ABSTRACT
PURPOSE: We explored the associations between socioeconomic status, as evaluated by the Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry Social Vulnerability Index (SVI), and characteristics of open globe injury (OGI) in a Level I trauma center during the COVID-19 pandemic. METHODS: Retrospective review of electronic medical records of patients who underwent OGI evaluation and repair at Harborview Medical Center between March/2017 and March/2021. Demographic data and patient characteristics were recorded. The SVI was obtained based on the patient's home address. Patients were grouped into the "historical" (pre-COVID) cohort, including dates from March 2017 - March 2020, and the "COVID" cohort, including dates from March 2020 - March 2021. RESULTS: 318 patients (77.4% male) were included. Average ± S.D. age (years) and SVI scores were 44.7 ± 22.7 and 0.413 ± 0.195, respectively. SVI scores were significantly higher (more vulnerable) during the COVID-19 pandemic compared to years prior (p = 0.017), however when compared to scores for the same patients prior to the pandemic, no difference was found (p = 0.609). There was no significant difference between intentional and non-intentional trauma, work-related injuries, OGI type, presence of endophthalmitis, or ocular trauma score (p ≥ 0.293). Still, significantly fewer motor vehicle-associated (MVA) OGIs occurred during the pandemic (p = 0.041). CONCLUSIONS: Patients with OGI during the COVID-19 pandemic had higher SVI scores, however when considering the overall effect of the pandemic, our findings are likely reflective of the societal changes at large. There was no identifiable impact on the mechanisms or characteristics of ocular injuries, except for fewer MVA injuries.
Subject(s)
COVID-19 , SARS-CoV-2 , Social Class , Humans , COVID-19/epidemiology , Male , Female , Retrospective Studies , Adult , Middle Aged , Eye Injuries, Penetrating/epidemiology , Pandemics , Aged , Trauma Centers/statistics & numerical data , Young Adult , AdolescentABSTRACT
Ocular trauma, a preventable public health issue, is one of the common causes of ophthalmic morbidity and monocular blindness worldwide. It can occur in almost any setting and at any age in either sex but largely affects males. The mechanism and type of injury, the extent of damage, and the time-lapse between the occurrence of injury and eye care are among the factors that determine the visual outcome of ocular injuries. This study is designed to assess the clinical profile and visual outcome of patients presenting with penetrating ocular injury. A prospective hospital-based study was conducted among penetrating ocular trauma patients who visited UOG tertiary eye care and training center during the study period. All patients with penetrating ocular trauma who fulfilled the inclusion criteria were included in the study. Data on demography, initial and final visual acuity, type of injury, as well as management, were included in a structured questionnaire. The collected data were processed and analysed using Statistical Packages for the Social Sciences (SPSS) version 25.0. The study included 91 cases of penetrating ocular injuries. The majority of the patients 81.2% were males. The male-to-female ratio was 4.3:1. The left eye was involved in 52.7% of the patients. The median age was 20 years, with an IQR of 10-35. The majority (31.9%) of the cases were in the age range of 5-10 years. nearly half of the study participants (45.1%) sustained the injury at home. The commonest source of injury was wooden sticks 49.5%. Six patients were lost to follow-up at three-month visits. Traumatic cataracts (p = 0.001), and poor initial visual acuity were poor prognostic factors. Still ocular injury is a common cause of monocular blindness. We recommend that more has to be done on the primary prevention and control measures.
Subject(s)
Eye Injuries, Penetrating , Visual Acuity , Humans , Male , Female , Adult , Adolescent , Eye Injuries, Penetrating/epidemiology , Child , Young Adult , Prospective Studies , Ethiopia/epidemiology , Middle Aged , Hospitals, Special , Blindness/etiology , Blindness/epidemiologyABSTRACT
The purpose of this study was to examine how demographics, etiology, and clinical examination findings are related to visual outcomes in subjects with open globe injury (OGI) across a large and generalizable sample. A retrospective cohort analysis was performed using data collected from the electronic medical records of four tertiary university centers for subjects with OGI presenting from 2018 to 2021. Demographic information, injury mechanisms, clinical exam findings, visual acuity (VA) at presentation and most recent follow-up were recorded. In subjects with bilateral OGIs, only right eyes were included. A modified ocular trauma score (OTS) using presenting VA, the presence of perforating injury, OGI, and afferent pupillary defect was calculated. The risk of subjects' demographic characteristics, ocular trauma etiology, clinical findings and modified OTS on the presence of monocular blindness at follow-up were assessed using univariable and multivariable regression models. 1426 eyes were identified. The mean age was 48.3 years (SD: ± 22.4 years) and the majority of subjects were men (N = 1069, 75.0%). Univariable analysis demonstrated that subjects of Black race were 66% (OR: 1.66 [1.25-2.20]; P < 0.001) more likely to have monocular blindness relative to White race at follow-up. OTS Class 1 was the strongest predictor of blindness (OR: 38.35 [21.33-68.93]; P < 0.001). Based on multivariable analysis, lower OTS category (OTS Class 1 OR: 23.88 [16.44-45.85]; P < 0.001) moderately predicted visual outcomes (R2 = 0.275, P < 0.001). OGI has many risks of poor visual outcome across patient groups that vary by demographic category, mechanism of injury, and clinical presentation. Our findings validate that a modified OTS remains a strong predictor of visual prognosis following OGI in a large and generalizable sample.
