Birmingham Eye Trauma Terminology System Research Articles

Ocular Trauma Characterization in a Reference Emergency Eye Centre in Colombia (FOSCAL).

Ocular trauma is one of the most important causes of ocular morbidity and inadequate visual acuity in developed and developing countries. In some countries, eye trauma is the leading cause of monocular blindness. Studies conducted in developing countries like Colombia suggest that there is a lack of awareness of preventive measures. In Colombia, there is no countrywide ocular trauma registry. The purpose of the present study is to describe and analyse characteristics of ocular trauma at a tertiary ophthalmology emergency department in Colombia. Patients who consulted or were referred to the ophthalmologic emergency department of FOSCAL due to eye injuries between March 1, 2022, and January 10, 2023, were included in this cross-sectional study. Of 1 957 patients, 2 088 eyes were included. Men comprised 78.5% of the patients, the median age was 36 years, and 75.0% lived in urban areas. The median latency between trauma and ophthalmology consultation was 21.8 hours. Of the eyes, 1 805 (88.4%) had suffered mechanical or mixed (mechanical plus burn) trauma. Of the injuries, 87.5% were unilateral. In terms of the circumstances, 45.9% of injuries occurred during working or educational activities (in 85.6% of these cases, without eye protection), 28.2% in home accidents, and 14.0% in transportation situations. According to the Birmingham Eye Trauma Terminology System (BETT), 1 735 eyes (91.1%) were closed globe injuries, and 49 eyes (2.7%) were open globe injuries. Fifty eyes (2.8%) could not be categorised according to BETT at the initial consultation and were classified as "still to be determined". In the Ocular Trauma Score (OTS), 85.8% were category 5. Of the ocular burn cases, 93.0% were categorised as grade I according to the Roper Hall classification. In line with global literature, a much higher proportion of men than women sought consultation for ocular trauma. The findings suggest a need for improvement in the referral process from institutions with the lowest level of care. Lack of awareness about eye protection is an issue. Surgical exploration or additional tests may be necessary for precise injury classification. We therefore propose adding a "still to be determined" category to the BETT initial classification. These cases may be reclassified later, thus improving the accuracy of OTS calculation.

Epidemiological and clinical characteristics of open globe injuries in Southwest China.

Open globe injuries (OGIs) are one of the leading causes of monocular vision loss, and the clinical characteristics of OGIs are region specific. The features and patterns of OGIs in Southwest China are poorly known and not well studied. Our study aimed to review the epidemiological and clinical characteristics of patients hospitalized for OGIs in Southwest China. A retrospective study of OGI patients admitted to the West China Hospital from January 1st, 2015, to December 31st, 2019, was performed. Demographic characteristics and injury details were recorded. The Birmingham Eye Trauma Terminology system and the ocular trauma score (OTS) were used. A total of 3,014 patients were included. The male-to-female ratio was 5.2:1, and the mean age was 35.6 ± 19.1 years. 15.2% of patients were from the ethnic groups. The highest-risk occupation was the farmer (30.3%), followed by the worker (28.5%). OGIs occurred more frequently in people with middle (37.0%) and primary school (33.1%) education levels. Types of injuries included 46.8% penetration, 21.2% rupture, 2.9% perforation, and 29.1% intraocular foreign body (IOFB). The injuries types differed between age and occupation groups (p < 0.001). IOFBs had a higher risk of causing endophthalmitis, retinal detachment, and traumatic cataracts (p < 0.001). The most common injuries resulted from sharp objects (72.7%). The causes of the injuries were significantly associated with age, ethnicity, and occupation (p < 0.001). Explosion injuries and attacks by animals were more common among people of Tibetan and Yi ethnicities. Blunt trauma, vehicle crashes, falls and age older than 60 years were risk factors for a lack of light perception and lower OTS scores prognosis. OGIs in Southwest China mainly affected working-aged males, especially workers or farmers. Severe vision loss and IOFBs are more common findings. OGIs in older patients and ethnic minorities requires additional attention.

