Value of ocular trauma score and ocular structural parameters in the assessment of healing visual acuity from ocular trauma / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To explore the value of ocular trauma score(OTS), initial visual acuity, and ocular structural parameters in the assessment of healing visual acuity from ocular trauma.METHOD: A total of 302 cases(302 eyes)of ocular trauma were selected as subjects, which were accepted and issued clear appraisal opinions by the Academy of Forensic Science from June 2015 to June 2021. The subjects were grouped according to the healing best corrected visual acuity(BCVA)from ocular trauma. Group Ⅰ included 63 cases(63 eyes)with BCVA <3.7; Group Ⅱ included 70 cases(70 eyes)with 3.7≤ BCVA <4.5; Group Ⅲ included 78 cases(78 eyes)with 4.5≤ BCVA <4.9; Group Ⅳ included 91 cases(91 eyes)with BCVA≥4.9. In addition, 77 cases(77 healthy eyes)of ocular trauma were selected as the control group, namely Group Ⅴ. The healing BCVA and ocular structural parameters from ocular trauma and theirs correlation were analyzed, and the random forest(RF)and support vector machine(SVM)model of healing visual acuity was established by the IBM SPSS Modeler 18.0.RESULTS: The initial visual acuity, OTS, the grading of corneas, lenses, and fundus, and the thickness of the retinal never fiber layer of ocular trauma patients were correlated with the healing BCVA(P<0.01). There were significant differences in ocular structural parameters among groups, except the central subfield thickness(P<0.001). The SVM model had higher accuracy of predicting healing visual acuity than the RF model, and the accuracy rate was over 80% when the error was within 0.15.CONCLUSION:OTS and ocular structural examination can provide effective information for the clinical forensic medicine appraisal of visual dysfunction after ocular trauma, and they are valuable in discriminating camouflage of visual dysfunction.

New model for the prediction of visual outcomes in young children with mechanical ocular conditions and comparison with other models

Purpose: Herein, we compared the efficacy among the Ocular Trauma Score (OTS), Toddlers Ocular Trauma Score (TOTS), and Pediatric Ocular Trauma Score (POTS) for prognosis prediction in Indian children who had mechanical ocular conditions causing traumatic cataract. Methods: This prospective, interventional study recruited consecutive children undergoing operation for traumatic cataracts caused by mechanical eye injuries at Drashti Netralaya. The following details were obtained from their medical files: the circumstance and time of injuries, penetrating injury type, initial and final visual acuity (VA), time of operation, and associated eye diseases. Specific variables were employed to determine the OTS, TOTS, and POTS. For all patients, the final and predicted VA determined using all scores were compared using Fischer’s exact test. Accuracy, specificity, and sensitivity were evaluated for all the scores by using the area under receiver operating characteristic curve. Results: We enrolled 124 eyes. Patients’ mean value for age was 4.6 ± 1.29 years; 44 (35.41%) and 74 (64.5%) were female and male patients, respectively. Visual outcomes significantly improved after operation, and the outcomes did not differ between closed? and open?globe injuries (P = 0.162). The actual and predicted VA did not exhibit a statistically significant difference among the three scores. TOTS and POTS were more suitable for evaluating low?risk injuries, whereas the OTS could more efficiently examine high?risk cases. Conclusion: TOTS and POTS were more accurate than the OTS in VA prediction after operation in toddlers with traumatic cataracts caused by mechanical globe injury. TOTS and POTS were more suitable for evaluating low?risk injuries, whereas the OTS could more efficiently examine high?risk cases. All the examined scores can be helpful in estimating VA following treatment

Analysis of 74 Open Globe Injuries Requiring Vitreo-Retinal Intervention and Its Correlation with Ocular Trauma Score

Aim: Retrospective study of 74 eyes with open globe injuries requiring V-R Intervention & its correlation with ocular trauma score.Results: Commonest cause of injury: Hammer-chisel/stone in 32.43% (24) & Thorn/wooden stick 27% (20). Average age-30.5yrs. Average interval between trauma & intervention was -10.04days (4hrs – 52days).Discussion: Delay of presentation to ophthalmologist has lot of significance,high incidence of endophthalmitis & retinal detachment compared to other studies. Surgical outcome shows lower incidence of NO Light Perception & Significant reduction in number of cases with </=HM. Patients had better prognosis & visual outcome, higher incidence of 1/200- 20/50; 35.14% cases with >20/200. 60% of our cases had traumatic cataract, visual acuity may be underestimated in traumatic cataract. Faulty Projection of rays probably would be better criteria than RAPD. Extension of wound beyond pars plana, and aniridia (6.7%) are important risk factor.Conclusion: Modification of raw points is recommended in OTS criteria in Indian scenario.

