RESUMO
Aims: To describe the demographics, characteristics and outcomes of open-globe injuries (OGI) with respect to zone of injury. Methods: Medical records of all patients presenting with OGIs to University Hospital, Newark, NJ between January 2001 and December 2008 with a follow-up of at least 3 months were reviewed. Demographics, characteristics of the trauma and outcomes were compared with respect to the zone of injury; location of injury is confined to the cornea and limbus in zone 1 (Z1), <5 mm posterior to the limbus in zone 2 (Z2) and >5mm posterior to the limbus in zone 3 (Z3). Results: Of the 309 patients (310 eyes) identified, 228 (74%) were male. The mean age at presentation was 35.3 years (1-96). Mean follow-up was 22.8 months (3-108 months). Most of the eyes presented with Z1 injury: 141 eyes (46%) Z1 injury, 83 (27%) Z2 and 86 (28%) Z3. Rupture was the most common type of injury in Z2 and Z3 injuries. Nineteen (86%) of 22 eyes with an intraocular foreign body (IOFB) had a Z1 injury. 32 (42%) of 77 eyes with Z3 injury had no light perception (NLP) at presentation, compared with 9 (8%) of 119 Z1 and 13 (17%) of 78 Z2-injured eyes. Four percent of Z1, 11% of Z2 and 18% of Z3-injured eyes had a final vision (VA) of NLP. Primary enucleation was undertaken in 10 eyes (9 were Z2 injured eyes). Secondary enucleation was performed in 12 (9%) of 141 Z1, 7 of 82 (9%) of Z2 and 22 (26%) of 78 Z3 eyes. Thirty (36%) of 86 Z3 injuries resulted in primary or secondary enucleation. The final Snellen VA was 1.05, 1.41, and 2.19 respectively in Z1, Z2 and Z3-injured eyes. Posterior segment surgery was performed in 30% Z1, 39% Z2 and 49% Z3-injured eyes. Retinal detachment (RD) was diagnosed in 11% Z1, 27% Z2 and 40% Z3 injuries. Conclusion: Z1 injury may be associated with a better visual prognosis than Z2 and Z3 injuries. The visual prognosis of Z3 injured eyes is poor with one-third of these eyes being enucleated.
RESUMO
We studied retrospectively the results of consecutive vitrectomy following traumatic ruptured globe repair in 31 patients, who had been followed six months or longer postoperatively. Twenty-seven patients (87%) were male and 21 (68%) were between the second and fourth decades. Functional success was achieved in 13 patients(42%) and anatomic success in 14 patients(45%). Nine patients vitrectomized within two weeks after primary repair had 100% success rate, and seven patients operated between two weeks and one month had 96% success rate, but 15 patients vitrectomized after one month had 80% success rate. Five among eight eyes which underwent other operations prior to vitrectomy showed success, in contrast to 96% (22 eyes) success among 23 eyes which underwent planned vitrectomy without any other intervening surgical procedure. Better previtrectomy conditions including simple vitreoretinal incarceration or proliferative vitreoretinopathy of Grade B or milder achieved success in 96%, but poor conditions including prephthisical status and proliferative vitreoretinopathy of Grade C or more severe in 67% In conclusion, the overall success rate of consecutive vitrectomy in repaired ruptured globe was 87%. Prephthisical condition and severe proliferative vitreoretinopathy showed poor prognosis. We emphasize the necessity of well-planned vitreous surgery and the importance of its adequate timing in the management of penetrating injury.