Plasma Photoinactivation of Bacterial Isolated from Blood Donors Skin: Potential of Security Barrier in Transfusional Therapy.

The presence of skin bacteria capable of forming biofilm, exhibiting antibiotic resistance, and displaying virulence represents a significant challenge in the field of transfusion medicine. This underscores the necessity of enhancing the microbiological safety of blood and blood components against pathogens with virulent characteristics. The aim of this work was to demonstrate bacterial inactivation in plasma by using a photoinactivation method against virulent bacteria and to evaluate coagulation factors before and after treatment. Logarithmic loads of biofilm-producing, antibiotic-resistant, and virulent bacteria isolated from skin (Enterobacter cloacae, Klebsiella ozaenae, and Staphylococcus epidermidis) were used in artificial contamination assays of fresh frozen plasma bags and subjected to photoreduction. FVIII and FI activity were evaluated before and after photoinactivation. The photoinactivation of plasma was demonstrated to be an effective method for the elimination of these bacteria. However, the efficiency of this method was found to be dependent on the bacterial load and the type of test microorganism. Conversely, decay of coagulation factors was observed with net residual activities of 61 and 69% for FVIII and FI, respectively. The photoinactivation system could have a bias in its effectiveness that is dependent on the test pathogen. These findings highlight the importance of employing technologies that increase the safety of the recipient of blood and/or blood components, especially against virulent bacteria, and show the relevance of the role of photoinactivation systems as an option in transfusion practice.

Molecular Characterization of Bacterial Agents Causing External Ocular Infections Isolates of Patients in a Third Level Hospital.

Empirical use of antibiotics in the treatment of eye infections leads to bacterial pathogens becoming resistant to antibiotics; consequently, treatment failure and eye health complications occur. The aim of this study was to describe the phenotype and genotype of the resistance and adherence of bacterial agents causing eye infections in patients at Hospital Juárez de México. An observational, prospective, cross-sectional, and descriptive study was carried out in patients with signs and symptoms of ocular infection. Bacterial agents were isolated and identified by classical microbiology and mass spectrometry. Antibiotic resistance and adherence profiles were determined. Finally, resistance (mecA/SCCmec) and virulence (icaA and icaD) genes were detected in the Gram-positive population. The results showed that blepharitis was the most prevalent condition in the study population. A MALDI-TOF analysis revealed that Staphylococcus and Pseudomonas genus were the most prevalent as causal agents of infection. Resistances to ß-lactams were detected of 44 to 100%, followed by clindamycins, aminoglycosides, folate inhibitors, and nitrofurans. A multiple correspondence analysis showed a relationship between mecA genotype and ß-lactams resistance. The identification of SCCmecIII and SCCmecIV elements suggested community and hospital sources of infection. Finally, the coexistence of icaA+/icaD+/mecA(SCCmecIII) and icaA+/icaD+/mecA(SCCmecIV) genotypes was detected in S. aureus. The identification of resistant and virulent isolates highlights the importance of developing protocols that address the timely diagnosis of ocular infections. Herein, implications for the failure of antimicrobial therapy in the treatment of ocular infections in susceptible patients are analysed and discussed.

Cambios retinianos periféricos detectados mediante fotografía no midriática de campo ultra amplio en sujetos asintomáticos / Peripheral retinal changes detected by ultra-widefield non-mydriatic photography in asymptomatic subjects

Resumen Objetivo: La fotografía de campo ultra amplio no requiere midriasis, evalúa 200° de la retina y es adecuada para detectar cambios desapercibidos, con riesgo de desprendimiento de retina en individuos asintomáticos; se identificó la frecuencia de cambios periféricos retinianos y cambios con riesgo de desprendimiento de retina, en una muestra de sujetos fáquicos asintomáticos. Materiales y Métodos: Estudio no experimental, analítico, prospectivo, transversal en sujetos con edades de 40-70 años, de cualquier sexo, sin cirugía intraocular previa o síntomas de desgarros retinianos (fotopsias, eritropsia, escotoma periférico). Se obtuvieron imágenes de campo ultra amplio de retina (sin midriasis) con el equipo Optos y se identificó la proporción e intervalos de confianza (I.C.) del 95% de la muestra que tuvo cambios en la retina periférica y cambios con riesgo de desprendimiento de retina (agujeros retinianos, desprendimiento de retina subclínico). Se comparó esta proporción entre sexos y grupos de edad (χ2). Resultados: 1204 ojos de 602 sujetos (promedio de edad 52,92 desviación estándar D.E. ± 7,83 años), 74,41% de los sujetos fueron del sexo femenino. El 16,61% de la muestra presentó cambios periféricos retinianos (I.C. 95% 13,64- 19,58), el 1% de la muestra tuvo cambios con riesgo de desprendimiento de retina. Los cambios periféricos fueron más frecuentes en el grupo de edad de 50-59 años y en mujeres. La miopia superior a -6,00 dioptrías fue infrecuente en ojos con riesgo de desprendimiento de retina. Conclusiones: La fotografía de campo ultra amplio ayuda a demostrar, sin necesidad de dilatar la pupila, que existe una prevalencia baja de cambios retinianos periféricos y cambios con riesgo de desprendimiento de retina en sujetos fáquicos asintomáticos.

