• Users Online: 12763
  • Home
  • Print this page
  • Email this page

   Table of Contents      
BRIEF COMMUNICATION
Year : 2010  |  Volume : 58  |  Issue : 4  |  Page : 321-323

Descriptive study on ocular survival, visual outcome and prognostic factors in open globe injuries


OEU Institute of Ophthalmology, Kasturba Medical College, Manipal, India

Date of Submission27-Jun-2007
Date of Acceptance27-Feb-2009
Date of Web Publication7-Jun-2010

Correspondence Address:
Lavanya G Rao
OEU Institute of Ophthalmology, Kasturba Medical College, Manipal
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0301-4738.64116

Rights and Permissions
  Abstract 

A prospective observational study was done to assess ocular survival, visual outcome and prognostic factors of open globe injury. Eighty eyes of penetrating trauma between 2004 and 2006 were categorized according to the ocular trauma classification system. Primary repair was done and outcomes were assessed at one, three and six months. The final vision was categorized as per World Health Organization classification of visual impairment. Factors at presentation were evaluated for prognostic value towards visual outcome. Sixty-nine eyes with minimum one month follow-up were included for analysis. Statistical analysis was done using Univariate and Multivariate analysis. We found Grade IV visual acuity (<5/200) at presentation (64%) as the most important factor contributing to poor visual outcome. Statistically insignificant factors were time since injury, cataract, and presence of intraocular foreign body. Ocular survival was 97%. We concluded that initial visual acuity, hyphema, zone and length of injury, retinal detachment and vitreous hemorrhage are statistically significant factors affecting outcome in open globe injuries.

Keywords: Outcome, penetrating eye injury, prognostic factors


How to cite this article:
Rao LG, Ninan A, Rao KA. Descriptive study on ocular survival, visual outcome and prognostic factors in open globe injuries. Indian J Ophthalmol 2010;58:321-3

How to cite this URL:
Rao LG, Ninan A, Rao KA. Descriptive study on ocular survival, visual outcome and prognostic factors in open globe injuries. Indian J Ophthalmol [serial online] 2010 [cited 2024 Mar 19];58:321-3. Available from: https://journals.lww.com/ijo/pages/default.aspx/text.asp?2010/58/4/321/64116

Knowledge of the prognostic factors help the physician in making decisions regarding patient management and rehabilitation. [1] Factors reported to correlate with visual outcome were: [1] type, location, extent of injury, initial visual acuity, afferent pupillary defect, lenticular involvement, vitreous hemorrhage, intraocular foreign body. In this study we have evaluated visual outcome, ocular survival, prognostic factors and complications of open globe injuries.


  Materials and Methods Top


This was a prospective observational study of 80 cases of penetrating trauma which presented to our hospital between November 2004 and August 2006. Relevant history included patient details, mechanism, and time since injury. Examination was done to detect initial visual acuity (Snellen's acuity), length of wound, zone of injury, presence of iris prolapse, afferent pupillary defect, cataract, hyphema, retinal detachment, vitreous hemorrhage, intraocular foreign body. These factors were categorized according to ocular trauma classification system. [2] Primary repair was done under general anesthesia. Patients were reviewed at one, three and six months. Assessment included best corrected visual acuity, wound status, intraocular pressure (IOP), fundus examination and B-scan ultrasonography. Final visual acuity was graded according to World Health Organization (WHO) visual impairment categories:

≥ 20/70, (good visual outcome), <20/70 - 20/200, <20/200 - 20/400, <20/400 (low visual outcome)

Eleven eyes were lost to follow-up and 69 eyes were included for statistical analysis. Eight eyes had only one month follow-up. Univariate analysis was done using Chi Square test, multivariate analysis was done to find prognostic significance. P value <0.05 was considered significant.


  Results Top


The age, sex distribution, grade, zone of injury and length of wound have been shown in [Figure 1],[Figure 2],[Figure 3],[Figure 4],[Figure 5]. One four-year-old child, was not cooperative for assessment and was placed under no response [Figure 3]. Afferent pupillary defect in one eye with no perception of light was eviscerated . Foreign bodies were found in 11 eyes (16%), four corneal, one in iris, six in vitreous, foreign bodies were removed during primary repair, one eye was eviscerated.

Endophthalmitis was found in eight eyes (12%), out of which seven were at presentation and in one eye after a month. Six eyes received intravitreal vancomycin and ceftazidime. Two eyes, which progressed to panophthalmitis were eviscerated. Four of 6 eyes had final visual acuity < 20/400. One eye had a good outcome of 20/30.

