Alain Bauza

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.

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.

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.

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.

Approach to Management of Eyes with no Light Perception after Open Globe Injury.

Loss of light perception (LP) after open globe injury (OGI) does not necessarily mean the patient will have permanent complete visual loss. Findings that seem to be associated reliably with permanent profound vision loss after OGI include optic nerve avulsion, optic nerve transection, and profound loss of intraocular contents, which can be identified with CT/MRI imaging albeit with varying degrees of confidence. Eyes with NLP after OGI that undergo successful primary repair with intact optic nerves may be considered for additional surgery, particularly if there is: (1) recovery of LP on the first day after primary repair; (2) treatable pathology underlying NLP status (e.g., extensive choroidal hemorrhage, dense vitreous and subretinal hemorrhage); (3) NLP in the fellow eye. We counsel patients that the chance of recovering ambulatory vision under these circumstances is very low (~5%).

Gender Disparities in Open Globe Injuries: Ten- Year Review of an Urban Population

Aims: To characterize gender differences in the ophthalmic findings and clinical outcomes of patients with open globe (OG) injuries. Study Design: Retrospective case series. Place and Duration of Study: Department of Ophthalmology, University Hospital, New Jersey Medical School between January 2001 and June 2010. Methodology: The medical records of all patients presenting with OG injuries to University Hospital, Newark, NJ from January 1, 2001 through June 30, 2010 were reviewed. Demographics, characteristics of the trauma, ophthalmic findings, and outcomes were compared in male and female patients. Results: A total 603 eyes (602 patients) with OG injuries were identified. Most of the patients (76.4%) were male. The mean patient age was 39.14 years which was significantly lower in males (35.66 years vs. 50.43 years in females; p<0.001). The vast majority of injuries were penetrating and/or work-related in men, whereas fall-related ruptures comprised the most common pattern of injury in women. Zone I was the most commonly injured zone in both genders, and Zone III wounds were more commonly seen Research Article British Journal of Medicine & Medical Research, 3(4): 1380-1387, 2013 1381 in males (p=0.03). Although females were more likely to present with a worse visual acuity (VA, p=0.005), the final VA was not significantly different between males and females (p=0.06), and a statistically significant improvement in vision occurred in both genders (p<0.001 in both). Fifteen percent of patients had an unfavorable anatomic outcome and underwent either primary or secondary enucleation; the rate was not different among males and females (17% in both). Conclusion: Male and female victims of OG injuries follow different trends in terms of demographics, etiology, and type of injury. This highlights the importance of applying different prevention strategies in the genders.

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

ABSTRACT 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.

Characteristics of open-globe eye injuries with respect to zone of injury.

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 Hospita l, 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 corn ea and limbus in zone 1 (Z1), 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 presentationwas 35.3years (1-96). Meanfollow-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 fore ign 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 visi