Abstract Objective: Ultra wide field photography requires no mydriasis, evaluates 200° of the retina and is adequate to detect overlooked retinal changes, with a risk of retinal detachment in asymptomatic subjects; we identified the frequency of peripheral retinal changes and changes with risk of retinal detachment, in a sample of asymptomatic phakic subjects. Materials and methods: Non-experimental, analytical, prospective, cross- sectional study in subjects aged 40-70 years, of any gender, without previous intraocular surgery or symptoms of retinal tears (photopsia, eritrhopsia, peripheral scotoma). We obtained ultra wide field retinal photographs (without mydriasis) with the Optos device and identified the proportion and 95% confidence intervals (C.I.) of the sample that had peripheral retinal changes and changes with risk of retinal detachment (retinal holes, subclinical retinal detachments). This proportion was compared between genders and age groups (χ2). Results: 1204 eyes of 602 subjects (mean age 59,92 standard deviation ± 7,83 years), 74,41% of the subjects were female. 16,61% of the sample had peripheral retinal changes (95% C.I. 13,64-19,58), 1% of the sample has changes with risk of retinal detachment. Peripheral retinal changes were more frequent in the 50-59 years age group and in women. Myopia over -6.00 diopters was infrequent in eyes with risk of retinal detachment. Conclusions: Ultra wide field photography helped to prove, without the need of mydriasis, that there is a low prevalence of peripheral retinal changes and changes with risk of retinal detachment, in phakic asymptomatic subjects.

Compensatory contribution of retinal larger vessels to perfusion density in diabetics without retinopathy.

Vessel and perfusion densities may decrease before diabetic retinopathy appears; it is unknown whether these changes affect the contribution of vessel density to perfusion density. This was a non-experimental, comparative, prospective, cross-sectional study in non-diabetic subjects (group 1) and diabetics without retinopathy (group 2). Vessel and perfusion densities in the superficial capillary plexus were compared between groups at the center, inner, and full regions and by field (superior, temporal, inferior, nasal) using optical coherence tomography angiography. Coefficients of determination (R2) between vessel and perfusion densities were calculated to find the contribution of larger retinal vessels to perfusion density. Percent differences were used to evaluate the contribution of these vessels to perfusion density in a regression model. There were 62 participants, 31 eyes by group; vessel and perfusion densities as well as the coefficients of determination between them were lower in group 2, especially in the nasal field (R2 0.85 vs. 0.71), which showed a higher contribution of larger retinal vessels to perfusion density. The regression model adjusted to a quadratic equation. In diabetics without retinopathy the contribution of vessel density to perfusion density may decrease; a low vessel density may increase the contribution of larger retinal vessels to perfusion density.

[Comparación de la densidad capilar parafoveal entre sujetos sanos y diabéticos con y sin retinopatía].

BACKGROUND: Parafoveal capillary density changes have not been characterized in type 2 diabetics without retinopathy. OBJECTIVE: To compare parafoveal capillary density between healthy subjects, and diabetics with and without retinopathy. METHOD: Observational, prospective, transversal and comparative study; subjects without diabetes (group 1), diabetics without retinopathy (group 2), with retinopathy (group 3) and with diabetic macular edema (group 4), without macular ischemia, were included. The study variable was parafoveal capillary density, and the predictor variables were the measures of the foveal avascular zone, retinal thickness and the group. The variables were compared between groups using Kruskal-Wallis and Spearman's Rho tests. RESULTS: One hundred and forty eyes were evaluated; parafoveal capillary density was higher in group 1 than in the rest (p < 0.05). Area, perimeter and diameter of the foveal avascular zone were higher in group 3. A positive correlation existed a positive between parafoveal capillary density and central field thickness in groups 1, 2 and 3. CONCLUSION: Parafoveal capillary density decreases as diabetes-induced damage increase; a reduction may exist in diabetics without retinopathy and normal retinal thickness and foveal avascular zone are normal. The clinical impact of this finding requires further evaluation.

