Prognostic value of a classification and regression tree model in patients with open-globe injuries

Objective@#To evaluate the accuracy of the Classification and Regression Tree (CART) model in prognosticating visual outcomes of patients with open-globe injuries@*Methods@#This was a retrospective, single-center, cohort study of patients with open-globe injuries seen over a two-year period. Purposive sampling of hospital medical records was done to collect data from both in- and out-patient cases. The CART algorithm was utilized to determine the predicted visual outcome for each case, and the accuracy of prognostication was measured by computing for sensitivity, specificity, positive predictive value, and negative predictive value. The area under the receiver operating characteristic curve was used to check its discriminatory capability.@*Results@#A total of 65 eyes (65 patients) with the following diagnoses based on the Birmingham Eye Trauma Terminology (BETT) classification were included: penetrating eye injury (n=58), globe rupture (n=2), and intraocular foreign body (n=5). Majority were male patients (81.5%) in the 17-39 year age group (40%). The sensitivity and specificity of CART were 100% (95% CI 93.6 to 100%) and 77.8% (95% CI 40 to 97.2%), respectively, with an overall accuracy of 96.9% (95% CI 89.3 to 99.6%). Area under the curve (AUC) was statistically significant at 0.89 (95% CI 0.79 to 0.95), indicating that the CART model can discriminate vision survival versus no vision.@*Conclusion@#The CART model demonstrated high accuracy in prognosticating visual outcomes after an openglobe injury in the local setting. It may be used as a helpful tool to guide treatment decisions in open-globe injuries.

Prognostic factors for visual outcome after surgical repair of limbal corneal laceration at a tertiary eye care center in South India

Purpose: To determine the factors affecting the visual outcome after surgical repair of limbal corneal lacerations at a tertiary eye care center in South India. Methods: A retrospective analysis of patients diagnosed with limbal tears between 2011 and 2021 was conducted. Demographic information such as age, gender, cause of injury, and size of the laceration was recorded. Comprehensive ocular examination was performed, including gentle B scan evaluation whenever not contraindicated for detailed posterior segment evaluation. Only those cases with a minimum follow?up of one year were included. Postoperative best?corrected visual acuity, intraocular pressure (IOP), cornea clarity, and integrity of the wound at last follow?up were noted. Results: Out of the 20 patients, 15 (75%) were males and 5 (25%) were females. The mean age was 42.6 � 22.4 years. All 20 patients had a penetrating injury, with four (20%) injured by a stick, two (10%) by an iron rod, three (15%) due to road traffic accident (RTA), three (15%) by glass, and eight (40%) with other nonspecific objects [two (10%) with needle, two (10%) with elastic rope, two (10%) with bangle, and two (10%) with metal]. The average time between the injury and the surgery was 48 hours (2 days). Four (20%) patients underwent a second surgery within a week of repair. After limbal tear repair, at final follow?up at 3 years, 7 (35%) had VA worse than 20/800, 3 (15%) had VA between 20/100 and 20/800, and 10 (50%) achieved VA better than 20/80. Conclusion: Preoperative visual acuity (VA), mode of injury, and size of wound affect the final visual outcome after surgical repair of limbal corneal laceration. Preoperative VA and mode of injury were statistically significant even in the multivariate analysis.

A series of 777 pellet gun ocular injuries over a 4-month period in Kashmir

Purpose: To examine the incidence, clinical findings and management of pellet gun–related ocular injuries that occurred during protests in Kashmir region. Methods: This retrospective study included records from 777 patients diagnosed with pellet gun–related ocular injuries admitted to a tertiary hospital in Srinagar, India, between July and November 2016. By reviewing the clinical records, the following data were collected: demographics, clinical information pertaining to the injury, imaging reports including computer tomography and ultrasonography B?scan, management in the emergency setting, and follow?up treatment. Results: Mean age was 22.3 ± 7.2 years and majority patients were male (97.7%). In terms of laterality, 94.3% and 5.7% of the patients sustained monocular and binocular injuries, respectively. In terms of the nature of injury, 76.3% of the eyes had open globe injury while 23.7% of the eyes had closed eye injury. Emergency surgical exploration was performed in 67.7% of closed globe injuries while emergency primary repair was done in 91.1% of open globe injuries. The vast majority of patients (98.7%) who required surgery underwent surgical intervention on the day of admission or the next day. Final best?corrected visual acuity (BCVA) after treatment was counting fingers or worse in 82.4% of the eyes. Conclusion: Pellet gun–related ocular injuries resulted in significant ocular morbidity, mostly manifesting as open globe injuries. Treatment often required surgical interventions, but despite expeditious management, visual prognosis remained poor for most of the patients.