Subject(s)
Eye Injuries, Penetrating , Visual Acuity , Humans , Male , Female , Middle Aged , Adult , Retrospective Studies , Eye Injuries, Penetrating/epidemiology , Eye Injuries, Penetrating/complications , Aged , Blindness/etiology , Blindness/epidemiology , Young Adult , AdolescentABSTRACT
The characteristics of patients with endophthalmitis due to penetrating ocular trauma are still limited. The aim of the study was to fill these gaps among Chinese population. This retrospective study included patients diagnosed as penetrating ocular traumatic endophthalmitis between January 2016 to December 2018. During the past 3-year period, a total of 201 patients with antecedent penetrating eye injuries were evaluated. Of which, 42 (20.9%) patients presented a clinical course compatible with acute infectious endophthalmitis. 39 (92.86%) patients were males, and 15 (35.71%) patients had mechanical injuries from intraocular foreign body (IOFB), the rate of endophthalmitis due to IOFB was 13.43%, higher to the rate among patients without IOFB (7.46%). The duration between injury occurrence and endophthalmitis onset was 1 day in 10 (23,80%) patients; 2 to 7 days in 31 (73.80%) patients, and 7 to 14 days in 1 (2.38%) patient. After 1 year follow-up, best corrected visual acuity (BCVA) better than 20/400 was observed in 15 (35.71%) patients, counting fingers and hand move in 17 (40.48%) patients, light perception in 5 (11.9%) patients and no light perception in 5 (11.9%) patients, respectively. Patients with promising outcomes had better initial BCVA at baseline (Pâ <â .001). Endophthalmitis is a severe ocular infectious condition that may lead to irreversible vision loss. A greater attention must be paid to penetrating eye injuries within males, who had poor BCVA at baseline, particularly with obvious IOFB.
Subject(s)
Endophthalmitis , Eye Foreign Bodies , Eye Injuries, Penetrating , Visual Acuity , Humans , Endophthalmitis/epidemiology , Endophthalmitis/etiology , Male , Eye Injuries, Penetrating/epidemiology , Eye Injuries, Penetrating/complications , Female , Retrospective Studies , Adult , Eye Foreign Bodies/epidemiology , Middle Aged , China/epidemiology , Young Adult , AdolescentABSTRACT
INTRODUCTION: Open globe injuries are a major cause of visual impairment in children, related to the severity of the trauma or secondary to induced amblyopia. Intraocular foreign bodies (IOFB) have been reported in approximately one third of cases of open globe injuries. As clinical presentation and management may differ between adults and children, data is lacking about IOFBs in children under 18years of age. The purpose of this study was to assess the clinical characteristics and visual prognosis of ocular trauma associated with intraocular foreign bodies in children. MATERIALS AND METHODS: This single-center retrospective study included patients under 18years of age treated for ocular trauma with IOFB. Demographic characteristics, complete initial and final ophthalmological examination, imaging data and details of medical and surgical management were collected. RESULTS: Fourteen patients were included (78.6% boys), with a mean age of 10.3years (min 7months-max 17years). In 92.9% of cases, patients were found to have a single IOFB, mostly metallic (71.4%). Posterior segment IOFBs were found in 50% of cases, anterior segment IOFBs in 28.6% and orbital IOFBs in 21.4%. The clinical examination permitted detection of the IOFBs in 50% of cases, while they were visible on CT scan in all cases. The mean initial visual acuity was 20/320, and the mean final visual acuity was 20/125. Endophthalmitis occurred in 2 cases (14%). DISCUSSION: Open globe injuries associated with IOFB are severe and sight-threatening. Localization of the IOFB in the posterior segment has a worse prognosis. CT scan is mandatory, especially in children, as the trauma history is often missing. Retinal detachment and endophthalmitis appear to be the main prognostic factors requiring urgent specialized pediatric ophthalmology management.