Hyphema was noted in 29 eyes (42%), and was drained during primary repair. Lens opacities were found in 28 eyes (41%). Fourteen had cataract extraction. The remaining 14 had useful vision in spite of lens opacities. Iris prolapse was found in 40 eyes (58%) (abscission - 30 eyes, iris released - 10 eyes). Retinal detachment was found in four eyes (6%). Vitreous hemorrhage was found in nine eyes (13%).

Visual outcomes at one, three and six months have been shown in [Table 1].

Ocular survival at the end of the study period was 97% (67 eyes). Two eyes were eviscerated. Six eyes had phthisis, nine eyes had raised IOP, three underwent combined surgery and the rest were put on medical management.


  Discussion Top


Average age was 30 years (4-58 years). Seventy per cent patients were below 40 years of age. Statistical analysis at one month showed age as a significant factor (P <0.001) for predicting visual outcome. The age distribution is similar to other studies. Usha Vasu found 81% patients below 45 years of age. [3] Sternberg et al, found age as a significant factor affecting visual outcome. [4]

In our study 90% patients were males and 10% females. Gender was found to be a statistically significant factor (P<0.001). William et al, [5] had 98% male patients, Vasu et al, found 95% were males. [3] This could be attributed to increased outdoor activities of males.

The most important factor of prognostic significance in penetrating injury is the initial visual acuity. Sternberg et al, found initial visual acuity >20/800 as the most important factor for favorable prognosis. [4] Williams et al, [5] Barr et al, [6] Esmaeli et al, [7] concluded that initial visual acuity is an important prognostic indicator of visual outcome. Using univariate analysis, initial visual acuity had statistically significant influence on the outcome at one, three and six months. Multiple logistic regression proved this factor to be statistically significant (P <0.001) at one month.

Charles Barr found hyphema to be a predictor of visual outcome. [6] We found hyphema significant (P<0.001) at one month. Of these, 76% at one month, 55% at three and six months had poor outcome (<20/400).

The second important prognostic factor is length of the wound. [5],[6],[7] By multivariate analysis it was a prognostic factor at one and six months (P<0.001).

Many reports mention lens damage as a predictor of outcome. [1],[6],[8] We found statistically no significant predictive value for lens damage by univariate, multivariate analysis.

Hutton et al[9] and Sternberg et al, [4] found that corneal wounds have better result than the others. By multivariate analysis the zone of injury was a significant predictor at one, three and six months (P = 0.004 at one month, P < 0.001 at three and six months) . Statistical analysis did not show intraocular foreign body as a predictive factor in our study, but 71% patients with foreign body had poor visual outcome (<20/400).

Endophthalmitis has been mentioned as a prognostic indicator by William et al[5] and Brinton et al. [10] The association in our study was statistically significant only at one month (P = 0.009).

Retinal detachment was found as a significant prognostic factor by Hutton et al[9] and Thompson et al. [8] We found that 100% patients with retinal detachment had poor visual outcome <20/400, showing it to be a significant prognostic factor (P <0.001) at three and six months.

Vitreous hemorrhage was found as a prognostic factor. [1],[6] In our study significant association was found at one and six months (P <0.001).

In our study 64% eyes came with a poor initial vision of <5/200. Young males (15-40 years) were most commonly affected, average age being 30 years. At six months, 35% had a good visual outcome of >20/70 and an equal number had a poor visual outcome of < 20/400. In our study significant predictors of outcome were initial visual acuity, hyphema, age, length of wound and zone of injury, retinal detachment and vitreous hemorrhage. Time since injury, cataract and intraocular foreign body were found to be insignificant for assessing the prognosis. The ocular survival rate was 97%.

 
  References Top

1.
De Juan E Jr, Sternberg P Jr, Michels RG. Penetrating ocular injuries, type of injuries and visual results. Ophthalmology 1983;90:1318-22.  Back to cited text no. 1
[PUBMED]    
2.
Piermici DJ, Sternberg P, Aaberg TM, Bridges WZ, Capone A, Cardillo JA, et al. Perspective: A system for classifying Mechanical injuries of the eye (globe). Am J Ophthalmol 1997;123:820-31.  Back to cited text no. 2
    
3.
Vasu U, Vasnaik A, Battu RR, Kurian M, George S. Occupational Open globe injuries. Indian J Ophthalmol 2001;49:43-7.  Back to cited text no. 3
[PUBMED]  Medknow Journal  
4.
Sternberg P Jr, De Juan E, Michels RG, Auer C. Multivariate analysis of prognostic factors in penetrating ocular injuries. Am J Ophthalmol 1984;98:467-72.  Back to cited text no. 4
    
5.
Williams DF, Mieler WF, Abrams GW, Lewis H. Results and prognostic factors in penetrating ocular injuries with retained intraocular foreign bodies. Ophthalmology 1988;95:911-6.  Back to cited text no. 5
[PUBMED]    
6.
Barr CC. Prognostic factors in corneoscleral lacerations Arch Ophthalmol 1983;101:919-24 .  Back to cited text no. 6
    
7.
Esmali B, Elner SG, Schork A, Elner VM .Visual outcome and Ocular Survival after penetrating trauma. Ophthalmology 1995;102:393-400.  Back to cited text no. 7
    
8.
Thompson SW, Rubsamen P, Flynn H, Schiffman J, Cousins S. Endophthalmitis after penetrating ocular trauma: Risk factors and visual acuity outcomes. Ophthalmology 1995;102:1696-701.  Back to cited text no. 8
    
9.
Hutton WL, Fuller DG. Factors influencing final visual results in severely injured eyes. Am J Ophthalmol 1984;97:715-22.  Back to cited text no. 9
[PUBMED]    
10.
Brinton GS, Topping TM, Hyndiuk RA. Post traumatic endophthalmitis. Arch Ophthalmol 1984;102:547-50.  Back to cited text no. 10
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]
 
 
    Tables

  [Table 1]