Efectividad del Ocular Trauma Score en la predicción de los resultados visuales en pacientes con catarata traumática / Effectiveness of the Ocular Trauma Score to predict visual outcomes in traumatic cataract patients

Objetivo: Evaluar la efectividad del Ocular Trauma Score como factor pronóstico de la agudeza visual final en pacientes con diagnóstico de catarata traumática. Métodos: Se realizó un estudio descriptivo, longitudinal y de evaluación de un sistema pronóstico en una serie de 61 casos. Los pacientes fueron divididos en dos grupos de acuerdo con el mecanismo del trauma. Se estudió la relación entre la agudeza visual a los tres meses después de la cirugía de catarata y las variables demográficas y clínicas. El resultado visual se predijo mediante el Ocular Trauma Score y se comparó con el obtenido. Resultados: La mediana de la edad de los pacientes estudiados fue de 52,8 (RI: 44,0-63,0) años. Los pacientes con antecedentes de trauma abierto tendieron a ser más jóvenes: 50,5 (RI: 43,0-54,0) años de edad vs. 57,0 (RI: 45,5-65,5) años. Predominaron los pacientes del sexo masculino (85,2 por ciento) y de baja escolaridad (55,7 por ciento). Se observó mejoría de la agudeza visual mejor corregida después de la cirugía, en particular en los pacientes con trauma cerrado. El Ocular Trauma Score pronosticó adecuadamente para agudeza visual de 20/40 o más. Conclusiones: Se logran buenos resultados con el uso del Ocular Trauma Score como factor pronóstico de la agudeza visual en pacientes con diagnóstico de catarata traumática(AU)

Objective: Evaluate the effectiveness of the Ocular Trauma Score as a prognostic factor for final visual acuity in patients diagnosed with traumatic cataract. Methods: A descriptive longitudinal evaluative study was conducted of a prognostic system in a series of 61 cases. The patients were divided into two groups according to the trauma mechanism. An analysis was performed of the relationship between visual acuity three months after cataract surgery and clinical and demographic variables. Visual outcome was predicted with the Ocular Trauma Score and then compared with the result obtained. Results: Mean age of the patients studied was 52.8 (IR 44.0-63.0) years. Patients with a history of open trauma tended to be younger: 50.5 (IR: 43.0-54.0) years vs. 57.0 (IR: 45.5-65.5) years. A predominance was found of male sex (85.2 percent) and a low educational level (55.7percent. Best corrected visual acuity was found to improve after surgery, particularly in patients with closed trauma. The Ocular Trauma Score predicted appropriately for visual acuity values of 20/40 or higher. Conclusions: Good results are obtained with the use of the Ocular Trauma Score as a prognostic factor for visual acuity in patients diagnosed with traumatic cataract(AU)