Subject(s)
Eye Foreign Bodies , Eye Injuries, Penetrating , Humans , Eye Foreign Bodies/diagnosis , Eye Foreign Bodies/epidemiology , Eye Foreign Bodies/complications , Eye Foreign Bodies/surgery , Retrospective Studies , Male , Child , Female , Child, Preschool , Infant , Adolescent , Eye Injuries, Penetrating/diagnosis , Eye Injuries, Penetrating/epidemiology , Eye Injuries, Penetrating/complications , Eye Injuries, Penetrating/surgery , Visual Acuity , PrognosisABSTRACT
AIMS: To characterize the clinical features of ocular trauma resulting from lawn mower, identify determinants of unfavorable final visual acuity (FVA), and assess the spectrum of microbial in posttraumatic endophthalmitis. METHODS: This retrospective study enrolled patients who experienced ocular trauma due to lawn mower at Zhongshan Ophthalmic Center from January 2013 to August 2021. Demographics, clinical features, isolated microorganisms, risk factors influencing reduced visual acuity, treatment regimens, and utilization of eyewear were collected. RESULTS: The study included 140 participants (140 eyes) (49.47 ± 12.03 years, 95% male). The predominant injury manifestations were penetrating globe injuries (75.7%) and intraocular foreign bodies (51.4%). Endophthalmitis occurred in 35 cases (25%) and Bacillus cereus (23.5%) was the primary pathogen, followed by Staphylococcus epidermidis (11.8%) and Streptococcus species (11.8%). Following the initial assessment, where 77.9% of patients had initial visual acuity (IVA) at grade IV (ranging from light perception to 4/200) and only 0.7% attained grade I (better than 20/40), post-treatment results revealed that 5.7% achieved FVA at grade I, with a concurrent decrease in patients with grade IV vision to 64.3%. Multivariate logistic regression revealed that injury protection (p < 0.001, OR = 0.237, 95% CI = 0.126-0.446), IVA (p = 0.001, OR = 4.102, 95% CI = 1.730-9.729), and retinal detachment (p = 0.042, OR = 8.105, 95% CI = 1.075-61.111) were significant independent risk factors impacting FVA. CONCLUSION: Lawn mower often cause severe ocular injuries, with high-velocity metal foreign bodies that can lead to infections, most commonly caused by Bacillus cereus. Correct use of protective gear, initial vision assessment, and detecting retinal detachment are crucial for visual prognosis.
Subject(s)
Endophthalmitis , Visual Acuity , Humans , Male , Female , Middle Aged , Retrospective Studies , Endophthalmitis/microbiology , Endophthalmitis/epidemiology , Adult , Eye Foreign Bodies/complications , Eye Foreign Bodies/epidemiology , Eye Injuries, Penetrating/complications , Eye Injuries, Penetrating/epidemiology , Eye Injuries/epidemiology , Eye Injuries/complications , Risk Factors , Aged , China/epidemiologyABSTRACT
Open-globe injuries (OGI) can lead to significant visual impairment. The Ocular Trauma Score (OTS) is the most widely recognized tool for predicting visual outcomes. This review aimed to identify prognostic factors and assess the effectiveness of the OTS in predicting visual outcomes. Twenty-one articles published on PubMed and Google Scholar were analyzed. Initial visual acuity and the zone of injury were found to be the most significant prognostic factors for OGI. Other significant prognostic factors include retinal detachment/involvement, relative afferent pupillary defect, vitreous hemorrhage, vitreous prolapse, type of injury, hyphema, lens involvement, and duration from incidence of OGI to vitrectomy. Of the 21 studies evaluated, 11 investigated the effectiveness of OTS. Four studies concluded that OTS was effective overall, while six studies suggested that it was only useful in certain OGI categories. Thus, there is a need for further research to develop an optimized ocular trauma prognosticating system.
Subject(s)
Eye Injuries, Penetrating , Eye Injuries , Retinal Detachment , Humans , Prognosis , Retrospective Studies , Eye Injuries/complications , Eye Injuries/diagnosis , Eye Injuries/epidemiology , Visual Acuity , Eye Injuries, Penetrating/diagnosis , Eye Injuries, Penetrating/epidemiology , Eye Injuries, Penetrating/surgery , Trauma Severity IndicesABSTRACT
PURPOSE: To assess clinical features, visual outcomes, and setting of mobile battery blast-induced eye injuries in children. METHODS: Retrospective case sheets of children with mobile battery blast injuries were reviewed at a tertiary eye care center from January 2015 to March 2022. We noted the mode of injury, battery status, and clinical presentation and analyzed the treatment outcomes. RESULTS: The study included 14 eyes of 11 patients. Three patients (27%) had bilateral ocular injuries. The most common reasons for the blast were wiring a bulb to the battery or charging the battery with a universal mobile charger, seen in four cases each. Three eyes had closed-globe injuries (CGIs), whereas 11 had open-globe injuries (OGIs). Of the 11 eyes with OGI, four also had a retained intraocular foreign body (IOFB). Only four (36%) eyes having OGI could achieve vision better than 6/60. All three eyes with CGIs developed secondary glaucoma, and two underwent trabeculectomy. However, the visual prognosis was better (>6/36) in eyes with CGI. Overall, mean visual acuity at the final follow-up was improved to 1.41 ± 1.14 logMAR from 2.32 ± 0.76 logMAR at presentation. This was also found to be statistically significant with a P value of 0.02. CONCLUSION: Battery blast-induced ocular injuries, although rare, often lead to poor outcomes. Apart from charging, playing with discarded or damaged batteries was a common reason for battery blasts in our series.