This article has been cited by
1 Functional and cosmetic reconstruction of ocular laceration complicated by extensive eyelid degloving injury: A case report
Masakatsu Hihara, Rina Hikiami, Natsuko Kakudo
Trauma Case Reports. 2023; 43: 100759
[Pubmed] | [DOI]
2 Clinical Presentations, Management, and Factors Affecting Outcomes in Posterior Segment Open Globe Injuries: An Analysis of 2,360 Eyes
Vivek Pravin Dave, Anthony Vipin Das, Sameera Nayak, Bhavik Panchal, Ferenc Kuhn
Ophthalmologica. 2023; 246(2): 150
[Pubmed] | [DOI]
3 Prognostic factors for visual outcome after surgical repair of limbal corneal laceration at a tertiary eye care center in South India
Prerana A Shetty, Ramya Natarajan, Sushank A Bhalerao, Sowjanya Vuyyuru, Uma Yogesh Thigale, Divya Tara
Indian Journal of Ophthalmology. 2023; 71(9): 3198
[Pubmed] | [DOI]
4 Global Current Practice Patterns for the Management of Open Globe Injuries
Sarah C. Miller, Michael J. Fliotsos, Grant A. Justin, Yoshihiro Yonekawa, Ariel Chen, Annette K. Hoskin, Richard J. Blanch, Kara Cavuoto, Prajna Meeralakshmi, Rebecca Low, Matthew Gardiner, Tin Yan Alvin Liu, Rupesh Agrawal, Fasika A. Woreta
American Journal of Ophthalmology. 2022; 234: 259
[Pubmed] | [DOI]
5 The Predictive Value of Computed Tomography Findings for Poor Visual Outcome in Traumatic Eye Injury
Ping Ren, Yan Jiao, Chunling Zhang, Guoyue Chen, Marta Sacchetti
Journal of Ophthalmology. 2022; 2022: 1
[Pubmed] | [DOI]
6 Epidemiology and prognosis factors in open globe injuries in the Federal District of Brazil
Marina Berquó Peleja, Felipe Bruno Santos da Cunha, Mariana Berquó Peleja, Juliana Tessari Dias Rohr
BMC Ophthalmology. 2022; 22(1)
[Pubmed] | [DOI]
7 Role of Socioeconomic Status (SES) in Globe Injuries: A Review
Panagiotis Kousiouris, Olga Klavdianou, Konstantinos AA Douglas, Nikolaos Gouliopoulos, Klio Chatzistefanou, Maria Kantzanou, Georgios S Dimtsas, Marilita M Moschos
Clinical Ophthalmology. 2022; Volume 16: 25
[Pubmed] | [DOI]
8 Risk Factors for Enucleation Following Open Globe Injury: A 17-Year Experience
Avi Toiv, Asad F Durrani, Yunshu Zhou, Peter Y Zhao, David C Musch, Michael J Huvard, David N Zacks
Clinical Ophthalmology. 2022; Volume 16: 3339
[Pubmed] | [DOI]
9 Relationship of Neutrophil-to-Lymphocyte and Platelet-to-Lymphocyte Ratio With Visual Acuity After Surgical Repair of Open Globe Injury
Karim Mohamed-Noriega, Alan B. Trevińo-Herrera, Jibran Mohamed-Noriega, Braulio H. Velasco-Sepúlveda, Víctor A. Martínez-Pacheco, Dante A. Guevara-Villarreal, Delia L. Rodríguez-Medellín, Anna G. Sepúlveda-Salinas, Gerardo Villarreal-Méndez, Jesús H. González-Cortés, Rodrigo E. Elizondo-Omańa, Santos Guzmán-López, Jesús Mohamed-Hamsho
Frontiers in Medicine. 2021; 8
[Pubmed] | [DOI]
10 Non-traumatic open globe injuries: presenting characteristics and visual outcomes
Andrew W. Gross, James Z. Fan, Margaret L. Pfeiffer, Alice Z. Chuang, Karina Richani, Eric L. Crowell
Eye. 2021;
[Pubmed] | [DOI]
11 Current pattern of ocular trauma as seen in tertiary institutions in south-eastern Nigeria
Chinwe Cynthia Jac-Okereke, Chukwunonso Azubuike Jac-Okereke, Ifeoma Regina Ezegwui, Rich Enujioke Umeh
BMC Ophthalmology. 2021; 21(1)
[Pubmed] | [DOI]
12 Open-globe-injury: A single center Spanish retrospective 5-year cohort study
Elena Guzmán-Almagro, Guillermo Fernandez-Sanz, Diana Herrero-Escudero, Inés Contreras, Julio González Martín-Moro
European Journal of Ophthalmology. 2020; : 1120672120
[Pubmed] | [DOI]
13 Clinical outcomes in traumatic pseudophacocele: A rare clinical entity
Priya Narang, Amar Agarwal
Indian Journal of Ophthalmology. 2017; 65(12): 1465
[Pubmed] | [DOI]
14 Golden half ring sign for identification of pseudophacocele
ShivcharanLal Chandravanshi, Anamika Dwivedi, EvaR Tirkey, Pankaj Choudhary
Indian Journal of Ophthalmology. 2015; 63(3): 259
[Pubmed] | [DOI]
15 OPEN GLOBE OCULAR TRAUMA
Nishant G. Soni,Alain M. Bauza,Jung H. Son,Paul D. Langer,Marco A. Zarbin,Neelakshi Bhagat
Retina. 2013; 33(2): 380
[Pubmed] | [DOI]
16 Retinal Detachment After Open-globe Injury
Yewlin E. Chee,Mrinali M. Patel,Demetrios G. Vavvas
International Ophthalmology Clinics. 2013; 53(4): 79
[Pubmed] | [DOI]
17 Vitrectomy for removal of posterior segment intraocular Foreign bodies: With careful surgical planning, PPV for IOFB removal can yield favorable outcomes
Olmos, L.C., Wilkin Parke, D.
Retina Today. 2012; : 1-5
[Pubmed]
18 Prognostic factors influencing final visual acuity in open globe injuries
Tök, O.Y., Tok, L., Eraslan, E., Ozkaya, D., Ornek, F., Bardak, Y.
Journal of Trauma - Injury, Infection and Critical Care. 2011; 71(6): 1794-1800
[Pubmed]
19 Prognostic factors for vision outcome after surgical repair of open globe injuries
Agrawal, R., Rao, G., Naigaonkar, R., Ou, X., Desai, S.
Indian Journal of Ophthalmology. 2011; 59(6): 464-470
[Pubmed]
20 Characteristics of open globe injuries in geriatric patients | [Geriatrik hastalarda açi{dotless}k göz küresi yaralanmalari{dotless}ni{dotless}n özellikleri]
Tök, L., Yalçin Tök, O., Özkaya, D., Elif, E., SÖnmez, Y., Örnek, F., Yavuz, B.
Ulusal Travma ve Acil Cerrahi Dergisi. 2011; 17(5): 413-418
[Pubmed]
21 Prognostic Factors Influencing Final Visual Acuity in Open Globe Injuries
Ozlem Yalcin Tök,Levent Tok,Elif Eraslan,Dilek Ozkaya,Firdevs Ornek,Yavuz Bardak
The Journal of Trauma: Injury, Infection, and Critical Care. 2011; 71(6): 1794
[Pubmed] | [DOI]
22 Factors influencing the final visual outcome in open globe injuries
Chandravanshi, S., Rathore, M., Tirkey, E., Tiwari, U.
Indian Journal of Ophthalmology. 2011; 59(3): 264
[Pubmed]
23 Prognostic factors for final vision outcome in patients with open globe injuries
Agrawal, R.
Indian Journal of Ophthalmology. 2011; 59(3): 259-260
[Pubmed]



 

Top
 
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
Abstract
Materials and Me...
Results
Discussion
References
Article Figures
Article Tables

 Article Access Statistics
    Viewed3271    
    Printed78    
    Emailed2    
    PDF Downloaded436    
    Comments [Add]    
    Cited by others 23    

Recommend this journal