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      Demographic Characteristics and Clinical Outcome of Work-related Open Globe Injuries in the Most Industrialised Region of Turkey

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          Abstract

          Objectives:

          To evaluate demographic characteristics and clinical outcomes of work-related open globe injuries in the most industrialized region of Turkey.

          Materials and Methods:

          The demographic and medical records of patients with work-related open globe injuries who presented to the ophthalmology or emergency departments with an official occupational accident report were retrospectively reviewed. Visual acuity categories were defined according to the World Health Organization. The injury types and zones of the open globes were classified according to Birmingham Eye Trauma Terminology System.

          Results:

          Among 479 patients with work-related eye injuries in 5 years, there were 102 eyes of 101 patients with open globe injuries (21%). The mean age of the patients was 34.5±8.9 years with a mean follow-up of 12.5±12.6 months. The injuries peaked in June in the hour between 12:00 and 13:00. Eighty-six percent presented to emergency services within 12 hours after the injury. Twenty-two percent of the patients had been wearing protective eyewear at the time of injury. The open globe injuries were penetrating in 51%, intraocular foreign body in 40%, rupture in 7% and perforation in 2% of the eyes. The most frequent finding was traumatic cataract. Final visual acuity of 33.3% of patients was below 3/60. Seventy-eight percent of patients that had visual acuity worse than 6/18 at presentation had visual acuity of 6/18 or better at final visit. Sixty-three percent of eyes which had injuries involving all 3 zones resulted in phthisis bulbi, enucleation or evisceration.

          Conclusion:

          Work-related open globe injuries may have severe consequences such as visual impairment and blindness among the young male working population in industrialized areas. Nearly half of the occupational open globe injuries resulted in visual impairment and blindness.

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          Most cited references 30

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          A standardized classification of ocular trauma.

          No internationally standardized classification of ocular trauma terminology has existed previously. Despite a growing interest in eye injuries, the absence of a common language continues to impede both clinical care and research. A classification has been developed initially based on the authors' extensive personal experience. It then has undergone repeated reviews over a 3-year period by international ophthalmic audiences, incorporating suggestions from respondents in 13 countries and selected ocular trauma experts. By always using the entire globe as the tissue of reference, the new classification is unambiguous, consistent, and simple. It provides definitions for the commonly used eye trauma terms within the framework of a comprehensive system. The new classification has been endorse by the Board of Directors of the International Society of Ocular Trauma, the United States Eye Injury Registry, the Hungarian Eye Injury Registry, the Vitreous Society, the Retina Society, and the American Academy of Ophthalmology. It can be reasonable expected that the system eventually will become the standardized international language of ocular trauma. The authors urge ophthalmologists to begin using this terminology in both clinical practice and research.
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            Endophthalmitis following open-globe injuries.

            The incidence of traumatic endophthalmitis may be decreasing due to earlier wound closure and prompt initiation of antibiotics. Risk factors for endophthalmitis include retained intraocular foreign body, rural setting of injury, disruption of the crystalline lens, and a delay in primary wound closure. The microbiology in the post-traumatic setting includes a higher frequency of virulent organisms such as Bacillus species. Recognizing early clinical signs of endophthalmitis, including pain, hypopyon, vitritis, or retinal periphlebitis may prompt early treatment with intravitreal antibiotics. Prophylaxis of endophthalmitis in high-risk open-globe injuries may include systemic broad-spectrum antibiotics, topical antibiotics, and intravitreal antibiotics to cover both Gram-positive and Gram-negative bacteria. For clinically diagnosed post-traumatic endophthalmitis, intravitreal vancomycin, and ceftazidime are routinely used. Concurrent retinal detachment with endophthalmitis can be successfully managed with vitrectomy and use of intravitreal antibiotics along with a long acting gas or silicone oil tamponade. Endophthalmitis is a visually significant complication of open-globe injuries but early wound closure as well as comprehensive prophylactic antibiotic treatment at the time of injury repair may improve visual acuity outcomes.
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              Endophthalmitis following open globe injury.

              To study the clinical characteristics of post-traumatic endophthalmitis following open-globe injury and identify factors affecting its frequency in order to gain further knowledge about possible risk factors for the development of endophthalmitis. All consecutive records of open globe injury cases (4968 eyes in 4865 inpatients) in 15 tertiary referral hospitals in China over 5 years (January 2001 to December 2005) were retrospectively reviewed. The information was collected from a standardised database of eye injuries from which a detailed analysis of factors influencing the incidence of endophthalmitis was performed. 173 eyes (one bilateral rupture of a male) removed within 24 h after trauma were excluded. It was observed that 571 eyes (571 patients) out of a total of 4795 eyes (4693 patients) developed endophthalmitis, and the rate of incidence was 11.91%. Laceration was an independent risk factor for open globe injury. Primary repair within 24 h, intraocular tissue prolapse and self-sealing of wounds seemed to impart protective effects against the development of endophthalmitis. However, gender, age, lens breach and posterior zone of wounds were not significant. Intravitreal antibiotic and corticosteroid therapy was administered to 53 eyes (9.28%), and vitrectomy was performed on 305 eyes (53.42%). At discharge or follow-up, the proportion (16.81%) of enucleation/evisceration of eyes with endophthalmitis was higher than that (8.71%) without endophthalmitis. Laceration was associatied with a significantly higher risk of endophthalmitis for open globe injuries. Early primary repair, intraocular tissue prolapse and self-sealing of wounds were independent protective factors against the development of endophthalmitis.
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                Author and article information

                Journal
                Turk J Ophthalmol
                Turk J Ophthalmol
                TJO
                Turkish Journal of Ophthalmology
                Galenos Publishing
                2149-8695
                2149-8709
                January 2017
                17 January 2017
                : 47
                : 1
                : 18-23
                Affiliations
                [1 ] Uludağ University Faculty of Medicine, Department of Ophthalmology, Bursa, Turkey
                [2 ] Düziçi Sate Hospital, Ophthalmology Clinic, Osmaniye, Turkey
                Author notes
                * Address for Correspondence: Uludağ University Faculty of Medicine, Department of Ophthalmology, Bursa, Turkey Phone: +90 224 295 24 47 E-mail: bernaakova@ 123456hotmail.com
                Article
                1894
                10.4274/tjo.81598
                5282536
                ©Turkish Journal of Ophthalmology, Published by Galenos Publishing.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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