Subject(s)
Blast Injuries , Eye Foreign Bodies , Eye Injuries, Penetrating , Eye Injuries , Humans , Child , Blast Injuries/diagnosis , Blast Injuries/epidemiology , Blast Injuries/etiology , Retrospective Studies , Eye Injuries/complications , Eye Injuries/diagnosis , Eye Injuries/epidemiology , Eye Foreign Bodies/diagnosis , Eye Foreign Bodies/epidemiology , Eye Foreign Bodies/etiology , Visual Acuity , Treatment Outcome , Prognosis , Eye Injuries, Penetrating/diagnosis , Eye Injuries, Penetrating/epidemiology , Eye Injuries, Penetrating/etiologyABSTRACT
BACKGROUND: Ocular trauma is a leading cause of vision loss. Penetrating ocular injury is a major type of open globe injury(OGI), while its epidemiology and clinical characteristics are still uncertain. The aim of this study is to reveal the prevalence and prognostic factors of penetrating ocular injury in the Shandong province. METHODS: A retrospective study of penetrating ocular injury was performed at the Second Hospital of Shandong University, from January 2010 to December 2019. Demographic information, injury causes, ocular trauma types, and initial and final visual acuity(VA) were analyzed. To obtain more precise characteristics of penetrating injury, the eye global was divided into three zones and analyzed. RESULTS: Among 210 OGI, there are 83 penetrating injuries which account for 39.5% of all. In addition, the final VA of 59 penetrating injuries recovered to 0.1 or better, which possesses the highest frequency among OGI. In order to research the relationship between the wound location and the final VA, we took 74 cases of penetrating injuries without retina or optic nerve damage for analysis. Results show that 62 were male and 12 were female. The average age was 36.01 ± 14.15. The most frequent occupation is the worker followed by the peasant. Statistics show that there is an obvious deviation in the Ocular trauma score (OTS) predicting the final VA and the actual final VA in the 45-65 score group (p < 0.05). Results suggest that the commonest penetrating injury zone is zone III (32 cases, 43.8%). Zone III, which is farthest from the center of the visual axis, has the largest improvement of the final VA (p = 0.0001). On the contrary, there is no statistical difference in the visual improvement in zone I and zone I + II that involves the injury of the central visual axis. CONCLUSION: This study describes the epidemiology and clinical characteristics of patients hospitalized for penetrating ocular injury without retina damage in Shandong province. It can be concluded that larger size and closer location to the visual axis of damage are accompanied by worse prognosis improvement. The study provides a better understanding of the disease and enlightenment for the prediction of visual prognosis.
Subject(s)
Eye Injuries, Penetrating , Eye Injuries , Humans , Male , Female , Young Adult , Adult , Middle Aged , Retrospective Studies , Trauma Severity Indices , Eye Injuries/epidemiology , Visual Acuity , Prognosis , Eye Injuries, Penetrating/diagnosis , Eye Injuries, Penetrating/epidemiologyABSTRACT
BACKGROUND: Explosions can produce blast waves, high-speed medium, thermal radiation, and chemical spatter, leading to complex and compound eye injuries. However, few studies have comprehensively investigated the clinical features of different eye injury types or possible risk factors for poor prognosis. METHODS: We retrospectively reviewed all consecutive records of explosive eye injuries (1449 eyes in 1115 inpatients) in 14 tertiary referral hospitals in China over 12 years (between January 2008 and December 2019). Data on demographics, eye injury types, ocular findings, treatments, and factors affecting visual prognosis were extracted from a standardized database of eye injuries and statistically analyzed. RESULTS: Mechanical ocular trauma accounted for 94.00% of explosion-related eye injuries, among which intraocular foreign bodies (IOFBs) resulted in 55.17% of open globe injuries (OGIs) and contusion caused 60.22% of close globe injuries (CGIs). Proliferative vitreous retinopathy (PVR) was more common in perforating (47.06%) and IOFB (26.84%) than in penetrating (8.79%) injuries, and more common with laceration (24.25%) than rupture (9.22%, P < 0.01). However, no difference was observed between rupture and contusion. Ultimately, 9.59% of eyes were removed and the final vision was ≤ 4/200 in 45.82% of patients. Poor presenting vision [odds ratio (OR) = 5.789], full-thickness laceration of the eyeball ≥ 5 mm (OR = 3.665), vitreous hemorrhage (OR = 3.474), IOFB (OR = 3.510), non-mechanical eye injury (NMEI, OR = 2.622, P < 0.001), rupture (OR = 2.362), traumatic optic neuropathy (OR = 2.102), retinal detachment (RD, OR = 2.033), endophthalmitis (OR = 3.281, P < 0.01), contusion (OR = 1.679), ciliary body detachment (OR = 6.592), zone III OGI (OR = 1.940), and PVR (OR = 1.615, P < 0.05) were significant negative predictors for poor visual outcomes. CONCLUSIONS: Explosion ocular trauma has complex mechanisms, with multiple eyes involved and poor prognosis. In lethal level I explosion injuries, eyeball rupture is a serious condition, whereas contusion is more likely to improve. In level II injuries, IOFBs are more harmful than penetrating injuries, and level IV represents burn-related eye injuries. PVR is more associated with penetrating mechanisms than with OGI. Identifying the risk predictors for visual prognosis can guide clinicians in the evaluation and treatment of ocular blast injuries.