Innovative method for wound debridement in open globe injury

Background: Open globe injury is a serious sight threatening condition. Full-thickness, non-selfsealing corneal lacerations require repair in the operating room. During repair, debridement of the wound is an important step. Incarceration of the intraocular structures in the wound eg. Iris, lens capsule, vitreous leads to improper healing if not removed properly. Purpose: To demonstrate the technique of wound debridement in open globe injury. Synopsis: Manual removal of incarcerated tissue contents leads to incomplete cleaning & enormous traction on intra ocular contents. In this video, we have tried vitrectomy cutter with higher vacuum for cleaning the edges of the wound especially in the posterior aspect and debri removal, followed by easy suturing. All tissue in the wound edges are removed effectively without any traction on intraocular contents. Highlights: Vitrectomy cutter is a very useful and effective tool to clean wound edges and good apposition & suturing of wound

Open globe injuries from projectile impact: Initial presentation and outcomes

Purpose: To describe the characteristics and correlates of open globe injuries secondary to projectile injury and outcomes following surgical open globe repair at an urban tertiary referral center. Methods: Records of all patients with a history of open globe injury secondary to projectile injury and surgical open globe at a tertiary referral hospital between January 1, 2010 and December 31, 2016 were reviewed. Demographics, type of trauma, wound extent, presence of foreign body, and presenting clinical findings are reported. Outcomes for patients with greater than 6 months of follow?up included additional surgeries, final visual acuity, and clinical findings. Results: Of 214 patients who underwent open globe repair, 73 (34.1%) were due to projectile impact. Mean age was 37.9 years and patients were primarily male (n = 66, P < 0.001). Most injuries resulted in globe laceration (68.5%, P < 0.001), and wound extent was zone 1 (45.2%), zone 2 (20.5%), zone 3 (27.4%), or unknown (6.8%). Associated findings included foreign body (35.6%) and orbital fracture (15%). Of 41 patients with at least 6 months of follow?up, 70% had additional surgeries following their initial surgical repair. Laceration injuries tended to be more anterior (P = 0.002) with better visual outcomes (P = 0.045) than those with globe rupture, and concomitant orbital fracture associated with poor visual outcomes. Overall, 58.5% of patients had 20/40 or better final best?corrected visual acuity. Conclusion: This is the largest report of open globe injury due to projectile impact. Visual prognosis in this population is very good, with most patients achieving better than 20/40 vision in our study

Factors affecting visual outcomes of children with open globe injury

Objective@#This study described the demographics of pediatric patients who sustained open globe injuries, determined the visual outcome of open globe injuries in pediatric patients and the factors associated with final visual acuity. @*Methodology@#The medical charts of 195 patients aged 0-18 years seen for open globe injury in a Philippine tertiary hospital for three years were reviewed. @*Results@#The average age of patients was 7.9 years with 41% belonging to the 5-9 years old group. Seventy-five percent (75%) of the patients were males. Ninety-five percent (95%) of the open globe injuries were accidental, mostly from play (67%). The most common agents of injury were metallic objects (42%) followed by wooden objects (24%). The cornea was injured in 80% of the cases, cornea and sclera in 10%, sclera in 7%, and globe rupture in 3%. Eighty-six percent (86%) of the patients underwent surgery. Initial visual acuity was associated with the presence of complication and the site of injury. Final visual acuity was associated with the initial visual acuity, the interval from injury to consultation, the site of injury, and the presence of complications. @*Conclusions@#The majority of the injuries were accidental and thus avoidable. The education of parents and caregivers on proper storage of potentially harmful objects at home and proper supervision of children at play are important in addition to early consultation after the injury as well as a timely intervention.

