Globe Ruptures: Outcomes and Prognostic Analysis of Severe Ocular Trauma

Abstract

Purpose: Eye trauma is an important cause of monocular visual loss worldwide. This study aimed to describe the structural and functional characteristics and outcomes of 281 globe ruptures. Methods: Medical records of all patients undergoing surgery for a ruptured globe at Centro Hospitalar Universitário do Porto in the last 17 years were retrospectively reviewed. Results: 281 eyes of 277 patients were included. The majority of them were males (71%) with a mean age of 59.7 ± 20.5. In 38.8% of the cases, the cause was a fall. At the time of admission, 29.5% of the eyes had a visual acuity (VA) greater than 20/200 and 12.5% had no light perception. The median time between trauma and primary repair was less than 8 h (interquartile range 5–12 h). A primary reconstruction was always attempted. Primary evisceration was performed in 14 cases (5%). In multivariable analysis, independent predictors of vision survival were male gender, shorter wound size, and absence of vitreous hemorrhage. Conclusion: In this large, retrospective study on globe ruptures, we identified male gender, short wound length, and the absence of vitreous hemorrhage or retinal detachment as predictors of improved functional outcome. We found a correlation between the presenting and final VAs. The Ocular Trauma Score predicted the outcome well. Our determination to reconstruct the traumatized eyes as early and as completely as possible was justified by the functional results: despite the severity of the injuries, one out of four eyes reached a final VA greater than 20/200.