastic hook while the cord is stretched. Trauma with bungee cord is usually affecting working age group male with injury resulting in loss of workable vision to loss of eye hence there is need of appropriate intervention like use of printed warning on package and modification of hook design to decrease the incidence of bungee cord related trauma.

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Pars Plana Vitrectomy following Traumatic Ocular Injury and Initial Globe Repair: A Retrospective Analysis of Clinical Outcomes

Military Medicine ◽

10.1093/milmed/usaa286 ◽

2021 ◽

Vol 186 (Supplement_1) ◽

pp. 491-495

Author(s):

Hunter H Phillips ◽

Halward J Blegen IV ◽

Christopher Anthony ◽

Brett W Davies ◽

Marissa L Wedel ◽

...

Keyword(s):

Visual Acuity ◽

Retrospective Analysis ◽

Pars Plana Vitrectomy ◽

Ocular Trauma ◽

Ocular Injury ◽

Complication Rates ◽

Vitreoretinal Disease ◽

Open Globe ◽

Initial Injury ◽

Pars Plana

ABSTRACT Introduction Penetrating and perforating ocular trauma are often devastating and may lead to complete visual loss in the traumatized eye and subsequent compromise of the fellow eye. A significant proportion of traumatic injuries are complex, often requiring vitreoretinal intervention to preserve vision. A retrospective analysis at a level 1 trauma center was performed to evaluate the time course, incidence, and outcomes following pars plana vitrectomy (PPV) after traumatic ocular injury and initial globe repair. Materials and Methods Eyes that underwent open globe repair following ocular trauma at Brooke Army Medical Center, between January 1, 2014 and December 30, 2016 were analyzed. Specific factors evaluated include mechanism of injury, defect size and complexity, ocular trauma score, zone of injury, associated orbital trauma, and time from injury to surgical intervention. A subset analysis was conducted specifically on eyes requiring subsequent PPV for vision preservation because of vitreoretinal disease. Surgical outcomes, time to secondary intervention, and complication rates were then assessed. Results In total, 70 eyes requiring open globe repair were examined, with 43 having undergone PPV. Average and median time to vitrectomy were 18.8 and 8 days, respectively. Eyes that underwent PPV were more likely to have an afferent papillary defect, vitreous hemorrhage, intraocular foreign body, and retinal detachment at the time of initial injury (although the latter two factors were not statistically significant), and were more likely to receive penetrating keratoplasty. Proliferative vitreoretinopathy occurred in 37.2% of eyes that underwent PPV, versus 3.7% of those that did not (P = 0.0013). Timing of PPV (i.e., before or after 14 days) had no statistically significant effect on the rate of PVR (Table I). Eyes that underwent PPV showed an improvement of visual acuity from average 2.5 logMAR following initial injury to 1.5 logMAR 6 months after PPV, equivalent to 18.7 Early Treatment Diabetic Retinopathy Study (ETDRS) letters gained, versus 37.7 ETDRS letters gained in eyes without PPV. Among PPV eyes, early repair (<14 days) was associated with greater improvement in visual acuity. Conclusion Overall, patients requiring PPV following open globe repair generally had more severe injuries and worse 6-month postoperative visual acuity. Patients who underwent more expedited vitrectomy showed greater improvement in visual acuity as measured by ETDRS letters gained.

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Open globe injuries in geriatric population in Iran: characteristics and outcomes

International Journal of Ophthalmology ◽

10.18240/ijo.2021.08.16 ◽

2021 ◽

Vol 14 (8) ◽

pp. 1237-1240

Author(s):

Maryam Zamani ◽

◽

Akbar Fotouhi ◽

Morteza Naderan ◽

Mohammad Soleimani ◽

...

Keyword(s):

Visual Acuity ◽

Ocular Trauma ◽

Final Visual Acuity ◽

Open Globe Injury ◽

Geriatric Population ◽

Cross Sectional ◽

Female Ratio ◽

Globe Rupture ◽

Open Globe ◽

Open Globe Injuries

AIM: To investigate the patterns and outcomes of open globe injuries in the elderly population in Iran. METHODS: In this retrospective cross-sectional chart review, medical records of 248 patients (aged 60y and more) with the diagnosis of open globe injury from 2006 to 2016 were reviewed. Demographic features, type, and mechanism of open globe injury, ocular trauma score (OTS), visual acuity before and after treatment, the zone of injuries, and the associated injuries found at the presentation or thereafter were documented. RESULTS: A total of 248 eyes of 248 patients were included. The mean age was 69.2±5.8y (range: 60-90y). Male/ female ratio was about 3:1 (187 vs 61). The three most common causes of injury were falling (25.2%), sharp objects (18.9%), and tree branches (13.9%). Penetrating injury accounted for most of the geriatric ocular trauma (50.4%), followed by globe rupture (40.3%), intraocular foreign body (IOFB; 7.3%), and perforating injury (2.0%). The median raw OTS for the population was 60.5 and the most common OTS class was 3. The injuries tend to affect zone I more than zone II and zone III. The only predictor of final visual acuity was the class of OTS (P<0.001). CONCLUSION: Geriatric open globe injury should be valued specifically. The most common type of open globe injury in Iran is penetrating injuries but falling remain the main cause. The OTS class must be considered as an important predictor of final visual acuity.

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To Study the Pattern of Ocular Trauma and Predict-ing the Final Visual Outcome in Paediatric Ocular Trauma Cases in a Tertiary Eye Care Centre of Eastern India

Ophthalmology Research An International Journal ◽

10.9734/or/2020/v12i330150 ◽

2020 ◽

pp. 29-33

Author(s):

Rahul Prasad ◽

Deepti Tiwari ◽

Bibha Kumari ◽

Antabha Bandyopadhyay

Keyword(s):

Visual Acuity ◽

Ocular Trauma ◽

Visual Outcome ◽

Trauma Patients ◽

Care Centre ◽

Eastern India ◽

Eye Care ◽

Counting Finger ◽

Open Globe ◽

Common Causes

Aim: The study was done to identify causes, demographic and clinical profile and to evaluate factors influencing visual outcome in paediatric ocular trauma patients (up to 15 years). Study Design: It was a prospective interventional study Place and Duration of the Study: The study was done in a tertiary eye care centre of eastern India between January 2019 to February 2020. Materials and Methods: The study was done from January 2019 to February 2020 on children between 1 year to 15 years of either sex with ocular trauma. Demographic details, cause of injury, presenting visual acuity were noted. Follow up was done till 2 months after carrying out appropriate intervention. Results: A total 106 eyes of 106 patients were evaluated and it was observed that children who were of 7 yrs and above were more affected (67%) than below (33%). Male children (59%) were more affected than female (41%). Injuries to Adnexa were found in 52% eyes, 40% injury cases were due to closed injury while open globe injuries comprised 8% of total cases. Common causes of injury were found to be mainly blunt objects and projectile objects. Maximum correction in visual acuity (VA) of more than 6/18 was achieved in 66% eyes, 6/18-6/60 in 11% eyes, <6/60-counting finger at 1 meter in 10% eyes. Conclusion: Late reporting, poor initial visual acuity, involvement of posterior segment, and no immediate primary intervention at time of injury adversely affect visual outcome. Early intervention and globe salvaging repair should be done in all eyes of trauma.

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Factors Affecting Final Functional Outcomes in Open-Globe Injuries and Use of Ocular Trauma Score in Nepalese population

10.21203/rs.3.rs-86664/v1 ◽

2020 ◽

Author(s):

Saurav Man Shrestha ◽

Casey Leigh Anthony ◽

Justin A. Grant ◽

Madhu Thapa ◽

Jyoti Baba Shrestha ◽

...

Keyword(s):

Visual Acuity ◽

Ocular Trauma ◽

Final Visual Acuity ◽

Delayed Presentation ◽

Ocular Trauma Score ◽

Visual Outcomes ◽

Open Globe ◽

The Mean ◽

Trauma Score ◽

Open Globe Injuries

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 (p<0.05). Conclusion: 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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Secondary Sulcus-Fixed Foldable IOL Implantation with 25-G Infusion in Patients with Previous PPV after Open-Globe Injury

European Journal of Ophthalmology ◽

10.5301/ejo.5000963 ◽

2017 ◽

Vol 27 (6) ◽

pp. 786-790

Author(s):

Tiangeng He ◽

Caiyun You ◽

Song Chen ◽

Xiangda Meng ◽

Yuanyuan Liu ◽

...

Keyword(s):

Visual Acuity ◽

Open Globe Injury ◽

Corneal Incision ◽

Iol Implantation ◽

Clear Corneal Incision ◽

Secondary Iol Implantation ◽

Open Globe ◽

Uncorrected Visual Acuity ◽

Pars Plana ◽

The Mean

Purpose To evaluate the safety and efficacy of secondary sulcus-fixed foldable intraocular lens (IOL) implantation through a clear corneal incision with 25-G infusion in patients with previous pars plana vitrectomy (PPV) after open-globe injury, and to analyze postoperative outcomes and prognostic factors of treatment. Methods Clinical data of 89 eyes of 89 patients with open-globe injury who underwent secondary sulcus-fixed foldable IOL implantation through a clear corneal incision with 25-G infusion after vitrectomy in our hospital between January 2008 and June 2015 were retrospectively analyzed. The examinations before IOL implantation mainly included visual acuity, slit-lamp examination, direct and indirect ophthalmoscope, visual electrophysiology, corneal endothelium, B scan, ultrasound biomicroscope, and intraocular pressure. Five eyes underwent suturing of peripheral iris and 7 eyes underwent suturing of iris laceration simultaneously. The mean follow-up was 18 months with a range from 6 months to 8 years. Results The mean interval between secondary sulcus-fixed foldable IOL implantation and vitrectomy was 2.8 months with a range from 2 to 6 months. The uncorrected visual acuity improved in all patients with a well-centered IOL ranging from 0.1 to 0.8 with the best-corrected visual acuity from 0.1 to 1.0 after secondary IOL implantation. The postoperative complications mainly included mild anterior chamber exudates in 10 eyes (11%), temporary IOP elevation in 12 eyes (13%), and recurrent retinal detachment in 5 eyes (6%), which were subsequently managed by surgery. Conclusions The interval of 2.8 months between vitrectomy and secondary IOL implantation is an appropriate and safe option to correct aphakia in patients receiving vitrectomy for open-globe injury.

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Clinical Characteristics and Visual Outcomes of Patients Hospitalized for Ocular Trauma in Shandong Province, China

Journal of Ophthalmology ◽

10.1155/2020/5826263 ◽

2020 ◽

Vol 2020 ◽

pp. 1-5

Author(s):

Fangnan Duan ◽

Xiunian Chen ◽

Sai Zhang ◽

Xiaolin Qi ◽

Weiyun Shi ◽

...

Keyword(s):