Subject(s)
Contusions , Explosive Agents , Eye Foreign Bodies , Eye Injuries, Penetrating , Lacerations , Humans , Prognosis , Lacerations/complications , Explosive Agents/adverse effects , Retrospective Studies , Eye Injuries, Penetrating/complications , Eye Injuries, Penetrating/epidemiology , Visual Acuity , Eye Foreign Bodies/epidemiology , Eye Foreign Bodies/etiology , Contusions/complicationsABSTRACT
INTRODUCTION: Open globe injury (OGI) is a rare but serious condition that carries with it a high rate of morbidity. OBJECTIVE: This review highlights the pearls and pitfalls of OGI, including presentation, diagnosis, and management in the emergency department (ED) based on current evidence. DISCUSSION: OGI refers to full-thickness injury to the layers of the eye. OGI can be caused by blunt or sharp trauma, and subtypes include penetration, perforation, intraocular foreign body (IOFB), globe rupture, or mixed types. OGI is more common in males and usually secondary to work-related injury, but in women it is most commonly associated with falls. Emergency clinicians should first assess for and manage other critical, life-threatening injuries. Following this assessment, a thorough eye examination is necessary. Computed tomography (CT) may suggest the disease, but it cannot definitively exclude the diagnosis. While point-of-care ultrasound (POCUS) is highly sensitive and specific for some findings in OGI, its use is controversial due to potential globe content extrusion. Management includes protecting the affected eye from further injury, preventing Valsalva maneuvers that could extrude ocular contents, updating tetanus vaccination status, administering broad-spectrum antibiotics, and ophthalmology consultation for surgical intervention to prevent the sequelae of blindness and endophthalmitis. CONCLUSION: An understanding of OGI can assist emergency clinicians in diagnosing and managing this sight-threatening traumatic process.
Subject(s)
Eye Foreign Bodies , Eye Injuries, Penetrating , Male , Humans , Female , Prevalence , Visual Acuity , Eye Foreign Bodies/diagnosis , Eye Foreign Bodies/epidemiology , Eye Foreign Bodies/surgery , Morbidity , Blindness , Retrospective Studies , Eye Injuries, Penetrating/diagnostic imaging , Eye Injuries, Penetrating/epidemiologyABSTRACT
OBJECTIVE: To identify and characterize the incidence and correlates of open-globe injuries documented at the Eye Institute of Alberta (EIA) at the Royal Alexandra Hospital in Edmonton. DESIGN: A 10-year single-centre retrospective chart review. METHODS: All patients who underwent traumatic open-globe injury repair at EIA from January 2009-December 2018 were identified using key search terms. Charts were individually assessed for key demographic variables, including mechanism and location of injury. Patterns in open-globe injury incidence over the 10-year period and across demographics were assessed using Poisson regression. Associations between key demographic variables also were analyzed. RESULTS: In total, 551 traumatic open-globe injuries were treated at the EIA from January 2009-December 2018, resulting in an average of 4.63 injuries per month over the 10-year period. Mean patient age was 42 ± 21.56 years. The number of males (nâ¯=â¯442) presenting for open-globe injury repair was 3.9 times higher than that for females (nâ¯=â¯114). Among patients for whom use of eye protection was recorded (nâ¯=â¯186), only 11% reported using eye protection at the time of the trauma. The incidence rate of injuries with zone 3 involvement was significantly higher in males (41.4%) than in females (29.8%). CONCLUSION: Open-globe injuries remain a significant source of ocular morbidity at EIA, averaging just over 1 emergency case a week. Given the strong association with sex and the infrequent use of eye protection, targeted public health strategies are necessary to mitigate the risk of these sight-threatening injuries.