Study on factors in patients to get rid of blindness with post traumatic infectious endophthalmitis / 国际眼科杂志(Guoji Yanke Zazhi)

AIM:To investigate the factors affecting patients with post traumatic infectious endophthalmitis(PTIE)relieving from blindness.METHODS: A retrospective study was conducted on 169 patients(169 eyes)with PTIE from January 2010 to December 2020 in the department of ophthalmology, the Affiliated Hospital of Nantong University. After treatment of intravitreal injection of antibiotics(IVIA)and/or pars plana vitrectomy(PPV), the patients were divided into the getting rid of blindness group(103 eyes)and unilateral blindness group(66 eyes)according to the last follow-up of best correct visual acuity(BCVA)≥0.05. The factors affecting the patients to get rid of blindness were analyzed.RESULTS: The rate of relieving from blindness was 53.5%. Univariate analysis showed that BCVA before treatment ≥ hand movement, no retinal detachment, fundus grade of endophthalmitis < grade 3 and no strong virulence of infected microorganisms were beneficial for patients to get rid of blindness(P<0.05). Multivariate Logistic regression analysis identified that BCVA before treatment ≥ hand movement(OR=0.253, 95%CI: 0.108-0.592)and no retinal detachment(OR=0.241, 95%CI: 0.103-0.564)were favorable factors for patient to get rid of blindness.CONCLUSION: Better BCVA before treatment, no retinal detachment, endophthalmitis fundus grade < 3, and no strong virulence of infected microorganisms are favorable factors for patients with PTIE to get rid of blindness finally.

Pattern and Final Visual Outcome in Paediatric Ocular Trauma in Central India.

Paediatric ocular trauma is one of the most common causes of preventable visual morbidity in children. One third vision loss occurs in the first decade of life, which is crucial stage for visual development. We wanted to evaluate the final visual outcome of paediatric ocular trauma and determine the various aetiological factors contributing to ocular trauma.METHODSProspective data regarding age, sex, visual acuity, etiological factors of 100 children who visited the emergency in the department of ophthalmology was collected. Children below 18 years of age were included. Children who could not cooperate or lost to follow-up were excluded from the study. Chi square test was done. P values were considered statistically significant at 0.01% level.RESULTSOf the 100 cases, closed globe injury accounted for 69% and the sex ratio was 3.2:1.48 children had visual acuity > 6/12, 18 had visual acuity 6/18 – 6/36, and 3 children had no perception of light (NOPL).CONCLUSIONSPaediatric ocular trauma is a major cause of the non-congenital unilateral blindness. Such injuries cannot always be prevented, but by identifying the underlying aetiological factor of serious injuries, it may be possible to determine the most effective method of reducing the incidence of visually challenging trauma. Although prognosis is mainly dependent on the extent of injury, choice of appropriate management can favourably affect the visual outcome.

Incidence, clinical profile, and short-term outcomes of post-traumatic glaucoma in pediatric eyes

Purpose: To report the incidence, modes of injury, treatment, and short-term outcomes in eyes with post-traumatic elevated intraocular pressure (IOP). Methods: This was a 5-year hospital-based retrospective study of children ?16 years who presented with open (OGI) or closed globe injury (CGI) and developed elevated IOP >21 mmHg. Those with a minimum follow up of 3 months were included. Analysis of various parameters such as influence of demographics, mode of injury, IOP, best-corrected visual acuity (BCVA), and effect of medical and surgical treatment on IOP and BCVA was done. Results: Out of 205 pediatric eyes with ocular trauma, 121 (59%) had CGI and the remaining 84 (41%) had OGI. Thirty-two eyes (15.6%) developed elevated IOP. The incidence of elevated IOP following CGI [25 eyes (20.6%)] was significantly higher than that following OGI [7 eyes (8.3%, P = 0.02)]. Hyphema (37.5%) and lens-related mechanisms (18.75%) were the most common causes of elevated IOP. The mean IOP at the time of diagnosis was 29.8 + 6.3 mmHg and reduced to 16.2 ± 2.2 mmHg at last follow up (P < 0.001). Surgical management was required in 12 eyes (37%) and significantly more eyes with CGI required trabeculectomy (24% in CGI vs. 0% in OGI, P = 0.03). Poor baseline vision and vitreoretinal involvement [0.67 line decrement, 95% confidence interval (CI) =0.1–1.25 lines, P = 0.025] increased risk of poor visual outcome. Conclusion: Post-traumatic IOP elevation occurred in 15% pediatric eyes, was more common with CGI compared to OGI and nearly one-fourth of eyes with CGI required glaucoma filtering surgery for IOP control. Overall, medical management was needed in 63% eyes and 37% required surgical management. Visual acuity was poor in eyes with OGI due to posterior segment involvement.

