Surgical Management and Outcome of Open Globe Injuries with Posterior Segment Complications: A 10-Year Review.

PURPOSE: To describe the characteristics, management, and outcomes of open globe injured (OGI) eyes that underwent pars plana vitrectomy (PPV) for posterior segment complications. METHODS: Retrospective chart review of cases that underwent PPV for posterior segment complications associated with OGI between 2003-2012 at University Hospital, Newark, NJ. RESULTS: 120 eyes were identified and classified as follows: "early retinal detachment (RD)" (within 30 days of OGI), 64 (53%) eyes; "delayed RD" (≥30 days after OGI), 30 (25%) eyes; and "no RD," 26 (22%) eyes. Injuries included penetrating (39 (33%) eyes), rupture (60 (50%) eyes), and penetrating wounds with retained intraocular foreign body (21 (17%) eyes). Injuries in Zones I, II, and III were seen in 40 (35%) eyes), 38 (34%) eyes, and 35 (31%) eyes, respectively, with statistically different ocular trauma scores (p<0.01) associated with each zone of injury. Mean presenting and final logMAR VA were 2.20± 0.63 and 1.87 ±0.60, respectively (p<0.01), with a mean follow-up of 3.2 years. Final overall anatomic success after surgeries was 98% for early RD and 95% for delayed RD. CONCLUSION: Despite a high anatomic success rate, the overall functional success rate for eyes with posterior segment trauma that undergo PPV is poor and comparable to other studies.

Full-Thickness Skin Graft as an Independent or Adjunctive Technique for Repair of Cicatricial Lower Eyelid Ectropion Secondary to Actinic Skin Changes.

PURPOSE: To retrospectively review and describe full-thickness skin graft repair of lower eyelid cicatricial ectropion secondary to actinic skin. METHODS: A retrospective, noncomparative chart review of all patients who underwent lower eyelid ectropion repair with placement of a full-thickness skin graft between June 2004 and March 2014 was conducted with IRB approval. The etiology of lower eyelid ectropion, demographics including age, gender, ethnicity, laterality, graft donor site, additional surgical procedures, graft viability, surgical success rate, complications, and clinical exam findings were summarized. RESULTS: Twenty-nine eyelids in 24 patients underwent skin grafting for repair of cicatricial ectropion secondary to actinic skin changes. Ninety six percent of patients were male and 96% were Caucasian. Donor sites for skin grafts included upper eyelid (9, 31%), supraclavicular skin (9, 31%), postauricular skin (7, 24%), inner brachial skin (2, 7%), axilla (1, 3.5%), and preauricular skin (1, 3.5%). Twenty-four of 29 eyelids in the series underwent 1 or more additional procedures at the time of full-thickness skin grafting, including lateral tarsal strip (9 eyelids, 37.5%), punctoplasty (8, 33%), canthoplasty (7, 29%), excision of keratinized conjunctiva (2, 8%), transverse tarsotomy (1, 4%), ipsilateral external dacryocystorhinostomy (3, 12.5%), and lesion removal (1, 4%). There was 100% viability of the skin grafts. Overall surgical success rate was 76%, with asymptomatic recurrence rate of 17% and symptomatic recurrence rate of 7%. CONCLUSION: Repair of cicatricial lower eyelid ectropion secondary to actinic skin changes may be accomplished with full-thickness skin grafting, and is often performed in conjunction with additional procedures to fully address anatomic abnormalities.

Open-globe injuries with motor vehicle accidents: a 12-year review.