Ocular Trauma in Children at Women and children Hospital (Hospital Wanita Dan Kanak-Kanak), Sabah, Malaysia

Ocular trauma is a significant health problem in paediatric age group. This study is to evaluate the demographics, etiology, management and visual outcome of paediatric ocular trauma in Sabah. This is a retrospective review of all ocular trauma occurring in the paediatric age group from age 12 years old and below from January to December 2014 at Hospital Wanita Dan Kanak-Kanak, Sabah. Medical records were reviewed and the data was examined based on Birmingham Eye Trauma Terminology (BETT) system. Incomplete case notes were excluded from the study. A total of 37 cases were accumulated during the study period. All the paediatric ocular trauma cases were admitted and accounted for 13.4% of the total paediatric eye ward admission. However, 4 cases were excluded from the study as the medical records were incomplete. There were 26(78.8%) males while 7(21.2%) female children with a ratio male: female of 3.7: 1. There were 31(93.9%) unilateral ocular injury cases while only 2(6.1%) bilateral injury caused by chemical injury. The most common type of ocular trauma was closed globe injury totaling 24 (72.7%) cases. Trauma caused by blunt object contributed to the highest mode of injury 15 (45.5%) of cases. Open globe injuries which had poor visual outcome accounted for 9 (27.3%) cases. Most of patients required surgical treatment 21(63.6%) while 12(36.4%) cases treated non-surgically. In conclusion, ocular trauma was more common in male and pre-school age group. The main aetiology was blunt injury. Most of the cases treated surgically. Poorer visual outcome was observed in open globe injury.

The Epidemiology, Etiology and Short Term Visual Outcome of Paediatric Ocular Emergencies in Tertiary Care Centre

Background: Vision development is a complex system that requires the development of neuro ocular pathways and depends on proper visual stimulation of both eyes.Paediatric age group is more vulnerable to ocular injuries and any damage to eyesight will result in affecting the child in their growth and development. Aims: To Study the patterns of ocular emergencies in Indian paediatric populationand its short term visual outcome. Setting and Design: Observational study, analytical study carried out for a period of two years. Data collection from August 2017 to September 2019including demographic profile, place ofinjury, type of health care facility first sought, time delay in first treatment, pattern of ocular injury on Birmingham Eye Trauma Terminology System (classification), treatment given by us, and best corrected visual acuity (BCVA). Results: Mean age of patients is 7.79 ± 2.53 years with 105 (60%) male patients and 70 (40%) female patients. In traumatic injuries children between the age of 7 and 10 years constituted the largest group accounting for 62.7 %(94/150) of total patients. 50.2% were from urban population. 50.7% of total cases contacted first sought treatment at tertiary health facility. Mean definitive treatment time interval (23.30 ± 8.04 h) was significantly higher when patients sought primary care at Primary health facility or private health facility first rather than coming directly to the tertiary care centre (15.70 ± 5.20 h). 58% (n=87) of total injuries were due to blunt objects. At the end of 2 months 92.6% of closed globe injury cases had VA of 6/18 or better. Conclusion: Majority of paediatric ocular emergencies are traumatic in nature, more in 7-10 years age group with equal rural and urban distribution. Most of the injuries were sustained in domestic environment. Key words: Blunt trauma, Corneal laceration, Cracker injury, Hyphema, Penetrating injury, Paediatric trauma; Ocular trauma

Predictive value and applicability of ocular trauma scores and pediatric ocular trauma scores in pediatric globe injuries

AIM: To evaluate the predictive value and applicability of Ocular Trauma Score (OTS) and Pediatric Ocular Trauma Score (POTS) for closed and open globe injuries in the pediatric group. METHODS: A retrospective study of closed and open globe injuries in children age of 0-18-year-old between 2012-2019 was conducted. Medical records were collected, and injuries were classified using Birmingham Eye Trauma Terminology System (BETTS). The predictive value and applicability of both OTS and POTS to final visual acuity (VA) were analyzed. RESULTS: Of 84 patients, 59 (70.2%) presented with closed globe injuries (CGI) and 25 (29.8%) with open globe injuries (OGI). The mean of initial VA was 0.832±0.904 logMAR. OTS and POTS was calculated. Initial VA (P&lt;0.001) and traumatic cataract (P&lt;0.001) were significantly associated with visual outcome, followed by organic/unclean wound (P=0.001), delay of surgery (P=0.001), iris prolapse (P=0.003), and globe rupture (P=0.008). A strong correlation between OTS and POTS and final VA (r=-0.798, P&lt;0.001; r=-0.612, P&lt;0.001) was found. OTS was more applicable in all age group of pediatric and in contrast to POTS, it was designed for 0-15 years old. POTS requires eleven parameters and OTS six parameters. Even though initial VA was not available, we could still calculate into POTS equation. CONCLUSION: OTS and POTS are highly predictive prognostic tools for final VA in CGI and OGI’s in children.