ANTECEDENTES: Los cambios de densidad parafoveal no se han caracterizado en diabéticos tipo 2 sin retinopatía. OBJETIVO: Comparar la densidad capilar parafoveal entre sujetos sanos y diabéticos con y sin retinopatía. MÉTODO: Estudio observacional, prospectivo, transversal y comparativo. Se incluyeron sujetos sin diabetes (grupo 1), diabéticos tipo 2 sin y con retinopatía (grupos 2 y 3), y con edema macular (grupo 4), sin isquemia macular. La variable de estudio fue la densidad capilar parafoveal, y las variables predictoras fueron las mediciones de la ZAF, el grosor retiniano y el grupo. Se compararon las diferencias entre grupos mediante las pruebas de Kruskal-Wallis y Rho de Spearman. RESULTADOS: 144 ojos; la densidad capilar parafoveal del grupo 1 superó la de los restantes (p < 0.05). El área, el perímetro y el diámetro de la ZAF fueron mayores en el grupo 3. Existió correlación positiva entre la densidad capilar parafoveal y el grosor del campo central en los grupos 1, 2, y 3. CONCLUSIONES: La densidad capilar parafoveal disminuye conforme avanza el daño por diabetes tipo 2; puede existir una reducción en sujetos con diabetes sin retinopatía, con grosor retiniano y ZAF normales. El impacto clínico de este hallazgo requiere evaluación adicional.

[Efficacy of dorzolamide in reducing retinal thickness after photocoagulation in diabetic macular oedema]. / Eficacia de la dorzolamida para reducir el grosor retiniano después de fotocoagulación en el edema macular diabético.

BACKGROUND: Focal photocoagulation interrupts vascular leakage in diabetic macular edema, and allows the retinal pigment epithelium to withdraw fluid that thickens the retina; this mechanism could be enhanced by dorzolamida, a topical carbonic anhydrase inhibitor. OBJECTIVE: To determine the efficacy of dorzolamida compared against placebo, in reducing retinal thickness after focal photocoagulation, in eyes with diabetic macular oedema. MATERIAL AND METHODS: Experimental, comparative, prospective, longitudinal, double blind study in diabetics with focal macular oedema treated with photocoagulation. Treated eyes were randomly assigned three weeks after the procedure to receive dorzolamide (group 1) or placebo (group 2), three times daily during three weeks. Means of visual acuity, center point thickness and macular volume were compared 3 and 6 weeks after photocoagulation within groups (Wilcoxon's t) and between groups (Mann-Whitneys's U). RESULTS: Sixty-nine eyes form patients aged 58.3 ± 8.3 years; 37 were assigned to group 1 and 42 to group 2. Mean center point thickness changed from 178.4 ± 34µm to 170 ± 29.1µm in group 1 (p = 0.04), and from 179.2 ± 22.4µm to 178.6 ± 20.8µm in group 2 (p = 0.7); mean macular volume changed from 7.63 ± 0.52mm(3) to 7.50 ± 0.50mm(3) in group 1 (p = 0.02) and from 7.82 ± 0.43mm(3) to 7.76 ± 0.42mm(3) in group 2 (p = 0.014). CONCLUSIONS: The efficacy of dorzolamide was higher than that of placebo, to reduce retinal thickness after focal photocoagulation in diabetics with macular oedema.

[Impact of follow-up loss over visual deficiency in open-globe ocular trauma]. / Impacto de la pérdida de seguimiento sobre la deficiencia visual en trauma ocular con globo abierto.