Epidemiological profile of pediatric ocular trauma in a tertiary hospital of northern India / 中华创伤杂志(英文版)

<p><b>PURPOSE</b>Ocular trauma is one of the most common causes of acquired blindness in children. It measures about 8%-14% of total childhood injuries. This study aims to determine the epidemiological profile of ocular trauma in the pediatric age group attending a tertiary hospital in northern India.</p><p><b>METHODS</b>A retrospective study was conducted in our hospital between June 2014 to July 2015 and all the children aged 0-16 years presenting with ocular trauma in eye outpatient department and emergency were enrolled in the study. Various epidemiological parameters like age, sex distribution, duration of presentation, mode of injury, type of injury and final visual outcome were analyzed.</p><p><b>RESULTS</b>Of total 357 patients, 271 (76%) were below the age of 12 years; 41.1% of children with ocular trauma belonged to age group 2-6 years. The male to female ratio was 2.9:1. Out of total patients, 242 (67.8%) presented with closed globe injury. Among the closed globe injury, the history of fall was present in about 35% of children, followed by trauma while playing with bat/ball (15.7%) and finger nail trauma (13.2%). Among open globe injury, trauma with needle, knife, glass and pen were common causes. Home was the most common place of injury (47.8%), followed by streets (17.9%) and playground (14.9%).</p><p><b>CONCLUSION</b>Children are vulnerable to ocular trauma and need more supervision. Sharp objects like needles, knives, household chemicals like acids should be out of reach of children.</p>

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.

Clinical observation of early vitrectomy for open globe injuries with intraocular foreign bodies / 局解手术学杂志

Objective To evaluate the clinical effect of vitrectomy for open globe injuries with intraocular foreign bodies in 48 hours after injury.Methods Retrospective analysis was used to evaluate the patients with open globe injuries (OGIs) accompanied by intraocular foreign bodies (IOFB) who underwent vitrectomy of pars plana vitrectomy (PPV) within 48 hours during the period from January 1,2009 to March 1,2015 in our hospital.Results Among the 56 eyes,16 eyes with intraocular foreign bodies occurred endophthalmitis,while the other 40 eyes did not;the intraocular foreign bodies removal rate was 100％.Among all the patient eyes,52 eyes were saved after surgery,while 4 eyes failed.The pars plana vitrectomy operation ratio of the intraocular foreign bodies patients with endophthalmitis and operated within 24 to 48 hours was 2.09 times than that within 24 hours.There was no significant difference in terms of eye preservation,one time of retinal reposition and abnormal intraocular pressure no matter the PPV surgery was conducted within 24 hours or 24 to 48 hours after injury.Conclusion Early vitrectomy is a safe and effective method for the treatment of open globe injuries with intraocular foreign bodies.