Subject(s)
Eye Injuries, Penetrating , Eye Injuries , Male , Female , Humans , Young Adult , Adult , Middle Aged , Retrospective Studies , Eye Injuries, Penetrating/diagnosis , Eye Injuries, Penetrating/epidemiology , Eye Injuries, Penetrating/surgery , Eye Injuries/epidemiology , Eye Injuries/complications , Morbidity , Incidence , Alberta/epidemiologyABSTRACT
OBJECTIVE: To evaluate the characteristics and outcomes of pediatric open globe injuries in preschool- and school-aged children. METHOD: Medical records of 93 children were reviewed. Patients were categorized in 2 groups: preschool-aged group (0-7 years) and school-aged group (8-15 years). Demographic data, characteristics of trauma, Ocular Trauma Score (OTS), and initial and final best-corrected visual acuity (BCVA) were recorded and compared between groups. RESULTS: The preschool-aged group consisted of 54 patients (mean age 4.6 ± 1.8 years), and the school-aged group consisted of 39 patients (mean age 11.5 ± 2.7 years). Most of the injuries were penetrating and caused by nonmetalic sharp objects in both groups. A corneal injury was detected in 45 patients (83.3%) in the preschool-aged group and 29 patients (74.4%) in school-aged group. Localization of the corneal wound was mostly central (46.7%) in the preschool-aged group and peripheral (48.3%) in school-aged group (pâ¯=â¯0.045). Mean corneal wound length was significantly longer in the preschool-aged group (pâ¯=â¯0.018). Most of the cases in the preschool-aged group were OTS group 2 (50%), whereas most of the cases in the school-aged group were OTS group 3 (38.5%). Poor visual outcome was significantly correlated with the following factors in both groups: lower OTS, worse initial BCVA, central corneal wound, longer corneal and total wound length, and presence of lens damage, retinal detachment, and hypotonia (p < 0.05 for all). Poor final BCVA also was significantly correlated with a longer scleral wound in the school-aged group and the presence of vitreous hemorrhage and uveal tissue prolapse in the posterior segment in the preschool-aged group (p < 0.05). CONCLUSIONS: Localization and length of the corneal wound is closely associated with visual outcome in children with open globe injuries. Especially in preschool-aged children, mostly central localization of a corneal wound can be a challenging factor for visual rehabilitation.
Subject(s)
Corneal Injuries , Eye Injuries, Penetrating , Eye Injuries , Retinal Detachment , Child , Child, Preschool , Humans , Adolescent , Visual Acuity , Prognosis , Retrospective Studies , Eye Injuries/diagnosis , Eye Injuries/epidemiology , Eye Injuries/etiology , Eye Injuries, Penetrating/diagnosis , Eye Injuries, Penetrating/epidemiology , Eye Injuries, Penetrating/surgery , Trauma Severity IndicesABSTRACT
OBJECTIVE: The aim of the study is to determine characteristic features of open globe injuries caused by firecrackers among pediatric population. METHODS: In this retrospective cross-sectional chart review, medical records of children with ocular trauma who were hospitalized in Isfahan, Iran, during 2013-2017 were reviewed. We analyzed the collected data before and after propensity score (PS) matching. RESULTS: Of 396 pediatric patients with open globe injury, 22 injuries (5.9%) were caused by firecrackers. Hyphema, iris prolapse, and lens rupture were noted in 15 (68.18%), 10 (45.45%), and 2 (9.09) eyes, respectively. None of patients had endophthalmitis. The mean age of patients in firecracker group was higher and significant (11.86 ± 4.05 in firecracker vs 7.80 ± 4.68 in nonfirecracker, P < 0.001). Furthermore, most boys were in firecracker group (95.5%, P = 0.005). Patients in firecracker group resided more in urban areas (86.4%, P = 0.054) and had more intraocular foreign body (IOFB) in the eyes (40.9%, P < 0.001). After PS matching, patients in firecracker group had higher IOFB ( P = 0.008). In logistic regression models, patients with corneal lacerations had lower odds for long-time admission (≥4 days) than patients with both corneal and scleral lacerations in crude model (odds ratio, 0.35; 95% confidence interval, 0.17-0.69) and adjusted model (odds ratio, 0.37; 95% CI, 0.18 to 0.74). After PS matching, there was no significant association between risk factors and outcomes. CONCLUSIONS: The present study showed several differences between the pediatric open globe injuries caused by firecrackers and other mechanisms of injuries, including the age, sex, living place, presence of IOFB, and length of hospital stay.
Subject(s)
Eye Foreign Bodies , Eye Injuries, Penetrating , Eye Injuries , Lacerations , Multiple Trauma , Male , Child , Humans , Lacerations/complications , Retrospective Studies , Iran/epidemiology , Cross-Sectional Studies , Eye Injuries, Penetrating/complications , Eye Injuries, Penetrating/epidemiology , Eye Injuries/epidemiology , Eye Injuries/etiology , Eye Foreign Bodies/epidemiology , Eye Foreign Bodies/etiology , HospitalsABSTRACT
OBJECTIVES: To describe the epidemiologic and clinical characteristics of open globe injuries (OGIs) treated in a tertiary hospital and analyse predictors of visual outcome. METHODS: This retrospective observational study included all patients with OGIs admitted to Cruces University Hospital between 2010 and 2020. The descriptive analysis included demographic data, type of injury classified as "rupture", "penetration", "perforation", or "intraocular foreign body", trauma mechanism and setting, injury zone, Ocular Trauma Score, delay to surgery, length of hospital stay, antibiotic prophylaxis, initial and final best corrected visual acuity (BCVA), complications and further surgery. Univariate analysis and logistic regression were performed to identify prognostic factors, based on final BCVA. RESULTS: Overall, 207 OGI cases were reported. The most common type of injuries were ruptures caused by domestic falls. Notably, 44.4% of eyes developed phthisis bulbi. In the univariate analysis, the following variables were significantly linked to visual outcome: age > 60 years, "rupture", "fall", posterior and/or combined zones of injury, lens damage, retinal/choroidal detachment, initial BCVA of no light perception, and Ocular Trauma Score ≤ 2 (p < 0.001). Delay to surgery, length of stay and further surgery did not have prognostic value. In the logistic regression, initial BCVA of no light perception (p < 0.001) and injury zone III (p = 0.005) remained significant predictors of poor outcome. CONCLUSIONS: In the population studied, most OGIs were caused by domestic falls usually affecting elderly patients with comorbidities. Visual outcome depended on patients´ specific characteristics and the nature of the trauma itself, whereas environmental factors failed to show any prognostic value.