El trauma ocular en la infancia / Ocular trauma in childhood

RESUMEN Objetivo: Determinar los resultados de la aplicación del ocular trauma score como herramienta de pronóstico visual en traumatismos. Métodos: Se realizó un estudio descriptivo longitudinal retrospectivo en el Servicio de Oftalmología del Hospital Pediátrico Provincial Docente "Eduardo Agramonte Piña", desde enero del año 2011 a enero de 2016. El universo estuvo conformado por 438 pacientes quienes recibieron ingreso hospitalario, y la muestra quedó conformada por 357 ojos de 356 pacientes con el diagnóstico de trauma ocular. Se analizaron las siguientes variables: etiología al ingreso, edad, sexo, topografía y tipo de lesión, evento traumático, agente causal, agudeza visual inicial según tipo de lesión y el pronóstico visual según el ocular trauma score. Resultados: El 81,3 por ciento de los pacientes ingresados presentaron etiología traumática; 64,6 por ciento fueron varones, con predominio del grupo de edad entre 5 y 9 años. Hubo una preponderancia de los traumas cerrados. Los accidentes recreativos fueron los más predominantes; los palos y las piedras resultaron el agente causal más frecuente y la agudeza visual final fue superior a la inicial. Conclusiones: La etiología traumática constituye la primera causa de ingreso en el Servicio de Oftalmología, donde se observa predominio de los pacientes entre 5 y 9 años, fundamentalmente del sexo masculino. Los traumas del globo ocular cerrado predominan sobre los del globo ocular abierto. Estos últimos presentan mayor afectación de la agudeza visual. El accidente recreativo y doméstico es más frecuente, así como los palos y las piedras como agentes causales. La mejoría de la agudeza visual fue significativa en este estudio, lo que se correspondió con la predicción sugerida por el ocular trauma score(AU)

ABSTRACT Objective: To determine the results of the application of the ocular trauma score as a tool for visual prognosis in traumatisms. Methods: Descriptive, longitudinal and retrospective study was carried out. The universe consisted of 438 patients who received hospital admission and the sample consisted of 357 eyes of 356 patients with the diagnosis of ocular trauma at admission. Different variables were analyzed: etiology at admission, age, sex, topography and type of injury, traumatic event, causal agent, initial visual acuity according to type of injury and visual prognosis according to ocular trauma score. Results: 81,3 percent of the patients admitted had traumatic etiology, 64.6 percent were males with predominance of the group aged between 5 and 9 years. There was a preponderance of closed traumas. The sticks and stones were the most frequent causal agent and the final visual acuity was superior to the initial one. Conclusions: The traumatic etiology is the first cause of admission in the Ophthalmology Service, where predominance is observed between 5 to 9 years, mainly of the male sex. The traumas to closed ocular globe predominate over those of open ocular globe presenting these last greater affectation of the visual acuity. The recreational and domestic accident is more frequent, as well as the sticks and stones as causal agents. The improvement in visual acuity is significant, corresponding with the prediction suggested by ocular trauma score(AU)

Utilidad del puntaje del trauma ocular como herramienta de pronóstico visual en la cirugía de catarata traumática / Usefulness of the ocular trauma score as a visual prognostic tool in traumatic cataract surgery

Objetivo: determinar la utilidad y la aplicabilidad del puntaje de trauma ocular para predecir los resultados visuales en la cirugía de catarata. Métodos: se realizó un estudio descriptivo, longitudinal y retrospectivo en 124 pacientes con catarata traumática, operados en el Centro de Microcirugía Ocular en el período comprendido entre enero del año 2010 y diciembre de 2015, quienes fueron subdivididos en dos grupos según el tipo de trauma ocular previo. Se evaluó cada paciente inicialmente con el ocular trauma score y se analizó, como variable dependiente, la agudeza visual final tras 3 meses de seguimiento. Se comparó con su valor inicial categorizado y estratificado según el ocular trauma score. En todas las pruebas estadísticas inferenciales se empleó el nivel de significación 0,05, a excepción de las pruebas de Kolmogorov-Smirnov y Levene, donde p debía ser mayor de 0,05. El análisis estadístico se sustentó en tablas y gráficos. Resultados: la incidencia de las cirugías traumáticas fue de 12,0 operaciones x cada 1 000 operaciones de catarata. Predominaron los pacientes con antecedentes de un trauma ocular cerrado (61,3 por ciento) y del sexo masculino (73,4 por ciento) con un promedio de edad de 56,4/15,2 años. La agudeza visual fue de 20/40 o mejor en el 76,6 por ciento de los casos. Los factores predictores fueron: tipo de trauma, desprendimiento de retina, vitrectomía par plana y elevación de la presión intraocular. Conclusiones: El ocular trauma score muestra utilidad para identificar aquellos pacientes que alcanzan una agudeza visual de 20/60 o mayor