Open Globe Injury in Hospital Serdang - An 8-year Retrospective Review

Introduction: Open globe injury may lead to devastating visual outcome. Urgent management and subsequent follow-up is important to maximise recovery. More data on open globe injury in Malaysia is needed to identify risk groups and prognostic factors. This study was carried out to investigate open globe injury, the socio-epidemic profile, clinical characteristics and outcome of the open globe injury in the Hospital Serdang, Malaysia. Methods: All patients managed for open globe injury to Hospital Serdang from January 2006 to December 2013 were included in this retrospective case review. Student’s T-test was used to determine difference between means and chi-square for categorical data. P value of less than 0.05 was regarded as statistically significant. Results: There were 155 patients managed for open globe injury with three of them had bilateral involvement. As such, there were 158 cases eligible for analysis in this study. The average age was 32.2 ± 16.5 years (mean ± standard deviation, SD). Male was at higher risk for open globe injury. Predictors for poor visual outcome were foreign nationality (p=0.047), lid laceration (0.008), type of injury (p=0.001), site of injury (p=0.008), RAPD (p<0.001), uveal prolapse (p<0.001), hyphaema (p=0.008), lens damage (p=0.010), vitreous loss (0.014), retinal detachment (p=0.011), intraocular foreign body (IOFB) (0.014) and poor presenting uncorrected visual acuity (UCVA) (p<0.001). Conclusions: Occupational injury was a main cause of open globe injury in Hospital Serdang. Although in general the visual outcome is good, effort should be put to prevent work-related injury.

Profile of ocular injury in pediatric age group / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To study the clinical profile of ocular injuries in children in a tertiary care center in Northern India.<p>METHODS: This was a hospital based descriptive study. All children of ocular injuries up to 16y of age were included. Data regarding the socio-economic status, medical/surgical treatment, and condition at discharge were recorded. Follow-up to 3mo was done in the study. Initial and final visual acuity was recorded. Ocular Trauma Classification Group guidelines and Birmingham Eye Trauma Terminology were used for the definitions and classifications of ocular trauma. Socio-economic status grading is done according to modified B.G. Prasad classification and Kuppuswamy's socio-economic scale.<p>RESULTS: Out of 42 children, male to female ratio was 3.6:1.Maximum number(50%)of injuries occurred between 11-16y of age. Most of the children(59.52%)belonged to lower socio-economic class and were from arural background. Ocular injuries occurred at home in 20(47.61%)children followed by 6(14.28%)each in school, playground, and street. Open globe injuries were seen in 19(45.24%)children and 23(54.75%)children had closed globe injuries. Injuries by wooden stick, stone, firework, fall, toy were 12(28.57%), 5(11.90%), 3(7.14%), 3(7.14%), and 2(4.76%). Seventeen(40.47%)children required medical management and 25(59.53%)were treated surgically.<p>CONCLUSION:Male children in rural regions and of lower socio-economic background were more prone to ocular injuries. Children were more risk of ocular injuries at home. Wooden sticks and stone were the commonest cause of ocular injuries. Ocular morbidity and poor visual outcome were seen more in open globe injuries. Further population-based studies are required to reinforce findings of present study. Based on this, a long term strategy can be planned to prevent ocular injuries in children in this region.

Changes in the Clinical Manifestations of Ocular Injuries Induced by Power Lawn Mowers

PURPOSE: To investigate changes in the clinical manifestations of ocular injuries induced by power lawn mowers. METHODS: In a retrospective study of 172 patients with ocular injuries induced by power lawn mowers in 2006, 2010, and 2014. Best corrected visual acuity (BCVA) at the time of presentation and 6 months after trauma, age, sex and seasonal distribution were analyzed. We assessed the degree of injury using slit lamp biomicroscopy, fundus examination, and computed tomography and analyzed the prognoses according to open/closed injury and, anterior/posterior segment injury. All patients underwent medical or surgical treatment, and the factors affecting final BCVA were analyzed. RESULTS: The ratio of closed injuries increased significantly (p = 0.027), as did the ratio of corneal erosion (p = 0.020), and, the ratio of corneal laceration decreased significantly (p = 0.014) over time. In the multivariate analysis, initial BCVA was the only risk factor of poor visual outcome in both open and closed injuries. CONCLUSIONS: The proportion of open globe injury has decreased over time. In contrast, the proportion of simple injuries such as corneal erosion has increased in ocular injuries induced by power lawn mowers. Lower initial visual acuity was the only risk factor of poor visual outcome in both open and closed injuries.

