Mehul Shah

Ocular injuries and visual status before and after their management in the tribal areas of Western India-A historical cohort study

BackgroundThe authors present the epidemiology of ocular trauma and visual status before and after their management from 2003 to 2005 at a hospital in a tribal area of India.MethodsThis was a historical cohort study. Persons exposed to open and closed globe types of injuries were reviewed. Ophthalmologists examined patients with the help of bio-microscope and also noted their visual acuity. Ocular Injuries were classified according to Birmingham Eye Trauma Terminology System (BETTS). Epidemiological profile, causes of injury, ocular status and visual gain after management were noted. Percentage scattergrams were plotted for both groups of injuries to evaluate visual gains. Binary logistic regression analysis was carried out to determine the predictors of visual outcomes following ocular trauma management.ResultsOf the 2,607 persons with ocular trauma, ‘open globe’ and ‘closed globe’ types of injuries were found in 451 and 2,156 persons respectively. Within 24 hours of injury, only 1,355 patients (52%) had consulted ophthalmologists. Improvement in vision following management was noted in 133 persons (29.4%) with ‘open globe’ injuries and 217 persons (48.1%) with ‘closed globe’ injuries. In 845 patients (39.5%), vision could be retained at same level after management.ConclusionsAgents and activities responsible for ocular injuries in our study differed from those reported in the industrialized countries. Late presentation was very common in our tribal area. Management improved the vision in eyes with trauma, but eyes with ‘closed globe’ type of ocular injuries had better results than ‘open globe’ type.

Effect of interval between time of injury and timing of intervention on final visual outcome in cases of traumatic cataract

Purpose. There are no clear guidelines to treat traumatic cataract. This study was conducted to pro-vide evidence-based care to patients with traumatic cataracts and to examine the effect of the time interval between injury and the first intervention on the final visual outcome. Methods. In a prospective cohort study, all patients presenting to our hospital with traumatic cataracts between January 2003 and December 2009 were enrolled. Information regarding demographics and ocular trauma was collected on the pretested World Eye Trauma Registry form for both the first and follow-up visits. In particular, we collected specific information on the time interval between the injury and intervention. The relationship between this time interval and the final visual outcome was analyzed. The study was conducted at a tertiary eye care center, in Dahod, at the junction of Gujarat, Madhya Pradesh, and Rajasthan states, in central western India. Results. The time interval between the injury and first intervention had a significant effect on the final visual outcome (p = 0.02, χ2 test). Conclusions. The morphology of traumatic cataracts plays an important role in determining the appropriate surgical technique and the final visual outcome.

Visual recovery and predictors of visual prognosis after managing traumatic cataracts in 555 patients.

Aim: The aim was to evaluate the visual recovery after managing traumatic cataracts and determine the predictors of a better visual prognosis. Materials and Methods: This was a prospective study. We enrolled patients with specific inclusion criteria, examined their eyes to review the comorbidities due to trauma, performed surgery for traumatic cataracts, and implanted lenses. The patients were reexamined 6 weeks postoperatively. We divided the cases of traumatic cataract into two groups, the “open globe” (Group 1) and “closed globe” (Group 2) groups, according to the ocular trauma based on the Birmingham Eye Trauma Terminology System (BETTS) and compared the determinants of visual acuity. Results: Our cohort of 555 eyes with traumatic cataracts included 394 eyes in Group 1 and 161 in Group 2. Six weeks postoperatively, the visual acuity in the operated eye was >20/60 in 193 (48%) and 49 (29%) eyes in Groups 1 and 2, respectively (P = 0.002, ANOVA). At follow-up, >20/60 vision was significantly higher in Group 1 than in Group 2 (OR = 1.61; 95% CI, 0.85–3.02). Overall 242 (43.5%) eyes gained a final visual acuity of >20/60. Conclusion: Open globe injury has a favorable prognosis for satisfactory (>20/60) visual recovery after the management of traumatic cataracts.

Ocular Trauma Score as a predictor of final visual outcomes in traumatic cataract cases in pediatric patients.