INTRODUCTION: Open-globe ocular trauma causes visual deficiency; calculating the magnitude of the latter often misses the estimation in patients without follow-up. AIM: to identify the modification of the postoperative proportion of visual deficiency in open-globe ocular trauma, which would introduce considering the proportion estimated in patients without follow-up. METHODS: Non-interventional, retrospective, longitudinal, analytical study. Visual outcome in eyes with open-globe trauma, with and without follow-up, was calculated using the Ocular Trauma Score. The observed postoperative proportion of visual deficiency was identified in eyes with follow-up; in eyes without follow-up, the postoperative proportion of visual deficiency was estimated using an analysis of scenarios: best (Ocular Trauma Score), mean (that of eyes with follow-up) and worst (last observation/no visual improvement). The estimated proportion of visual deficiency was added to that observed in eyes with follow-up, and the resulting proportion was compared with that expected in the sample, using the Ocular Trauma Score (χ(2)). RESULTS: 104 eyes, 70 without follow-up and 34 without it. In eyes with follow-up the expected proportion of visual deficiency was 58.6%, and the observed one was 71.4% (p = 0.1); the estimated proportion of visual deficiency in eyes without follow-up was 76.5%. The resulting postoperative proportion of visual deficiency in the sample would be 73.1%, which would overcome that expected by the Ocular Trauma Score (59.6%, p = 0.04). CONCLUSIONS: In open-globe ocular trauma, the efficacy of surgery to reduce the proportion of visual deficiency would decrease with regard to the standard expected by the Ocular Trauma Score, if the deficiency estimated in eyes without follow-up were considered.

Disparity between foveal thickness and macular volume in diabetic macular edema.

BACKGROUND: Optical coherence tomography (OCT) quantifies changes of foveal thickness and macular volume after photocoagulation in diabetic macular edema. Macular volume evaluates the whole macula, but it may underestimate changes in foveal thickness induced by photocoagulation. We undertook this study to evaluate the concordance between macular volume and foveal thickness for identifying clinically significant changes of retinal thickness after photocoagulation for diabetic macular edema. METHODS: We carried out an observational, retrospective, longitudinal, analytical study. Center point thickness (CPT), central subfield mean thickness (CSMT) and macular volume were measured with OCT before photocoagulation and 3 weeks after in diabetic patients with focal macular edema (January 2006--January 2010). Concordance among variables to detect clinically significant changes (CPT >17%, CSMT >11%, macular volume >3%) was identified using the kappa test. RESULTS: Sixty eight eyes were included; 47 eyes had nonproliferative retinopathy (69.1%). CPT increased significantly in 14.7% of the sample; CSMT in 8.8%, and macular volume in 11.8%. CPT decreased significantly in 4.4%, CSMT in 8.8%, and macular volume in 42.6%. Concordance was regular for CPT and CSMT increased (57%). Concordance was good for CPT and CSMT decreased (64%). Concordance was regular for CSMT and macular volume decreased in eyes with center involvement (43%). The remaining concordances were poor. DISCUSSION: Two independent events happen after focal photocoagulation: involution of the original thickening and increase in CPT. In order to detect both events, evaluation of either foveal thickness alone or macular volume alone is insufficient. CONCLUSION: Identifying the efficacy and safety of treatments for diabetic macular edema requires simultaneous measurement of CPT and macular volume.

[Efficacy of clinical evaluation in diagnosing injury zone in open globe ocular trauma]. / Eficacia de la evaluación clínica como prueba diagnóstica para identificar la zona de lesiónen un traumatismo ocular abierto.

BACKGROUND: Risk of retinal damage in open globe eye injuries increases as the zone (location of the wound vertex) is more rearward. The value of clinical exploration to assess this variable is unknown. OBJECTIVE: To establish the efficacy of clinical exploration as a diagnostic test to identify the injury zone in open globe ocular trauma. METHODS: Assessment of patients with open globe ocular trauma, preoperative clinical assessment of injury zone and surgical description of the wound were carried out. The proportion and 95% confidence intervals (CI) of eyes whose zone changed during surgical repair were established, and the efficacy of clinical evaluation to diagnose zone was estimated. Features of eyes with and without zone change were compared using χ(2) test. RESULTS: 89 eyes, mean age 27.1 years. Clinically, the identified zone was I in 36 eyes (40.4%), II in 38 (31.5%) and III in 25 (28.1%); the identified zone during surgery was I in 36 eyes (40.4%), II in 43 (48.3%) and III in 10 (11.2%). Zone changed in 30 eyes (34%, 95% C.I. 24 to 44). Specificity (96%), positive predictive value (93%) and positive likelihood ratio (13.9) were high only for zone II. No feature was associated with zone change. CONCLUSIONS: Clinical exploration was not efficient enough to identify injury zone in open globe trauma and has low prognostic value. It is not necessary to define the injury zone at first contact; it is enough identifying properly the agent, visual function and pupil reflexes for an efficient assessment.

Severity distribution of diabetic macular edema at the time of diagnosis.