Clinical characteristics and therapeutic effect of open globe injury / 国际眼科杂志(Guoji Yanke Zazhi)

? AIM: To analyze clinical characteristics and postoperative outcomes after open globe injury.?METHODS: Demographic characteristics ( age, gender, eye trauma, profession, cause of injury and injured part ) , as well as complications and prognosis were analyzed in 152 cases (152 eyes) of open globe injury.? RESULTS: Patients with open globe injury had an average age of 40. 45±38. 32 years old with a 5. 9:1 male-to-female gender ratio. The left-to-right eye ratio was 1. 27:1. Most patients were workers, farmers, or retired. The most common etiologies were scratches, boxing, and falls. Zone Ⅲ was the most commonly injured part. Iridoptosis or iris incarceration, retinal detachment, vitreal prolapse, hyphema or hypopyon, and vitreous hemorrhage were the most common complications. Visual acuity improved in 86 cases postoperatively but ophthalmectomy was still required in 25 eyes.?CONCLUSION: Vision can be improved after surgery in open globe injury. However, patients are usually seriously injured and improvement is minimal, thereby resulting in a great loss to patients and society.

Characteristics and visual outcomes of open globe injuries in children of amblyogenic age in Hong Kong / 国际眼科杂志(Guoji Yanke Zazhi)

AIM:To evaluate the demographics, characteristics and visual outcomes of open globe injuries in children of amblyogenic age in Hong Kong. METHODS: All medical records of children aged between 0 to 8y old who sustained open globe injuries between Jan. 1st, 2005 and Jan. 1st, 2015 were reviewed retrospectively. The demographics, clinical features ( laterality, etiology and zone of injury, other associated ocular injuries ) , type of primary and secondary operations performed, preoperative and postoperative best spectacle corrected visual acuity ( BSCVA ) complications were collected and analysed. RESULTS: A total of 7 cases, 2 males and 5 females were identified. The median age of presentation was 5 years old. All suffered from penetrating injuries (100%). Four cases ( 57%) had improvement of visual acuity compared with preoperative visual acuity. Final visual acuity was hand movement in one (14%) patient, 20/200-20/50 in four ( 57%) patients, and 20/40 or better in two (29%) patients. CONCLUSION: There is a relative low rate of open globe injuries in young children in Hong Kong. Good visual outcomes may be obtained depending on the location and severity of the open globe injury together with prompt surgical management to restore the integrity of the globe and aggressive management of amblyopia.

Factores predictivos relacionados con la aparición y el pronóstico visual de la endoftalmitis traumática / Predictive factors related to the occurrence and visual prognosis of traumatic endophthalmitis

Objetivo: determinar los factores predictivos relacionados con la aparición y el pronóstico visual de la endoftalmitis traumática. Métodos: se realizó un estudio longitudinal de serie de casos durante dos años, en 191 pacientes con trauma ocular a globo abierto severo. Se realizó interrogatorio, examen físico oftalmológico completo, refracción dinámica y en caso necesario ultrasonido ocular, radiografía y/o tomografía axial computarizada. Resultados: la prevalencia de endoftalmitis traumática se presentó en el 12,04 por ciento de los pacientes. La media de la edad fue 40,87 ± 14,25 con rango de 16-70 años, con predominio del sexo masculino (95,65 por ciento) y ojo derecho (69,57 por ciento). El análisis univariado de factores de riesgo de endoftalmitis traumática mostró significación estadística para ambiente (p= 0,052), presencia de cuerpo extraño intraocular (p= 0,069), disrupción cristalineana (p< 0,0001), tamaño de la herida (p< 0,0001)y reparación primaria de la herida (p< 0,0001). En el 26 por ciento de los pacientes con heridas autosellantes se decidió suturar, y todos los que tenían heridas autosellantes y desarrollaron endoftalmitis se encontraban dentro de las no suturadas. En el análisis univariado de factores de riesgo para el pronóstico visual de endoftalmitis traumática resultaron estadísticamente significativos: desprendimiento de retina (p=0,059), tamaño de la herida (p= 0,058) y uso de antibiótico sistémico (p= 0,004). Conclusiones: en el enfrentamiento del paciente con trauma ocular a globo abierto es esencial la profilaxis de endoftalmitis traumática, con seguimiento estricto del paciente. Puede ser aconsejable antibiótico sistémico, y constituye pilar importante la individualización mediante identificación de factores de riesgo que justifica la administración de antibiótico intravitreo(AU)