PURPOSE: To evaluate demographics, characteristics, and outcomes of open-globe injuries (OGIs) in motor vehicle accidents (MVAs). METHODS: Retrospective chart review of patients with OGIs related to MVAs that presented to University Hospital, Newark, from 2000 to 2012. RESULTS: Twenty-five patients were identified; the average age of the patients was 33.3 years old (range, 5-75). The majority of patients (64 %) were males. The 25 vehicles comprised 24 automobiles and one motorcycle. Ten patients (40 %) wore seatbelts, and five (20 %) did not wear seatbelts. The seatbelt status was not documented in the remaining cases. Ethanol was documented as a contributing factor in five of the accidents. In terms of open-globe classification, 15 OGIs (60 %) were ruptures, and five (20 %) were penetrating injuries; three (12 %) had intraocular foreign bodies. Ten eyes (40 %) had a final VA of 20/400 or worse. Fourteen eyes (56 %) achieved a final VA of 20/200 or better; seven eyes (28 %) achieved a final VA of 20/40 or better. CONCLUSION: Fifty-six percent of eyes with an open-globe injury related to MVAs achieved a final VA of 20/200 or better in this series. No eyes developed endophthalmitis.

A 10-year review of open-globe trauma in elderly patients at an urban hospital.

BACKGROUND: To describe the demographics, characteristics, and outcomes of open-globe injuries (OGIs) in elderly patients. METHODS: Retrospective chart review. RESULTS: Ninety cases (26 men) were identified. The average age was 80 years (range, 65-96 years). The types of OGIs included rupture (83.3%) and penetrating (16.7%) injuries. The causes of trauma were falls (64.4%), accidents (20%), motor vehicle accidents (5.5%), and assault (3.33%). Types of lacerations included corneal (44.4%), corneoscleral (26.7%), and scleral (28.9%). Forty-six cases were OGIs because of dehiscence of previous ocular surgical wound. Ten eyes had concurrent orbital fractures. Approximately 81.1% of cases underwent primary OGI repair within 24 hours of injury, and all cases underwent primary OGI repair within 24 hours of admission. The average visual acuity at presentation was 20/4,375 (SD, 0.64). Although 22 patients presented with no light perception, only 10 remained no light perception after OGI repair. Complications at presentation included uveal prolapse (70%), hemorrhagic choroidal detachment (37.8%), vitreous hemorrhage (51.1%), retinal detachment (20%), and afferent pupillary defect (42.2%). Three patients (3.33%) underwent primary pars plana vitrectomy for retinal detachment and vitreous hemorrhage. Three patients developed endophthalmitis. Overall, retinal attachment was achieved in all eyes that underwent primary pars plana vitrectomy. Primary enucleations were performed in 4 cases (4.44%) for nonsalvageable no light perception eyes. CONCLUSION: The visual prognosis of OGIs in the elderly population is poor; only 14.4% achieved 20/200 or better visual acuity. Precautionary measures should be taken to prevent OGIs in the elderly population.

Nail gun-induced open-globe injuries: a 10-year retrospective review.

PURPOSE: To describe the characteristics of nail gun-related open-globe injuries. METHODS: Retrospective series of all patients presenting with open globes secondary to nail gun injury from 2000 to 2010. Data were collected on demographics, setting of accident, presenting clinical examination findings, visual acuity, management, surgical procedures needed, and long-term outcomes. RESULTS: Forty-two patients (43 eyes; mean age, 31.6 years; 100% male; 79% Hispanic) suffered open-globe injury from nail gun accidents. Thirty-seven eyes (86%) sustained injury at work. One of 15 (6.7%) patients, on whom data were available, wore protective eyewear during the incident. Entrance wounds were classified into Zone I (n = 24 [56%]), Zone II (n = 12 [28%]), and Zone III (n = 7 [16%]). Six eyes (14%) had retained intraocular foreign bodies. Mean presenting logarithm of the minimum angle of resolution visual acuity was 1.64 ± 0.83, whereas mean final logarithm of the minimum angle of resolution visual acuity was 1.01 ± 0.96 (P = 0.004). Two eyes (4.7%) had no light perception vision at final examination. Seventeen (40%) patients developed a traumatic cataract, and 2 (4.7%) had dislocated lens fragments. Most common findings on presentation included vitreous hemorrhage (n = 30 [70%]) and hyphema (n = 28 [64%]). Two eyes (4.7%) had a retinal detachment at presentation, and 10 (23%) developed a retinal detachment during follow-up visits. Anatomical success was observed in 11 eyes (92%) with a retinal detachment. Three eyes (7.0%) became phthisical or prephthisical, and 1 was enucleated for severe pain. No eyes developed endophthalmitis or sympathetic ophthalmia. CONCLUSION: This is the largest compilation of nail gun-related open-globe injury reported to date. Posterior segment complications, noted in the majority of cases, likely contributed to the overall guarded visual outcomes. Preventative measures for eye protection should be strictly followed while using nail guns.