Subject(s)
Eye Injuries, Penetrating , Eye Injuries , Humans , Aged , Middle Aged , Eye Injuries, Penetrating/diagnosis , Eye Injuries, Penetrating/epidemiology , Eye Injuries, Penetrating/surgery , Prognosis , Spain/epidemiology , Visual Acuity , Trauma Severity Indices , Eye Injuries/etiology , Retrospective Studies , RetinaABSTRACT
BACKGROUND/OBJECTIVES: To evaluate the factors influencing final visual outcome after surgical repair of open globe injuries (OGIs) in a rural population using the International Globe and Adnexal Trauma Epidemiology Study (IGATES) online registry. SUBJECTS/METHODS: Retrospective cohort study of patients with OGI. OGIs were identified from the IGATES database at a tertiary referral eye care centre in rural West India over a period of 12 years. Patient demographics, clinical and pre-operative factors affecting final visual outcome was evaluated. RESULTS: A total of 791 eyes with OGIs were included in data analysis. 11 eyes that were lost to follow-up and 12 eyes with incomplete data were excluded. Most of the patients were male (559, 70.6%) and mean age of all patients was 23.9 years ± 19.4 years. Occupational hazards (including domestic housework) (307, 38.8%) and leisure play (324, 41.0%) were the leading causes of OGI. The most common mechanism of injury was being struck by a wooden stick (250, 31.6%). Univariate analysis of pre-operative variables showed initial visual acuity (VA), zone of injury, size of wound, structures involved in the injury and presence of infection were significant prognostic factors for worse final visual outcome (p < 0.001). Multivariate analysis showed VA ≤ 3/60 or worse at presentation had statistically significantly higher odds ratio of ending up with worse visual outcomes (p < 0.012). CONCLUSIONS: Males in working age groups suffer from OGIs more frequently, usually from agricultural and pastoral activities. Initial VA, zone 3 injuries, corneoscleral wound, large wound size and presence of post-traumatic infections are significant prognostic factors.
Subject(s)
Eye Injuries, Penetrating , Eye Injuries , Humans , Male , Young Adult , Adult , Female , Retrospective Studies , Eye Injuries, Penetrating/epidemiology , Eye Injuries, Penetrating/surgery , Eye Injuries, Penetrating/complications , Rural Population , Prognosis , Eye Injuries/etiology , India/epidemiologyABSTRACT
This study aimed to identify the prevalence and risk factors for globe removal among patients with open-globe injuries (OGIs) in agricultural regions. A retrospective chart review of patients with OGIs was performed between January 2010 and December 2019. Univariable and multivariable logistic regression models were used to identify the factors associated with globe removal in OGI. This study included 422 patients (422 eyes). The highest prevalence of OGI was observed in the middle age group (> 20 to 40 years). The most common cause of OGIs was agriculture-related injury (54.7%), followed by industry or workplace-related injury (20.4%), and assault (5.0%). Intraocular foreign bodies, endophthalmitis, and panophthalmitis were reported in 57.6%, 28.4%, and 5.7% of cases, respectively. Eight eviscerations and 43 enucleations were performed, accounting for 12.1% of OGIs. The most common indication for globe removal was panophthalmitis. Multivariable analysis revealed that the predictive factors significantly associated with globe removal were assault injuries (adjusted odds ratio (aOR) = 5.53; p = 0.026), presenting logarithm of the minimum angle of resolution visual acuity (aOR = 311.79; p < 0.001), and endophthalmitis and panophthalmitis (aOR = 3.58 and 734.94, respectively; p < 0.001). This knowledge would aid in patient counseling and encourage health promotion.
Subject(s)
Endophthalmitis , Eye Injuries, Penetrating , Panophthalmitis , Adult , Agriculture , Endophthalmitis/complications , Endophthalmitis/etiology , Eye Injuries, Penetrating/epidemiology , Eye Injuries, Penetrating/etiology , Eye Injuries, Penetrating/surgery , Humans , Middle Aged , Panophthalmitis/complications , Prognosis , Retrospective Studies , Risk Factors , Young AdultABSTRACT
Purpose: To examine the incidence, clinical findings and management of pellet gun-related ocular injuries that occurred during protests in Kashmir region. Methods: This retrospective study included records from 777 patients diagnosed with pellet gun-related ocular injuries admitted to a tertiary hospital in Srinagar, India, between July and November 2016. By reviewing the clinical records, the following data were collected: demographics, clinical information pertaining to the injury, imaging reports including computer tomography and ultrasonography B-scan, management in the emergency setting, and follow-up treatment. Results: Mean age was 22.3 ± 7.2 years and majority patients were male (97.7%). In terms of laterality, 94.3% and 5.7% of the patients sustained monocular and binocular injuries, respectively. In terms of the nature of injury, 76.3% of the eyes had open globe injury while 23.7% of the eyes had closed eye injury. Emergency surgical exploration was performed in 67.7% of closed globe injuries while emergency primary repair was done in 91.1% of open globe injuries. The vast majority of patients (98.7%) who required surgery underwent surgical intervention on the day of admission or the next day. Final best-corrected visual acuity (BCVA) after treatment was counting fingers or worse in 82.4% of the eyes. Conclusion: Pellet gun-related ocular injuries resulted in significant ocular morbidity, mostly manifesting as open globe injuries. Treatment often required surgical interventions, but despite expeditious management, visual prognosis remained poor for most of the patients.
Subject(s)
Eye Injuries, Penetrating , Eye Injuries , Adolescent , Adult , Eye Injuries/diagnosis , Eye Injuries/epidemiology , Eye Injuries/surgery , Eye Injuries, Penetrating/diagnosis , Eye Injuries, Penetrating/epidemiology , Eye Injuries, Penetrating/surgery , Female , Humans , Incidence , Male , Prognosis , Retrospective Studies , Visual Acuity , Young AdultABSTRACT
PURPOSE: To construct a new pediatric ocular trauma score for predicting visual outcome after open globe injuries (OGI) and to compare it to the ocular trauma score (OTS) and pediatric ocular trauma score (POTS). METHODS: This is a retrospective chart review study. For each case, the following data were collected: demographics, mechanism of the injury, initial ophthalmologic findings, presented and last follow-up visual acuity (VA), ocular treatments, and final ocular findings. We then analyzed the risk factors for the poor visual outcome (VA ≤ 20/200), and a modified pediatric ocular trauma score (MPOTS) was constructed accordingly and compared to the OTS and POTS for predicting poor outcome. Finally, a different cohort of pediatric OGIs was used for score validation. RESULTS: Forty-five cases were included, significant predicting factors for poor visual outcome were initial VA ≤ 20/200, zone 2-3 locations of injury, presence of retinal detachment, vitreous hemorrhage, hyphema, and iris prolapse at initial presentation. The calculated Spearman correlation coefficients between each system score and poor visual outcome were OTS 0.56, POTS 0.57, and MPOTS 0.64 (P < 0.001 for all). A total of 71 new cases were used as validation cohort, and calculated Spearman correlation coefficients between each system score and poor visual outcome were: OTS 0.50, POTS 0.51, and MPOTS 0.53 (P < 0.001 for all). CONCLUSIONS: We suggest a new scoring system for predicting poor final visual outcomes after OGI's in children, which is simpler and more clinically suitable for this study population. It was found to be a better predictor of visual outcome in this scenario compared with existing scoring systems.
Subject(s)
Eye Injuries, Penetrating , Eye Injuries , Child , Humans , Eye Injuries/diagnosis , Eye Injuries, Penetrating/diagnosis , Eye Injuries, Penetrating/surgery , Eye Injuries, Penetrating/epidemiology , Prognosis , Retrospective Studies , Trauma Severity IndicesABSTRACT
PURPOSE: To analyze the incidence and risk factors of postoperative endophthalmitis after primary surgical repair and intraocular foreign body (IOFB) removal within 24 hours of injury. METHODS: The records of all patients treated surgically for open globe injury and IOFB removal at the Eye Hospital of Shandong First Medical University between January 1, 2015, and June 30, 2020, were retrospectively reviewed. Variables included time from injury to operation, cause of injury, details of surgical repair, and follow-up. The incidence and risk factors of endophthalmitis after IOFB removal were studied. RESULTS: During 5 years, 99 patients with IOFB were reviewed. Of these, 19 patients were diagnosed with endophthalmitis on admission, and 5 were suspected of having endophthalmitis during operation. Fifty-four cases had no clinical signs of endophthalmitis on admission and during operation and were treated with operation within 24 hours after the injury. Two patients (2 of 54; 3.70%) developed endophthalmitis after IOFB removal, and the causative agent in both cases was Bacillus cereus. CONCLUSION: The incidence of infectious endophthalmitis after primary surgical repair combined with IOFB removal (≤24 hours) was 3.70% in patients who received a series of standard treatments, and B. cereus infection might be a risk factor.