Objective: to determine predictive factors related with the occurrence and the visual prognosis of traumatic endophthalmitis. Methods: longitudinal case series study of 191 patients with severe open globe trauma conducted in two years. The patients answered a questionnaire, underwent complete physical ophthalmological exam and dynamic refraction, and if necessary, ocular ultrasound, x-and/or computed tomography scanning were applied. Results: prevalence of traumatic endophthalmitis was 12,04 percent. Mean age was 40,87 ± 14,25 (range of 16-70 year years). Males (95,65 percent) and the right eye (69,57 percent) predominated. The risk factor analysis related with traumatic endophthalmitis showed statistical significance for environment (p= 0,052), presence of intraocular foreign body (p= 0,069), rupture of the lens (p< 0,0001), wound size (p< 0,0001) and primary wound repair (p< 0,0001). Twenty six percent of patients with spontaneous closing wounds were sutured. All the patients with spontaneous closing wounds, who developed endophthalmitis, were in the non-sutured group. Retinal detachment (p= 0,059), wound size (p= 0,058) and systemic antibiotic use (p= 0,004) were statistically significant factors for the visual prognosis. Conclusions: in the management of patients with ocular open globe trauma, it is essential to prevent traumatic endophthalmitis, with strict follow-up of the patient. It may be advisable to administer systemic antibiotic, and another important pillar will be the individualization of treatment through identifying the risk factors supporting the administration of an intravitreal antibiotic(AU)

Pattern of ocular trauma in tertiary care hospital in Khammam.

Background: Ocular trauma is an important public health hazard. The objective of the study was to determine the pattern of ocular trauma among patients presenting in Mamata Medical College and Hospital, Khammam. Methods: Two years retrospective review of records of 120 patients with ocular trauma seen from Jan 2013 to Feb 2015 was done using a structured format. Results: Ocular trauma accounted for 1.2% of the total ocular patients seen at OPD and Emergency. Of the studied 120 cases, 74 patients were below 30 years of age. 17 (14.16%) patients presented to hospital within 2-7 days of injury. Conclusion: Duration of presentation has significant association with the presence of infection & other complication. The cause of injury were road traffic accidents, occupation related and sports playing & recreational activities in 54(45%), 39(32.5%) and 24(20%) respectively. Closed globe injuries accounted for 38(31.66%) and open globe for 58(48.33%) and adenexal injuries constituted 24(20%). Delay in presentation was associated with complications.

Risk Factors and Clinical Manifestations of Ocular Hypertension after Primary Repair of Open Globe Injury

PURPOSE: To investigate the risk factors and clinical manifestations of ocular hypertension (HTN) after repair of open globe injury (OGI). METHODS: In a retrospective study of 284 patients who underwent primary repair of open globe injury at the day of trauma, best corrected visual acuity (BCVA) at the time of trauma and 6 months postoperatively, length of laceration, location of laceration and mean intraocular pressure (IOP) at 1 month after primary repair were analyzed. Presence of iris injury, lens injury, intraocular foreign body (IOFB) and vitreous hemorrhage (VH) were also analyzed. Ocular hypertension was defined as elevation of IOP greater than or equal to 21 mm Hg over 3 measurements. RESULTS: Fourteen (4.93%) of 284 patients had ocular hypertension. BCVA (log MAR) at the time of trauma in the ocular HTN group was significantly worse than in the normal IOP group (2.43 +/- 1.04 and 1.76 +/- 1.30, respectively, p = 0.033). In the multivariate analysis, ocular HTN increased significantly with IOFB (p = 0.038; odds ratio [OR], 3.584; 95% confidence interval [CI], 1.075-11.941) and VH (p = 0.028; OR, 3.971; 95% CI, 1.157-13.624). BCVA increased significantly after repair in both groups and mean IOP was well controlled after medical therapy (9 eyes) or surgical treatment (5 eyes) in the ocular HTN group (28.1 +/- 4.7 and 15.8 +/- 3.8, respectively, p < 0.01). CONCLUSIONS: Ocular HTN increased significantly with IOFB and VH at the time of trauma after repair of OGI and can be effectively treated by medication or surgical approach.