BACKGROUND: The International Clinical Diabetic Macular Edema Disease Severity Scale grades retinal thickening according to its distance from the macular center, but its definitions have not been standardized quantitatively. We undertook this study to identify the severity distribution of diabetic macular edema at the time of diagnosis. We used optical coherence tomography (OCT) in a standardized manner and identified the proportion of eyes that required immediate treatment. METHODS: We carried out an observational, prospective, cross-sectional, descriptive study. Diabetic patients with a diagnosis of clinically significant macular edema were evaluated. Severity levels according to the International Clinical Scale were operatively defined, guided by the thickening location in a 6-mm OCT fast macular map, as mild (thickening outside the 3-mm circle), moderate (thickening outside the 1-mm circle), and severe (thickening within the 1-mm circle). The proportion and 95% confidence intervals (CI) were identified for each severity level. RESULTS: We studied 118 eyes (mean ± SD: 59.9 ± 8.3 years). Seventy one eyes had nonproliferative retinopathy (60.1%), 94 eyes (79.7%) had focal macular edema, and 24 eyes (20.3%) showed diffuse edema. Edema severity was mild in 27 eyes (22.9%, 95% CI 15.3-30.5), moderate in 23 (19.5%, 95% CI 12.3-26.6) and severe in 68 (57.6% 95% CI 48.7-66.5). CONCLUSIONS: Standardization of the International Clinical Scale using OCT showed that the most common severity level of macular edema was severe; the minimum expected proportion of eyes with high risk of visual loss secondary to severe edema approached 50%. Opportune detection needs reinforcement because more than half of these eyes require immediate treatment.

Does the probability of developing ocular trauma-related visual deficiency differ between genders?

BACKGROUND: Ocular trauma affects males more often than females, but the impact of this condition regarding visual prognosis is unknown. We undertook this study to compare the probability of developing ocular trauma-related visual deficiency between genders, as estimated by the ocular trauma score (OTS). METHODS: We designed an observational, retrospective, comparative, cross-sectional and open-label study. Female patients aged ≥6 years with ocular trauma were included and matched by age and ocular wall status with male patients at a 1:2 male/female ratio. Initial trauma features and the probability of developing visual deficiency (best corrected visual acuity <20/40) 6 months after the injury, as estimated by the OTS, were compared between genders. The proportion and 95% confidence intervals (95% CI) of visual deficiency 6 months after the injury were estimated. Ocular trauma features and the probability of developing visual deficiency were compared between genders (χ(2) and Fisher's exact test); p value <0.05 was considered significant. RESULTS: Included were 399 eyes (133 from females and 266 from males). Mean age of patients was 25.7 ± 14.6 years. Statistical differences existed in the proportion of zone III in closed globe trauma (p = 0.01) and types A (p = 0.04) and type B (p = 0.02) in open globe trauma. The distribution of the OTS categories was similar for both genders (category 5: p = 0.9); the probability of developing visual deficiency was 32.6% (95% CI = 24.6 to 40.5) in females and 33.2% (95% CI = 27.6 to 38.9) in males (p = 0.9). CONCLUSIONS: The probability of developing ocular trauma-related visual deficiency was similar for both genders. The same standard is required.

[Expected effect of treatment on the rate of visual deficiency after ocular trauma]. / Efecto esperado del tratamiento del trauma ocular sobre la proporción inicial de deficiencia visual.

BACKGROUND: Ocular trauma (OT) is a common cause of monocular blindness and visual impairment worldwide. The Ocular Trauma Score (OTS) is a scale that estimates visual function that an injured eye can achieve 6 months after OT. In a sample population, the OTS may be useful to compare the expected functional result with the result of therapeutic interventions in OT. We undertook this study to identify the expected effect of treatment on the rate of visual deficiency 6 months after OT. METHODS: The rate of eyes with trauma-related visual deficiency (best corrected visual acuity <20/40) at the time of diagnosis was compared with that estimated 6 months later using the OTS (95% confidence intervals, CI). RESULTS: We evaluated 742 patients; 46% had visual deficiency initially (95% CI 43-50.2) and 32.1% would demonstrate it 6 months later (95% CI 28.7-35.4, p <0.001, OR 0.54). The rate changed from 29.1 to 18% in closed-globe (CG) trauma and from 84.3 to 63% in open-globe (OG) trauma. CONCLUSIONS: Treating OT would reduce the proportion of visual deficiency by 14.5 percentage points (11 in CG, 21.3 in OG trauma). Up to 66% of the injured eyes could reach normal vision. OT prevention requires enhancement because a high rate of eyes would remain disabled despite receiving the best available treatment.

