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      Clinical Characteristics and Visual Outcomes of Patients Hospitalized for Ocular Trauma in Shandong Province, China

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          Abstract

          Purpose

          To analyze the clinical characteristics and visual prognoses of patients with ocular trauma treated in Shandong Eye Hospital.

          Methods

          The inpatient data of patients with eye injuries hospitalized in our institution from January 2014 to December 2018 were retrospectively reviewed, including demographic information, types of trauma, causes of injury, treatment, and initial and final visual acuities.

          Results

          A total of 1,425 patients (1,622 eyes), aged 39.5 ± 18.5 years, were included. The ratio of male to female was 5.3 : 1. Of the mechanical eye injuries, there were 490 (34.4%) open-globe injuries and 454 (31.9%) closed-globe injuries. Nonmechanical eye injuries had 426 patients (29.9%), while 55 patients (3.9%) had adnexal injuries. Over a half of the traumas were work-related (51.1%, 728 patients). Most patients were treated with surgical intervention (1,404 eyes, 87.9%). There were significant differences in the final visual acuities between open-globe injuries and closed-globe injuries ( P < 0.001), as well as between mechanical injuries and nonmechanical injuries ( P < 0.001). The final visual acuity was closely correlated with the initial visual acuity (Spearman's correlation coefficient = 0.618, P < 0.001) and the OTS score (Spearman's correlation coefficient = 0.691, P < 0.001).

          Conclusion

          Ocular trauma usually occurs in young and middle-aged men and in the workplace in Shandong Province. The proportion of nonmechanical injuries is high, and the prognosis is poor. A comprehensive understanding of the characteristics of ocular trauma is useful for blindness prevention and treatment.

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          Most cited references22

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          The global impact of eye injuries.

          Using data compiled from the ophthalmic literature and WHO's Blindness Data Bank, the available information on eye injuries from an epidemiological and public health perspective has been extensively reviewed. This collection of data has allowed an analysis of risk factors, incidence, prevalence, and impact of eye injuries in terms of visual outcome. However, most of the estimates are based on information from More Developed Countries (MDCs). The severity of eye injuries can be assessed through proxy indicators such as: (i) potentially blinding bilateral injuries; (ii) open-globe injuries; (iii) endophthalmitis; (iv) enucleation or (v) defined visual impairment. Major risk factors for ocular injuries include age, gender, socioeconomic status and lifestyle. The site where the injury occurs is also related to a risk situation. Available information indicates a very significant impact of eye injuries in terms of medical care, needs for vocational rehabilitation and great socioeconomic costs. The global pattern of eye injuries and their consequences emerging from the present review, undertaken for planning purposes in the WHO Programme for the Prevention of Blindness, suggests that: some 55 million eye injuries restricting activities more than one day occur each year; 750,000 cases will require hospitalization each year, including some 200,000 open-globe injuries; there are approximately 1.6 million blind from injuries, an additional 2.3 million people with bilateral low vision from this cause, and almost 19 million with unilateral blindness or low vision. Further epidemiological studies are needed to permit more accurate planning of prevention and management measures; a standardized international template for reporting on eye injuries might be useful to this effect, along the lines of the reporting occurring through the US Eye Injury Registry.
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            The Ocular Trauma Score (OTS).

            Only based on a standardized terminology of ocular trauma terms, and using a very large number of injuries treated by a wide variety of ophthalmologists, could a reliable method be developed so that the functional outcome of a serious eye injury can be predicted with reasonable certainty. The authors used the databases of the United States and Hungarian Eye Injury Registries and, with a grant from the National Center for Injury Prevention at the Centers for Disease Control and Prevention, designed such a system.
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              A system for classifying mechanical injuries of the eye (globe). The Ocular Trauma Classification Group.

              To develop a classification system for mechanical injuries of the eye. The Ocular Trauma Classification Group, a committee of 13 ophthalmologists from seven separate institutions, was organized to discuss the standardization of ocular trauma classification. To develop the classification system, the group reviewed trauma classification systems in ophthalmology and general medicine and, in detail, reports on the characteristics and outcomes of eye trauma, then established a classification system based on standard terminology and features of eye injuries at initial examination that have demonstrated prognostic significance. This system classifies both open-globe and closed-globe injuries according to four separate variables: type of injury, based on the mechanism of injury; grade of injury, defined by visual acuity in the injured eye at initial examination; pupil, defined as the presence or absence of a relative afferent pupillary defect in the injured eye; and zone of injury, based on the anteroposterior extent of the injury. This system is designed to be used by ophthalmologists and nonophthalmologists who care for patients or conduct research on ocular injuries. An ocular injury is classified during the initial examination or at the time of the primary surgical intervention and does not require extraordinary testing. This classification system will categorize ocular injuries at the time of initial examination. It is designed to promote the use of standard terminology and assessment, with applications to clinical management and research stud ies regarding eye injuries.
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                Author and article information

                Contributors
                Journal
                J Ophthalmol
                J Ophthalmol
                JOPH
                Journal of Ophthalmology
                Hindawi
                2090-004X
                2090-0058
                2020
                15 April 2020
                : 2020
                : 5826263
                Affiliations
                1Medical College of Qingdao University, Qingdao 266071, China
                2Shandong Eye Hospital, Shandong Eye Institute, Shandong First Medical University, Shandong Academy of Medical Sciences, Jinan 250021, China
                3State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University, Shandong Academy of Medical Sciences, Qingdao 266071, China
                Author notes

                Academic Editor: Paolo Mora

                Author information
                https://orcid.org/0000-0003-4975-4068
                https://orcid.org/0000-0002-1326-6946
                Article
                10.1155/2020/5826263
                7180499
                32377421
                ad15423e-426e-4a4b-bd24-ef39148a5c0f
                Copyright © 2020 Fangnan Duan et al.

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

                History
                : 3 December 2019
                : 6 February 2020
                : 17 March 2020
                Funding
                Funded by: National Natural Science Foundation of China
                Award ID: 81570821
                Award ID: 81870639
                Award ID: 81530027
                Funded by: Taishan Scholar Program
                Award ID: 20150215
                Award ID: 201812150
                Funded by: Innovation Project of Shandong Academy of Medical Sciences, and the Academic Promotion Programme of Shandong First Medical University
                Award ID: 2019RC009
                Categories
                Research Article

                Ophthalmology & Optometry
                Ophthalmology & Optometry

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