PURPOSE: To validate the predictive value of the Ocular Trauma Score (OTS) in children with traumatic cataract. DESIGN: Retrospective cohort study. SETTING: Tertiary eye care center at nexus of Gujarat, Madhya Pradesh, and Rajasthan states, central Western India. METHODS: After meeting inclusion criteria, eyes with traumatic cataract were enrolled and examined to review comorbidities caused by trauma. Surgery was performed for traumatic cataract, intraocular lenses were implanted, and patients were treated for amblyopia, as applicable. Patients were reexamined 6 weeks postoperatively. Based on ocular trauma described according to the Birmingham Eye Trauma Terminology System, the patients were divided into 2 traumatic cataract groups: open‐globe injury and closed‐globe injury. The relationship between final corrected distance visual acuity (CDVA) and demographic and clinical variables was analyzed. Visual outcomes were predicted using the OTS, and the predictions were compared with actual outcomes using statistical tests. RESULTS: The study enrolled 354 children. Six weeks postoperatively, the CDVA was better than 20/200 in 181 eyes (63.0%) and 20/40 or better in 110 eyes (38.4%) in the open‐globe group and better than 20/200 in 36 eyes (53%) and 20/40 or better in 15 eyes (22.4%) in the closed‐globe group. The differences between the groups were not significant (P=.143). Of all eyes, 214 (61.3%) achieved a final CDVA of better than 20/200 and 123 eyes (35.3%), of 20/40 or better. CONCLUSION: The OTS was a reliable predictor of the final visual outcome in cases of pediatric traumatic cataract. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.

Controversies in ocular trauma classification and management: review

Ocular trauma is a topic of unresolved controversies and there are continuous controversial and debatable management strategies for open-globe injuries (OGIs). International classification of ocular trauma proposed almost 15 years ago needs to be reviewed and to be more robust in predicting the outcome in the setting of OGIs. Anterior segment trauma involves controversies related to patching for corneal abrasion, corneal laceration repair, and medical management of hyphema. Timing of cataract surgery and intraocular lens implantation in the setting of trauma is still debated worldwide. There are unresolved issues regarding the management of OGIs involving the posterior segment. Timing of vitrectomy has been and will continue to be debated by proponents of early versus delayed intervention. The use of prophylactic cryotherapy and scleral buckle is still practiced differently throughout the world. The role of intravitreal antibiotics in posterior segment trauma in the absence of infection is still debated. Similarly, the use of vitrectomy versus vitreous tap in the setting of traumatic endophthalmitis is not fully resolved. In optic neuropathy, the role of intravenous methylprednisolone versus conservative management is always debated and still there are no evidence-based guidelines about the beneficial role of pulse steroid therapy. The role of optic canal decompression in the setting of acute traumatic optic neuropathy is also not conclusive. Orbital and adnexal trauma has been shown to adversely affect the outcome of OGI patients but both lids and orbital injury are not taken as preoperative variables in international ocular trauma classification. The timing of intervention in blow-out fracture is still debated. The pediatric age group, owing to the high risk of amblyopia and intraocular inflammation as well as strong vitreoretinal adhesions, has to be managed by different principles. Although the risk of sympathetic ophthalmia is very rare, it is always one of the key debated issues while managing traumatized eyes with no light perception vision. Prospective, controlled clinical studies are not possible in the OGI setting and this article reviews pertinent data regarding these management issues and controversies, and provides recommendations for treatment based on the available published data and the authors’ personal experience.

Ocular Trauma Score: A Useful Predictor of Visual Outcome at Six Weeks in Patients with Traumatic Cataract

OBJECTIVE To validate the predictive value of the Ocular Trauma Score (OTS) in injury cases with traumatic cataracts. DESIGN Retrospective cohort study. PARTICIPANTS A total of 787 eyes. METHODS A total of 787 eyes of 787 subjects with traumatic cataracts were enrolled using specific inclusion criteria. The eyes were examined to review comorbidities caused by trauma. Surgery was performed for traumatic cataracts, lenses were implanted, and patients were treated for amblyopia, as applicable. The patients were reexamined 6 weeks postoperatively. On the basis of ocular trauma described according to the Birmingham Eye Trauma Terminology System, the patients were divided into 2 traumatic cataract groups: open globe injury and closed globe injury. The relationship of visual acuity (VA) with demographic and clinical variables was analyzed. The visual outcomes were predicted using the OTS, and the predictions were compared with the actual outcomes using statistical tests. MAIN OUTCOME MEASURES Visual acuity. RESULTS At 6 weeks postoperatively, 245 eyes (31%) had a VA ≥ 20/40 and 480 eyes (61.0%) had a VA >20/200. The OTS prediction was not significantly different when compared with actual visual outcome at 6 weeks postoperatively in all OTS categories. CONCLUSIONS The relationship of VA at 6 weeks with demographic and clinical variables was analyzed. In this study, the OTS was found as a reliable tool to predict visual outcome in cases of traumatic cataracts 6 weeks postoperatively.