Globe and Adnexal Trauma Terminology Survey

Ocular trauma terminology should be periodically updated to enable comprehensive capturing and monitoring of ocular trauma in clinical and research settings. To update terminology for globe and adnexal trauma. A 2-round modified Delphi survey was conducted from January 1 to July 31, 2021, using an expert panel, including 69 ophthalmologists identified through their membership in ophthalmology (globe and adnexal trauma) societies. Consensus was defined as at least 67% expert agreement. A steering committee developed questions after identifying gaps in the current terminology via a targeted literature review. Round 1 sought consensus on existing and newly proposed terminology, and round 2 focused on unresolved questions from round 1. Experts included ophthalmologists who had managed, on average, 52 globe or adnexal trauma cases throughout their careers and/or published a total of 5 or more globe or adnexal trauma-related peer-reviewed articles. Expert consensus on ocular and adnexal terms. A total of 69 experts participated in and completed round 1 of the survey. All 69 participants who completed round 1 were asked to complete round 2, and 58 responses were received. Consensus was reached for 18 of 25 questions (72%) in round 1 and 4 of 7 questions (57%) in round 2. Existing Birmingham Eye Trauma Terminology system terminology achieved consensus of 84% (58 of 69 experts) in round 1 and 97% (56 of 58 experts) in round 2. Experts agreed on the need for further refinement of the definition of zones of injury (55 of 69 [80%]), as the zone affected can have a substantial effect on visual and functional outcomes. There was consensus that the mechanism of injury (52 of 69 [75%]) and status of the lacrimal canaliculi (54 of 69 [78%]), nasolacrimal ducts (48 of 69 [69%]), lens (46 of 58 [80%]), retina (42 of 58 [73%]), and central and paracentral cornea (47 of 58 [81%]) be included in the revised terminology. There was consensus (defined as at least 67% expert agreement) on continued use of the existing Birmingham Eye Trauma Terminology system definitions and that additional terms are required to update the current ocular trauma terminology.

Prognostic value of Ocular Trauma Score and pediatric Penetrating Ocular Trauma Score in predicting the visual prognosis following ocular injury.

Aim: To assess the role of Ocular Trauma Score (OTS) and Pediatric Penetrating Ocular Trauma Score (POTS) in predicting visual prognosis following ocular injury. Methods: 120 patients, aged 3 to 70 years, with ocular injury, presenting between August 2020 and 2021, who fulfilled the inclusion criteria, were classified using the Birmingham Eye Trauma Terminology System (BETTS). Data regarding age, sex, injury type, location, initial visual acuity, and treatment were recorded. Patients were evaluated using OTS and POTS, wherever applicable, to predict visual prognosis. Follow-up was done for 6 months post-treatment to compare the predicted and actual visual outcome.Results: 120 patients (96 males and 24 females) were included in the study. The mean age was 17.2 ± 14.7 years (range 3 to 70 years). 91.6% patients included were under the age of 40 years. Blunt trauma (n=62) was slightly more common. 80 patients (66.67%) reported to the hospital after 48 hours of injury. 34 patients (28.33%) had traumatic cataract alone and IOL implantation was done as a primary procedure. In 20 patients (16.67%), lens aspiration was done primarily, with secondary IOL implantation. Six months after the treatment, the BCVA in the open globe injury patients was 20/ 200 or better in 36 patients (75%) and 20/ 40 or better in 18 patients (37.5%). Amongst the closed globe injuries, 48 patients (66.67%), had a BCVA 20/ 200 or better, while 32 (44.44%) had a BCVA of 20/ 40 or better. Conclusion: OTS is a reliable predictor of final visual outcome, both in blunt and penetrating injuries. The POTS shows gross underestimation of final visual outcome.Abbreviations: BETTS = Birmingham Eye Trauma Terminology System, POTS = Pediatric Penetrating Ocular Trauma Score, OTS = Ocular Trauma Score, OGI = Open Globe Injury, HM = Hand Movement, NLP = No Light Perception, LP = