Etiology and Visual Prognosis in Open Globe Injuries: Results of A Tertiary Referral Center in Turkey

Abstract

We aimed to analyse the clinical characteristics of OGI and evaluate the correlation between baseline ocular trauma score (OTS) and visual outcomes in cases with OGI. The charts of 257 OGI patients who had at least six months of follow-up were reviewed retrospectively. Demographics, data about the etiology, localization and size of the OGI, baseline and final best-corrected visual acuity (BCVA) were noted. At the time of approval OTS was calculated and compared with final BCVA. All analysis was performed in both entire study population and our pediatric subgroup. A total of 261 eyes of 257 patients with a mean age of 34.9 ± 19.8 years were enrolled. Globe injury with a mean size of 6.7 ± 4.5 mm was within zone I in 46.7% of the eyes. Older age (p < 0.001, OR = 1.029, 95% CI = 1.015–1.043), higher baseline logMAR BCVA scores (p < 0.001, OR = 4.460, 95% CI = 2.815–7.065), bigger wound size (p < 0.001, OR = 1.159, 95% CI = 1.084–1.240), relative afferent pupillary defect (RAPD) positiveness (p < 0.001, OR = 0.021 95% CI = 0.005–0.087), lower OTS (p < 0.001, OR = 27.034, 95% CI = 6.299–116.021), presence of concomitant retinal detachment (p < 0.001, OR = 0.157, 95% CI = 0.080–0.306), and endophthalmitis (p = 0.045, OR = 0.207, 95% CI = 0.044–0.962) were found to be related to poor visual prognosis. Cases with OGI caused by a sharp object (p = 0.007, OR = 0.204, 95% CI = 0.065–0.641) and those injured by a glass (p = 0.039, OR = 0.229, 95% CI = 0.056–0.931) had more favorable final vision. This study highlights that baseline BCVA, wound size, RAPD, retinal detachment, and OTS were the most significant markers for poor visual outcomes in both the entire population and pediatric subgroup. In cases with OGI, OTS was also found effective in predicting visual prognosis.

The Epidemiological Profile of Open Globe Injuries and Prognostic Factors in a Tertiary Care Centre

“…In this study, poor presenting visual acuity is significantly associated with poor post-operative visual outcomes. This is in accordance with other studies that showed presenting VA is the most important prognostic factor in determining visual outcome [2][3][4][5]. Presence of RAPD and vitreous loss were statistically significant to predict post-operative visual outcomes in this study.…”

“…This reflects the predominant involvement of men in higher-risk activities namely work or sports-related activities and motor vehicle accidents. The majority of patients were in the younger age group (less than 40 years old) which is also similar to other studies till date [ 2 - 4 ].…”

“…In most population-based studies, there is a strong tendency for open globe injuries to involve male [2][3][4][5][8][9][10][11][12][13][14][15]. Similarly in this study, male was the predominant gender.…”

“…Presence of RAPD and vitreous loss were statistically significant to predict post-operative visual outcomes in this study. The final visual outcome was worse if there was the presence of RAPD as seen in other studies [2][3][4][5]. Presence of vitreous loss was reported to be associated with poor visual outcome [8,[13][14][15].…”

“…Counselling and prognostication become an integral part of managing ocular trauma prior and after surgical repair of open globe injuries. The predictive factors for visual outcome after open globe injuries include pre-operative visual acuity (VA), relative afferent pupillary defect (RAPD), size and location of wound, uveal or vitreous prolapse, lens damage, hyphaema, presence of intraocular foreign body (IOFB) and number of surgeries done [2][3][4][5]. Based on extensive literature review, there is limited data on the epidemiology and outcome of open globe injuries in Malaysia.…”