Ocular trauma score at the initial evaluation of ocular trauma.

BACKGROUND: The system for classifying mechanical injuries of the eye can identify the status of an injured eye at the trauma room, but it has no prognostic value. The ocular trauma score (OTS) estimates the 6-month visual prognosis, but some of its variables require evaluation by an ophthalmologist. We identified the proportion of injured eyes without diseases that required assessment of an ophthalmologist during the initial evaluation in order to determine whether the OTS could be used by non-ophthalmologists at the trauma room. METHODS: We evaluated patients with ocular trauma who attended a general hospital in Mexico City between 1995 and 2008 and graded them with the system for classifying mechanical injuries of the eye. The rate of eyes with retinal detachment and endophthalmitis that needed evaluation by an ophthalmologist was identified, and all the eyes were assigned an OTS category. The proportion and 95% confidence intervals (95% CI) of eyes that could be graded using the OTS in a trauma room was determined. RESULTS: We evaluated 742 eyes. Retinal detachment was found in six eyes (0.8%, 95% CI 0.16-1.44) and endophthalmitis in two eyes (0.3%, 95% CI 0-0.69). The proportion of eyes that could be graded using the OTS in a trauma room was 98.9% (95% CI 98.15-99.65). CONCLUSIONS: OTS can be used to estimate the visual prognosis of almost every injured eye during the initial evaluation in a trauma room without the evaluation of an ophthalmologist.

Ocular trauma score para la evaluación inicial del trauma ocular / Ocular trauma score at the initial evaluation of ocular trauma

Introducción: El sistema de clasificación de lesiones mecánicas oculares establece el estado del ojo lesionado pero no tiene valor pronóstico. El objetivo de esta investigación fue identificar la proporción de ojos lesionados sin alteraciones que requirieron la participación del oftalmólogo durante la evaluación inicial, para saber si el ocular trauma score (que estima el pronóstico visual a los seis meses) pudiera ser empleado por médicos no oftalmólogos en la sala de trauma. Material y métodos: Con el sistema de clasificación de lesiones mecánicas oculares se evaluaron pacientes con trauma ocular atendidos en un hospital general de la ciudad de México entre 1995 y 2008. Se identificó la proporción de ojos que requería la evaluación por el oftalmólogo por desprendimiento de retina o endoftalmitis. A todos los ojos se les asignó una categoría del ocular trauma score. Se determinó la proporción y el intervalo de confianza de 95% de los ojos en que podría aplicarse el ocular trauma score en la sala de trauma. Resultados: Se evaluaron 742 ojos. Seis presentaron desprendimiento de retina (0.8%, IC 95% 0.16-1.44) y dos endoftalmitis (0.3%, IC 95% 0-0.69). La proporción de ojos en que podría aplicarse el ocular trauma score en la sala de trauma fue de 98.9% (IC 95% 98.15-99.65). Conclusiones: El ocular trauma score puede utilizarse en casi todos los ojos lesionados para estimar el pronóstico visual durante la evaluación inicial en la sala de trauma, sin la participación de un oftalmólogo.

BACKGROUND: The system for classifying mechanical injuries of the eye can identify the status of an injured eye at the trauma room, but it has no prognostic value. The ocular trauma score (OTS) estimates the 6-month visual prognosis, but some of its variables require evaluation by an ophthalmologist. We identified the proportion of injured eyes without diseases that required assessment of an ophthalmologist during the initial evaluation in order to determine whether the OTS could be used by non-ophthalmologists at the trauma room. METHODS: We evaluated patients with ocular trauma who attended a general hospital in Mexico City between 1995 and 2008 and graded them with the system for classifying mechanical injuries of the eye. The rate of eyes with retinal detachment and endophthalmitis that needed evaluation by an ophthalmologist was identified, and all the eyes were assigned an OTS category. The proportion and 95% confidence intervals (95% CI) of eyes that could be graded using the OTS in a trauma room was determined. RESULTS: We evaluated 742 eyes. Retinal detachment was found in six eyes (0.8%, 95% CI 0.16-1.44) and endophthalmitis in two eyes (0.3%, 95% CI 0-0.69). The proportion of eyes that could be graded using the OTS in a trauma room was 98.9% (95% CI 98.15-99.65). CONCLUSIONS: OTS can be used to estimate the visual prognosis of almost every injured eye during the initial evaluation in a trauma room without the evaluation of an ophthalmologist.