Objective: determine the usefulness and applicability of the ocular trauma score to predict visual results in cataract surgery. Methods: a retrospective longitudinal descriptive study was conducted of 124 traumatic cataract patients operated on at the Center for Ocular Microsurgery from January 2010 to December 2015. The patients were divided into two groups according to the type of previous ocular trauma. Each patient was initially evaluated with the ocular trauma score. The dependent variable was final visual acuity after three months of follow-up, which was compared with its initial value as categorized and stratified according to the ocular trauma score. All inferential statistical tests used a significance level of 0.05, except for Kolmogorov-Smirnov's and Levene's tests, where p should be above 0.05. The statistical analysis was supported by tables and charts. Results: the incidence of traumatic surgery was 12.0 operations per 1 000 cataract operations. A predominance was found of patients with a history of closed ocular trauma (61.3 percent) and male sex (73.4 percent). Mean age was 56.4/15.2 years. Visual acuity was 20/40 or better in 76.6 percent of the cases. The predictors were trauma type, retinal detachment, pars plana vitrectomy and intraocular pressure elevation. Conclusions: the ocular trauma score was found to be useful to identify patients who will have visual acuity values of 20/60 or higher(AU)

The Relationship between Visual Outcome and Ocular Trauma Score after Open Globe Injuries in Children

PURPOSE: We evaluated the prognostic factors of open globe injuries in children and adolescents, and compared the ocular trauma score (OTS) and pediatric penetrating ocular trauma score (POTS). METHODS: We performed a retrospective review of 77 children under 18 years of age who visited our clinic with open globe injuries between May 1993 and April 2014. We investigated the factors that may affect final visual acuity. We also compared the OTS and POTS using receiver operating characteristic curves as a method to predict final visual acuity. RESULTS: By univariate analysis, an initial visual acuity less than 20/200, globe rupture, wound size greater than 7.0 mm, retinal detachment, lens dislocation, and total number of operations contributed to worse visual outcomes (<20/200). Conversely, central corneal involvement, traumatic cataract, wound size less than 7.0 mm, and initial visual acuity greater than 20/200 were better prognostic indicators (≥20/32). Both OTS and POTS had diagnostic value as a predictor of final visual acuity, although there were no statistically significant differences between the two scoring systems. CONCLUSIONS: Initial visual acuity and wound size are important prognostic factors for the final visual acuity in children and adolescent, following open globe injuries. Both OTS and POTS are reliable prognostic models for open globe injuries in children and adolescents.

Effectiveness and prognosis of 23G vitrectomy for perforating ocular trauma caused by metallic foreign bodies / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To summarize the characteristics of ocular perforation caused by metallic foreign body, evaluate the effectiveness and safety of 23G vitrectomy, and analyze the factors that affect the final vision of patients with ocular trauma score. <p>METHODS: Continuous observation and analysis from July 1, 2014 to June 1, 2016, hospitalized in our hospital caused by metallic perforating ocular trauma for 23G vitrectomy in 38 cases(38 eyes). A prospective collection of patient included age, gender, eye, place of occurance of trauma, foreign body size, wound length, foreign body position, initial visual acuity and final visual acuity, macular etc.. The ocular trauma score(OTS)system was used to assess the effectiveness and prognosis of the patients. The follow-up time was over 6mo. <p>RESULTS: There were 38 eyes in 38 patients, including 37 males and 1 females, aged 16y-56y. Ocular trauma mainly occurred in the workplace, 33 cases accounted for 87%, followed by sports venues, 3 cases accounting for 8%. Corrected visual acuity more than 0.1 in eyes with intraocular foreign bodies underwent 23G vitrectomy were 21 cases, accounting for 55%. Preoperative retinal detachment, large foreign body(more than 5.0mm), damage of lens were important factors of poor prognosis. Foreign bodies were located in the vitreous body in 23 cases, accounting for 61%, located in the retina in 15 cases, accounting for 39%. When admitted to hospital, the patients suffered from retinal detachment in 21 cases(55%), endophthalmitis in 7 cases(18%), the size of intraocular foreign bodies(IFOB)was larger than 5.0mm in 7 cases(18%), severe postoperative proliferative vitreoretinopathy(PVR)was in 6 cases(16%), epiretinal membrance of macula in 5 cases(13%). Of the same OTS scores, visual acuity in 6mo was significantly better than preoperative; no matter preoperative vision or postoperative vision in 6mo, the higher the OTS scores, the better the visual acuity. <p>CONCLUSION: The ocular perforation caused by metallic foreign body mostly occurs in young men under 40y, and the main reason is injury in the workplace. No protective measures are adopted. The main factors affecting the final visual acuity are retinal detachment, foreign body greater than 5.0mm and postoperative PVR appearance after the injury, vitrectomy time has little effect. The 23G vitrectomy is safe, reliable and effective in the treatment of ocular penetrating injuries due to metallic foreign bodies. OTS score can be used effectively in patients with ocular perforation caused by metallic foreign bodies and make reasonable and useful postoperative visual acuity prediction.

The Availability of Modified Ocular Trauma Score in Korean Patients with Open Globe Injury

PURPOSE: To modify the ocular trauma score (OTS) model by analyzing the clinical characteristics of Korean patients with open globe injury and to determine the availability of the modified OTS in predicting the final visual acuity. METHODS: Among the prognostic factors in the original OTS, endophthalmitis and perforating injury were excluded, and wound location, vitreous hemorrhage, lens damage, and lid laceration were added to the modified OTS based on the data of 242 patients with open globe injury from January 2000 to September 2010. To determine the availability of the modified OTS, 29 patients from September 2010 to December 2011, not included in the previous data, were retrospectively reviewed, and the positive and negative predictive values for assessment of final visual acuity less than 0.02 were calculated by the original and modified OTS. RESULTS: The modified OTS was applied to the previous data, and the positive predictive value was 75.3% and negative predictive value was 90.8%. By using the original OTS, the positive predictive value was 70.1% and negative predictive value was 89.8%. The values of the modified OTS was higher than those of the original OTS, but it was not statistically significant (p = 0.5956, p = 0.9370). When the modified OTS was applied to the new 29 patients, the positive and negative predictive values were 75.0% and 90.5%, respectively. CONCLUSIONS: The prognostic factors of the original OTS were modified based on the previous data and the positive and negative predictive values of final visual acuity by modified OTS were similar to those by the original OTS. The modified OTS would be useful in analyzing the patients with open globe injuries and could be used as a prognostic model for Korean patients.

The Predictability of Ocular Trauma Score and Prognostic Factors of Open Globe Injury

PURPOSE: To determine the prognostic factors of visual outcome in open globe injury and to assess the possibility of an ocular trauma score (OTS) model of predictive value in open globe injuries in Koreans. METHODS: The medical records of 242 patients with open globe injury from 2000 to 2010 were retrospectively reviewed. Prognostic factors of visual outcome, positive predictive rate, and negative predictive rate were surveyed. RESULTS: In the multivariate analysis, old age, relative afferent pupillary defect, impaired initial visual acuity and retinal detachment were the worst predictive factors of vision survival. In OTS categories 1 and 2, worse final visual acuity was acquired, and positive predictive rate and negative predictive rate for assessment of final visual acuity less than 0.02 were 70.1% and 89.8%, respectively. CONCLUSIONS: The prognostic factors of open globe injury associated with impaired final visual acuity were old age, relative afferent pupillary defect, worse initial visual acuity, retinal detachment and OTS categories 1 and 2. The OTS may have prognostic value in open globe injuries in Korean patients. However, identified prognostic factors of the present study did not entirely coincide with those of other Koreans or previous studies. Therefore, additional studies on the modified open globe injury as a prognostic model in Korean patients are needed.