Characteristics, outcomes, and prognostic indicators of fall-related open globe injuries.

PURPOSE: To describe characteristics and outcomes of fall-related open globe (OG) injuries. METHODS: A total of 602 patients (603 eyes) presenting with OG injuries were included. Among them, 85 wounds (85 patients) were fall-related, which were compared with the nonfall-related OG injuries (control group). RESULTS: The mean patient age in the fall group was 65.8 years, which was higher than the control population (35.8 years; P < 0.001). Most of the fall-related injuries occurred in women (58.8%). The most common zone injured in both groups was Zone I (38.8% and 46% in the fall and control group, respectively). Compared with the control group, patients with fall-related OG injuries had a worse visual acuity on admission and at final visit (P < 0.001). The authors performed regression analysis to characterize factors associated with developing no light perception and need for enucleation. Injuries involving Zone III and presenting vision of no light perception were associated with a higher rate of no light perception. Similarly, patients presenting with no light perception were more likely to undergo enucleation, eventually. CONCLUSION: Fall-related OG injuries can lead to severe ocular morbidity especially in the elderly patients. They carry a worse visual prognosis compared with other injuries, which emphasizes on the importance of protective measures in this population.

A 10-year review of assault-related open-globe injuries at an urban hospital.

BACKGROUND: To describe the demographics and outcomes of assault-related open-globe injuries (OGI) at University Hospital (UH), Newark, New Jersey over a ten-year period. METHODS: The medical records of all subjects presenting to a single university referral center with an OGI were retrospectively analyzed to identify prognostic factors for enucleation and final visual acuity (VA) of no light perception (NLP). RESULTS: One hundred and forty-eight eyes of 147 patients presented to UH with assault-related OGI. Eighty-two percent of patients were male, and the mean age was 35.9 years. The anatomic site of the wound was zone 3 in the majority (54.1 %) of eyes. Most common type of injury noted was rupture (57.4 %), followed by penetrating injury (35.1 %). Mean initial presenting and final VA in LogMAR were 2.38 ± 0.12 and 2.18 ± 0.16 respectively. Initial Snellen VA was no light perception (NLP) in 57 eyes (38.5 %); four eyes had an initial VA of ≥ 20/40 (2.7 %). Final VA was NLP in 68 eyes (45.9 %) of which 46 were enucleated (31.1 %); 18 eyes (12.2 %) had a final VA of ≥ 20/40. Fifty eyes (33.8 %) underwent pars plana vitrectomy (PPV). Significant risk factors of final VA of NLP or enucleation included initial VA of NLP, perforating or rupture type of OGI, and zone 3 injury. Eyes that sustained penetrating injuries were less likely to have final VA of NLP or require enucleation. CONCLUSIONS: Assault-related OGIs carry an extremely poor visual prognosis and a high rate of enucleations. Only eighteen eyes (12.2 %) recovered VA ≥ 20/40. We found initial VA of NLP and zone 3 injury to be significant predictors of final VA of NLP or undergoing enucleation. Penetrating injuries were less likely to have a final VA of NLP or an enucleation.

Work-related open-globe injuries: demographics and clinical characteristics.