Morphology of traumatic cataract: does it play a role in final visual outcome?

Aim To study the morphology of traumatic cataract as an important predictor for final visual outcome after treatment of traumatic cataracts. Setting Tertiary eye care centre in Dahod at the trijunction of Gujarat, Madhya Pradesh, and Rajasthan states in central western India. Methods This was a prospective observational cohort study among all patients presenting at the hospital with traumatic cataracts between January 2003 and December 2009. All information regarding demographic and ocular trauma was collected on a pretested World Eye Trauma Registry form for both the first visit and follow-up. In particular, the authors collected specific information about the morphology of traumatic cataracts; the surgical technique was determined accordingly. Data were entered and analysed with regard to the relationship between type of trauma and resulting injury, results achieved with particular surgical techniques, and the relationship between morphology and final visual outcome. Outcome measures Final visual outcome. Results Traumatic cataracts of different morphologies showed significant differences in the final visual outcome (χ2 test, p=0.014). Conclusion The morphology of traumatic cataract plays an important role in the final visual outcome.

Visual outcome of traumatic cataract in pediatric age group

Purpose. To review results of traumatic cataracts in children. Methods. This is a retrospective cohort study done at a tertiary eye care center at the junction of Gujarat, Madhya Pradesh, and Rajasthan states in central western India. We enrolled children with specific inclusion criteria, examined their eyes to review the comorbidities due to trauma, performed surgery for traumatic cataracts, and implanted a lens, treating amblyopia if applicable. The patients were re-examined 6 weeks postoperatively. We divided the traumatic cataract cases into open-globe (group 1) and closed-globe (group 2) groups according to the ocular trauma based on the Birmingham Eye Trauma Terminology System and compared the determinants of visual acuity. Results. Our cohort of 354 eyes with traumatic cataracts in children included 287 eyes in group 1 and 67 in group 2. Six weeks postoperatively, the visual acuity in the operated eye was >20/200 in 181 (63%) and ≥20/40 in 109 (38%) eyes in the open-globe group and >20/200 in 36 (53%) and ≥20/40 in 16 (22.4%) eyes in the closed-globe group (p = 0.143), and the difference between the groups was not significant in children. Overall, 125 (35.3%) eyes gained a visual acuity at 6 weeks of ≥20/40 and >20/200 in 214 (61.3%) cases. Conclusions. Satisfactory visual outcome can be achieved in children with traumatic cataracts, with no significant difference found among open- and closed-globe injuries in the pediatric age group.

Controversies in traumatic cataract classification and management: a review

Traumatic cataract is one of the important causes of blindness after ocular trauma, either open or close globe. Visual outcome is unpredictable because it is not only lens that decides visual outcome. There is no standard classification, investigation, or treatment guidelines for the same. There are controversies regarding predictive models. We would like to highlight these controversies and try to reach certain guidelines that may help clinicians to manage traumatic cataracts.

Visual outcome of cataract in pediatric age group: does etiology have a role.

Purpose To compare visual outcome results among traumatic and nontraumatic groups of eyes with cataract in the pediatric age group. Methods This is a retrospective cohort study. This study comprised a consecutive series of pediatric patients under 5 years of age with unilateral congenital, developing, or traumatic cataract who underwent surgery between January 1999 and April 2012 at Drashti Netralaya, Dahod. Records were retrieved from the medical record department. Patients were grouped as traumatic or nontraumatic and their demographics, cataract type, presenting symptoms, surgical intervention, and postoperative visual acuity follow-up refractive changes were recorded and compared. Results A total of 128 eyes of 128 children under 5 years of age were included with unilateral cataract. A total of 85 (66.4%) were traumatic and 43 (33.3%) nontraumatic. The age at surgery ranged from 1 to 60 months. Eyes were grouped by etiology: group 1- traumatic 85 (66.4%) eyes that had traumatic cataracts. Group 2 non-traumatic 43 (33.3%) eyes that had congenital, developmental or complicated cataracts. The mean follow-up time was 117 days. Finally, 22 (51.1%) group 1 patients and 40 (47.1%) group 2 patients achieved visual acuity better than 20/200 (p = 0.000). Conclusions Surgical treatment with intraocular lens implantation for children with congenital, developmental, or traumatic cataract is an effective treatment for visual rehabilitation. Visual outcome is significantly better (p = 0.005) in case of nontraumatic cataracts than traumatic cataracts.