A comparison of primary and secondary eye removal after open globe injury: A multi-centre study

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.

To assist ophthalmologists in treating ocular trauma patients, this study developed and validated a prognostic model to predict vision survival after open globe injury. Retrospective cohort review. Two hundred fourteen patients who sought treatment at the Wilmer Ophthalmological Institute with open globe injuries from January 1, 2001, through December 31, 2004, were part of the data set used to build the classification tree model. Then, to validate the classification tree, 51 patients were followed up with the goal to compare their actual visual outcome with the outcome predicted by the tree grown from the classification and regression tree analysis. Binary recursive partitioning was used to construct a classification tree to predict visual outcome after open globe injury. The retrospective cohort treated for open globe injury from January 1, 2001, through December 31, 2004, was used to develop the prognostic tree and constitutes the training sample. A second independent sample of patient eyes seen from January 1, 2005, through October 15, 2005, was used to validate the prognostic tree. Two main visual outcomes were assessed: vision survival (range, 20/20-light perception) and no vision (included no light perception, enucleation, and evisceration outcomes). A prognostic model for open globe injury outcome was constructed using 214 open globe injuries. Of 14 predictors determined to be associated with a no vision outcome in univariate analysis, presence of a relative afferent pupillary defect and poor initial visual acuity were the most predictive of complete loss of vision; presence of lid laceration and posterior wound location also predicted poor visual outcomes. In an independent cohort of 51 eyes, the prognostic model had 85.7% sensitivity to predict no vision correctly and 91.9% specificity to predict vision survival correctly. The open globe injury prognostic model constructed in this study demonstrated excellent predictive accuracy and should be useful in counseling patients and making clinical decisions regarding open globe injury management.

To report the visual and anatomic outcomes as well as to predict the visual prognosis of combat ocular trauma (COT) during Operations Iraqi and Enduring Freedom. Retrospective, noncomparative, interventional, consecutive case series. Five hundred twenty-three consecutive globe or adnexal combat injuries, or both, sustained by 387 United States soldiers treated at Walter Reed Army Medical Center between March 2003 and October 2006. Two hundred one ocular trauma variables were collected on each injured soldier. Best-corrected visual acuity (BCVA) was categorized using the ocular trauma score (OTS) grading system and was analyzed by comparing initial and 6-month postinjury BCVA. Best-corrected visual acuity, OTS, and globe, oculoplastic, neuro-ophthalmic, and associated nonocular injuries. The median age was 25+/-7 years (range, 18-57 years), with the median baseline OTS of 70+/-25 (range, 12-100). The types of COT included closed-globe (n = 234; zone 1+2, n = 103; zone 3, n = 131), open-globe (n = 198; intraocular foreign body, n = 86; perforating, n = 61; penetrating, n = 32; and rupture, n = 19), oculoplastic (n = 324), and neuro-ophthalmic (n = 135) injuries. Globe trauma was present in 432 eyes, with 253 eyes used for visual acuity analysis. Comparing initial versus 6-month BCVA, 42% of eyes achieved a BCVA of 20/40 or better, whereas 32% of eyes had a BCVA of no light perception. Closed-globe injuries accounted for 65% of BCVA of 20/40 or better, whereas 75% of open-globe injuries had a BCVA of 20/200 or worse. The ocular injuries with the worst visual outcomes included choroidal hemorrhage, globe perforation or rupture, retinal detachment, submacular hemorrhage, and traumatic optic neuropathy. Additionally, COT that combined globe injury with oculoplastic or neuro-ophthalmologic injury resulted in the highest risk of final BCVA worse than 20/200 (odds ratio, 11.8; 95% confidence interval, 4.0-34.7; P<0.0005). Nonocular injuries occurred in 85% of cases and included traumatic brain injury (66%) and facial injury (58%). Extremity injuries were 44% (170 of 387 soldiers). Amputation is a subset of extremity injury with 12% (46 of 387) having sustained a severe extremity injury causing amputation. Combat ocular trauma has high rates of nonocular injuries with better visual outcomes in closed-globe compared with open-globe trauma. The OTS is a valid classification scheme for COT and correlates the severity of injury with the final visual acuity and prognosis. Globe combined with oculoplastic or neuroophthalmologic injuries have the worst visual prognosis. The author(s) have no proprietary or commercial interest in any materials discussed in this article.