RESUMO
PURPOSE: The aim of this study was to investigate the predictive factors for evisceration or enucleation surgery after open globe injury (OGI) and to investigate the effectiveness of the ocular trauma score (OTS) in predicting the outcome. METHOD: Data from 380 patients who underwent OGI repair were retrospectively analyzed. The eyes of 31 patients who underwent evisceration or enucleation after OGI repair and who were followed up for at least 6 months were included in the study. Demographic characteristics, presence of rupture, penetrating injury, endophthalmitis, retinal detachment and afferent pupillary defect were evaluated and OTS was calculated. The etiology of OGI, the interval between OGI repair and evisceration, the presence of eyelid and canalicular laceration, orbital fractures, prolapsed choroidal tissue, and the presence of foreign bodies were also analyzed. The size of the sphere after evisceration/enucleation, the need for revision surgery and the time to revision surgery were evaluated. RESULTS: Of the 380 patients, 31 (8.15%) underwent evisceration or enucleation after OGI. 19 of 31 patients underwent evisceration after primary repair of OGI, 10 patients underwent evisceration without OGI repair; 1 patient underwent enucleation after OGI repair and 1 patient underwent enucleation without OGI repair. The mean OTS was 37.95 in the group with evisceration/enucleation after OGI repair and 29.55 in the group without repair. The mean interval between OGI and evisceration was 2.4±5.9 (0-13) months. The etiology of 10 (32.2%) OGIs were traffic accidents, 9 (29%) were penetrating trauma with cutting or penetrating instruments, 8 (25.8%) were blunt trauma, and 4 (12.9%) were gunshot wounds. The mean follow-up time was 38.9±23.59 (6-72) months. There was no significant difference in OTS according to age, gender, affected side and etiology. Although OTS was lower in patients with additional injuries than in those without, the difference not statistically significant. There was a statistically significant decrease in OTS from zone 1 (cornea and limbus) to zone 3 (posterior to 5mm from the limbus) (P=0.015, r=-0.433). CONCLUSION: The decision and consent for evisceration/enucleation after an open globe injury is very difficult for both patients and physicians. We believe that the presence of the injury in zone 3 and the presence of rupture are poor prognostic factors and that an OTS below 49 could be a risk factor for evisceration/enucleation. In conclusion, the OTS could be an objective parameter that provides an objective idea of visual rehabilitation and prognosis and helps in decision making for further surgery.
RESUMO
OBJECTIVE: To determine the efficacy of ocular trauma score (OTS) in determining the prognosis in patients with open globe injury who admitted to our clinic. MATERIALS AND METHODS: Data of patients with open globe injury who were admitted to our clinic between 2014 and 2016 were retrospectively analyzed. The OTS raw score of each patient was determined and translated into OTS categories according to OTS study. Prognostic results of OTS study and current study was compared with chi square analysis. RESULTS: In our study, 101 eyes of 101 patients were examined. The mean age of the patients was 27.08±15.36 years. The mean follow-up period was 12.84±9.04 months. In total, 86 of the cases were male (85.1%). In our study, the mean initial visual acuity of the patients was 0.10±0.23. In 64.3% of the cases, IVA was at hand movement level or lower. IVA was found to be≥20/40 in 10.9%. The mean FVA was 0.38±0.37. In total, 41.6% of the cases had a FVA≥20/40. In 28.7% of these cases, FVA was at hand movement level or lower. While no significant difference was found in patients with OTS3, OTS 4 and OTS 5 (P>0.05), prognosis of patients with OTS 1 and OTS 2 was better than OTS study (P<0.001) CONCLUSION: Although OTS can be effective and safe data in terms of prognosis, it can be improved with more comprehensive studies.