Clinical Study
Eye (2006) 20, 1336–1341. doi:10.1038/sj.eye.6702099; published online 23 September 2005
Open globe injuries: factors predictive of poor outcome
Interests, financial and other: None
I Rahman1, A Maino1, D Devadason1 and B Leatherbarrow1
1Manchester Royal Eye Hospital, Lister Centre, Manchester, UK
Correspondence: I Rahman, Manchester Royal Eye Hospital, Lister Centre, Nelson Street, Manchester M13 9WL, UK. Tel: +44 161 276 1234; Fax: +44 161 272 6618; E-mail: imran1973@ tiscali.co.uk
Received 20 June 2005; Accepted 4 August 2005; Published online 23 September 2005.
Abstract
Objective
Despite advances in ocular and orbital imaging, instrumentation, materials, and surgical procedures, the management of open globe injuries continues to pose difficult management dilemmas. In this retrospective study, we identify clinical characteristics and outcome of a series of open globe injuries presenting to a major UK centre.
Method
Operating department records were reviewed to identify all patients who had undergone repair of an open globe injury from 1 January 1998 to 1 January 2003 at the Manchester Royal Eye Hospital. Case notes were examined to determine demographic data, mechanisms of injury, influence of alcohol/drugs, and location of injury. The Snellen visual acuity on presentation and initial clinical signs were recorded.
Results
In total, 115 cases of open globe injury were identified of which 107 cases notes were available for review. Injury to the eye with a sharp object accounted for 71/107 (66%) cases and blunt mechanisms for 30/107 (28%) cases. In six (6%) cases the cause of injury was unknown. The rate of secondary enucleation in our series of 107 open globe injuries was 13/107 (12%). Significant risk factors on presentation associated with eventual enucleation included relative afferent pupillary defect (P<0.001), absence of a red reflex (P<0.001), presence of a lid laceration (P<0.02), a blunt mechanism of injury (P<0.02), and an initial VA worse than 6/60 (P=0.03).
Conclusion
From this retrospective study, we have identified several factors that may aid the clinician in deciding on the prognostic value of primary repair. Blunt injuries associated with adnexal trauma, with poor initial visual acuity, the presence of an RAPD or retinal detachment, and the absence of a red reflex are associated with a significantly higher rate of subsequent enucleation.
Keywords:
prognostic factors, open globe injuries, enucleation, visual outcome, penetrating eye injuries