Visual Acuity ◽

Correlation Coefficient ◽

Clinical Characteristics ◽

Ocular Trauma ◽

Shandong Province ◽

Eye Injuries ◽

Work Related ◽

Open Globe ◽

Spearman’S Correlation ◽

Open Globe Injuries

Purpose. To analyze the clinical characteristics and visual prognoses of patients with ocular trauma treated in Shandong Eye Hospital. Methods. The inpatient data of patients with eye injuries hospitalized in our institution from January 2014 to December 2018 were retrospectively reviewed, including demographic information, types of trauma, causes of injury, treatment, and initial and final visual acuities. Results. A total of 1,425 patients (1,622 eyes), aged 39.5 ± 18.5 years, were included. The ratio of male to female was 5.3 : 1. Of the mechanical eye injuries, there were 490 (34.4%) open-globe injuries and 454 (31.9%) closed-globe injuries. Nonmechanical eye injuries had 426 patients (29.9%), while 55 patients (3.9%) had adnexal injuries. Over a half of the traumas were work-related (51.1%, 728 patients). Most patients were treated with surgical intervention (1,404 eyes, 87.9%). There were significant differences in the final visual acuities between open-globe injuries and closed-globe injuries (P<0.001), as well as between mechanical injuries and nonmechanical injuries (P<0.001). The final visual acuity was closely correlated with the initial visual acuity (Spearman’s correlation coefficient = 0.618, P<0.001) and the OTS score (Spearman’s correlation coefficient = 0.691, P<0.001). Conclusion. Ocular trauma usually occurs in young and middle-aged men and in the workplace in Shandong Province. The proportion of nonmechanical injuries is high, and the prognosis is poor. A comprehensive understanding of the characteristics of ocular trauma is useful for blindness prevention and treatment.

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Analysis of Ocular Injury Characteristics in Survivors of the 8.12 Tianjin Port Explosion, China

Journal of Ophthalmology ◽

10.1155/2019/1360805 ◽

2019 ◽

Vol 2019 ◽

pp. 1-7 ◽

Cited By ~ 1

Author(s):

Hao Jiang ◽

Chao Xue ◽

Yanlin Gao ◽

Yan Wang

Keyword(s):

Visual Acuity ◽

Ocular Trauma ◽

Final Outcome ◽

Ocular Injury ◽

Light Perception ◽

Severe Injuries ◽

Hand Motion ◽

Injury Characteristics ◽

Retinal Injury ◽

Open Globe

Introduction. On the evening of August 12, 2015, a large chemical explosion occurred at Tianjin Port. We analyzed ocular injury characteristics in the survivors of this accident. Methods. Twenty injured eyes of 17 hospitalized patients were included. Initial best-corrected visual acuity (BCVA), injury type, injury cause, relative afferent pupillary defect (RAPD), zone of injury (ZOI), and ocular trauma score (OTS) were evaluated. Final BCVA and enucleation were the final outcome index. The relationship between risk factors and final outcomes was analyzed. Results. The patients comprised 14 males and 3 females (mean age, 35.24 ± 12.68 years). Eighteen eyes had open-globe and 2 had closed-globe injuries. Fifteen ocular injury types were reported. Initial visual acuity (VA) was 20/50 to 20/200, 20/200 to finger counting (FC), hand motion to light perception (HM-LP), and no light perception (NLP) in 2, 7, 7, and 4 eyes, respectively. RAPD was found in 5 eyes. Most eyes sustained severe injuries with OTSs of 1 (25%) and 2 (40%). Of the injured eyes, 50% had Zone III injuries. In 95% of the injured eyes, glass was the cause of injury. Three of 4 eyes with an initial VA of NLP had a final VA of NLP and an outcome of enucleation. In 5 eyes with RAPD, 3 had a final VA of NLP and a final outcome of enucleation. Eyes with lower OTSs generally had poorer outcomes. All eyes with a final VA of NLP and an enucleation outcome had Zone III injuries. All 3 eyes with an enucleation outcome had retinal injuries, whereas eyes with no retinal injury had a better final BCVA. Conclusions. Explosions can inflict severe ocular trauma, even indoors; 90% of injured eyes had open-globe injuries caused by glass fragments. Initial NLP, RAPD, low OTS, posterior extended wound, and retinal injury indicate a poor final outcome.

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Factors affecting final functional outcomes in open‐globe injuries and use of ocular trauma score as a predictive tool in Nepalese population

BMC Ophthalmology ◽

10.1186/s12886-021-01819-4 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Saurav M. Shrestha ◽

Casey L. Anthony ◽

Grant A. Justin ◽

Madhu Thapa ◽

Jyoti B. Shrestha ◽

...

Keyword(s):

Visual Acuity ◽

Ocular Trauma ◽

Final Visual Acuity ◽

Predictive Tool ◽

Ocular Trauma Score ◽

Visual Outcomes ◽

Open Globe ◽

The Mean ◽

Trauma Score ◽

Open Globe Injuries

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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