Visual outcomes associated with delay from trauma to surgery for open globe eye injury in Palestine: a retrospective chart review study

Abstract

BackgroundOpen globe eye injuries have poor visual outcomes. In Palestine, no studies have completely described the impact of time delays to surgery on visual outcomes. This study examines the causal factors for open globe eye injuries, time to presentation, and the effects of delays to surgery on visual outcomes. MethodsA retrospective review was carried out of 413 patients with monocular open globe eye injuries attending St John Eye Hospital, Jerusalem, occupied Palestine territory, from Jan 1, 2000, to Dec 31, 2005. Injury cause, time to presentation, visual acuity on arrival, and the final corrected visual outcomes were assessed. FindingsOpen globe eye injuries were caused by traumatic injury during the Intifada in 2002 (13%) and military actions throughout the study period (14%), but most injuries (38%) occurred in workplace or were related to domestic eye injuries (20%). The median time from open globe eye injury to arrival at hospital was 4 hours (IQR 11–3); 290 (70%) of 413 patients arrived within 8 h of injury. Visual acuity on arrival was normal only in five eyes (1·2%), functionally accepted vision in 42 eyes (10%), visually impaired in 77 eyes (18.6%), blindness in 229 (55%), and difficult to measure in 60 (15%). Surgical repair was performed in 366 eyes (89%) and 47 (11%) eyes were removed. After surgery, visual status was classified as visual acuity impaired in 85 (20·6%) of 336 repaired eyes, blindness in 87 (21%), normal vision restored in 58 eyes (14%), functionally acceptable vision restored in 116 eyes (28%), difficult to measure in 20 (4·8%). Among the 290 patients who presented within 8 h of injury, the final visual outcomes were impaired visual acuity in 72 (25%), blindness in 71 (24%), eye removed in 38 (13%), and visual acuity difficult to measure due to very young age or devastating injury remaining after surgery in 14 (4.8%) and vision was restored in 95 (33%). InterpretationDespite the devastating nature of open globe eye injury, minimum time from trauma to surgical intervention could save the injured eyes. Further studies should investigate whether delay in surgery affects outcomes in relation to the severity of injuries, as this study is cross-sectional and longitudinal epidemiological studies might yield better interpretations. FundingNone.