PURPOSE: To describe the demographics and clinical characteristics of work-related open-globe injuries (OGIs) at a level I trauma center over a 10-year period. METHODS: Retrospective series. RESULTS: A total of 183 eyes with work-related OGIs were identified. The majority of injuries occurred in men (96.7%). The anatomic site of the wound was zone 1 in 107 eyes (72.3%). The most common cause was nail gun use (47.0%). The types of OGI included 32 ruptures (17.5%), 112 penetrating injuries (61.2%), 38 intraocular foreign bodies (IOFB) (20.8%), and 1 mixed rupture/IOFB injury (0.5%). Presenting visual acuity (VA) was worse than 20/200 in 112 eyes (65.9%) and no light perception (NLP) in 10 eyes (5.8%). Final VA worse than 20/200 occurred in 64 eyes (37.2%); 11 eyes underwent enucleation. In comparison to non-work-related OGIs (420 eyes), we found significant differences in types and zones of injury, initial and final mean VA, enucleation rate, incidence of cataracts, hyphema, retinal detachment, hemorrhagic choroidals, and afferent pupillary defect (APD). Using multivariate analysis, significant prognostic factors for a final VA of NLP were zone 3 injury, rupture injury, and initial VA of NLP. Risk factors for enucleation included zone 3 injury, APD, and endophthalmitis. CONCLUSIONS: Work-related injuries were noted to have a much higher incidence of IOFBs and cataracts compared to non-work-related OGIs. Zone 3 injuries, rupture injuries, and a presenting VA of NLP were found to be significant predictors for a final VA of NLP. Zone 3 injury, APD, and endophthalmitis were found to be significant predictors for enucleation.

Open globe ocular trauma: functional outcome of eyes with no light perception at initial presentation.

PURPOSE: To evaluate characteristics and prognostic factors for functional success in eyes that present with no light perception (NLP) after open globe trauma. METHODS: The medical records of all subjects presenting to a single university referral center with visual acuity (VA) of NLP after sustaining an open globe eye injury from January 1, 2001, through June 30, 2010, were retrospectively analyzed to determine epidemiologic and clinical factors associated with visual outcomes. RESULTS: Of the 73 NLP eyes (73 patients) that underwent primary repair and were included in the study, final VA was 20/100 in 1 eye (1%), counting fingers in 2 eyes (3%), hand motion in 9 eyes (12%), light perception in 5 eyes (7%), and NLP in 56 eyes (77%). Recovery of some vision on postoperative Day 1, pars plana vitrectomy operation, and Zone 2 injury were significantly associated with an improvement in final VA. Zone 3 injuries were the most likely to result in NLP final VA, although this difference was not statistically significant. CONCLUSION: Visual recovery to light perception or better on postoperative Day 1 increases the likelihood of having a long-term improvement in VA. Pars plana vitrectomy may be beneficial in such eyes if posterior segment abnormalities are noted.

Twelve-year review of pediatric traumatic open globe injuries in an urban U.S. population.

PURPOSE: To evaluate the epidemiology, anatomical characteristics, and clinical outcomes of pediatric traumatic open globe injuries and to compare the observed final visual acuity to the expected visual acuity as predicted by the Ocular Trauma Score (OTS). METHODS: Retrospective chart review of 89 pediatric patients (89 eyes) with open globe injury presenting between 1997 and 2008. RESULTS: Sixty-five patients (73%) were male, average age was 9.7 years, and mean follow-up was 22.6 months. The most common causes of trauma were: accidents (79%), violence (10%), and motor vehicle accidents (9%). Penetrating ocular injury was the most common trauma (54%), followed by blunt rupture (34%). Zone 1 injuries represented 49% of cases, and zones 2 and 3 represented 29% and 21%, respectively. No patient developed endophthalmitis. The average presenting and final visual acuities were logarithm of the minimum angle of resolution 1.927 and 1.401, respectively. Lens trauma was noted in 44 (49%) eyes. Twenty-eight patients (31%) had retinal detachment within 6 months of presentation. Total retinal attachment was achieved in 12 (63%) of 19 eyes undergoing repair. Enucleation was performed in 9 (10%) patients. Final visual acuities were not statistically different from visual acuities predicted by OTS (P > .05). CONCLUSIONS: The visual prognosis in pediatric open globe injury is poor. The zone of injury may correlate with poor final visual acuity, risk of retinal detachment, and subsequent need for an enucleation. The final predicted visual acuity correlated well with the observed final visual acuity in these patients.