A Statistical Observation of Ocular Injuries and Visual Predictive Value of Ocular Trauma Score

PURPOSE: To investigate the clinical characteristics of ocular injuries for the prevention and predictability of visual prognosis and the treatment of ocular injuries using the ocular trauma score. METHODS: A retrospective survey was performed in 1341 eyes of 1257 patients, who visited Korea University Medical Center from May 2009 to December 2009. The sex, age, causes, diagnosis, primary ocular surgery, injury site, initial and final visual acuities and complications were statistically reviewed. The ocular trauma score was calculated by assigning certain numerical raw points to the following six variables: initial visual acuity, globe rupture, endophthalmitis, perforating injury, retinal detachment, and a relative afferent pupillary defect. The correlation of the ocular traumascore with the final visual acuity was investigated. RESULTS: The incidence of ocular injuries was higher in males (79.0%) than in females and was more common in people in their 40s and 20s respectively. Among the patient the diagnoses, corneal erosion was most common in males, orbital wall fracture was most common in females, and corneal erosion, orbital wall fracture, orbital contusion, and hyphema were most common overall. An ocular trauma score was less than 44 in 6 eyes (0.7%), 9 eyes (1.0%) between a score of 45 and 65, 48 eyes (5.2%) between a score of 66 and 80, 122 eyes (13.2%) between a score of 81 and 90, and 737 eyes (79.9%) between a score of 91 and 100. CONCLUSIONS: The present study determined that the ocular trauma score showed a good visual predictive value and could be used in prevention and treatment of ocular injuries.

Ocular trauma score para la evaluación inicial del trauma ocular / Ocular trauma score at the initial evaluation of ocular trauma

Introducción: El sistema de clasificación de lesiones mecánicas oculares establece el estado del ojo lesionado pero no tiene valor pronóstico. El objetivo de esta investigación fue identificar la proporción de ojos lesionados sin alteraciones que requirieron la participación del oftalmólogo durante la evaluación inicial, para saber si el ocular trauma score (que estima el pronóstico visual a los seis meses) pudiera ser empleado por médicos no oftalmólogos en la sala de trauma. Material y métodos: Con el sistema de clasificación de lesiones mecánicas oculares se evaluaron pacientes con trauma ocular atendidos en un hospital general de la ciudad de México entre 1995 y 2008. Se identificó la proporción de ojos que requería la evaluación por el oftalmólogo por desprendimiento de retina o endoftalmitis. A todos los ojos se les asignó una categoría del ocular trauma score. Se determinó la proporción y el intervalo de confianza de 95% de los ojos en que podría aplicarse el ocular trauma score en la sala de trauma. Resultados: Se evaluaron 742 ojos. Seis presentaron desprendimiento de retina (0.8%, IC 95% 0.16-1.44) y dos endoftalmitis (0.3%, IC 95% 0-0.69). La proporción de ojos en que podría aplicarse el ocular trauma score en la sala de trauma fue de 98.9% (IC 95% 98.15-99.65). Conclusiones: El ocular trauma score puede utilizarse en casi todos los ojos lesionados para estimar el pronóstico visual durante la evaluación inicial en la sala de trauma, sin la participación de un oftalmólogo.

BACKGROUND: The system for classifying mechanical injuries of the eye can identify the status of an injured eye at the trauma room, but it has no prognostic value. The ocular trauma score (OTS) estimates the 6-month visual prognosis, but some of its variables require evaluation by an ophthalmologist. We identified the proportion of injured eyes without diseases that required assessment of an ophthalmologist during the initial evaluation in order to determine whether the OTS could be used by non-ophthalmologists at the trauma room. METHODS: We evaluated patients with ocular trauma who attended a general hospital in Mexico City between 1995 and 2008 and graded them with the system for classifying mechanical injuries of the eye. The rate of eyes with retinal detachment and endophthalmitis that needed evaluation by an ophthalmologist was identified, and all the eyes were assigned an OTS category. The proportion and 95% confidence intervals (95% CI) of eyes that could be graded using the OTS in a trauma room was determined. RESULTS: We evaluated 742 eyes. Retinal detachment was found in six eyes (0.8%, 95% CI 0.16-1.44) and endophthalmitis in two eyes (0.3%, 95% CI 0-0.69). The proportion of eyes that could be graded using the OTS in a trauma room was 98.9% (95% CI 98.15-99.65). CONCLUSIONS: OTS can be used to estimate the visual prognosis of almost every injured eye during the initial evaluation in a trauma room without the evaluation of an ophthalmologist.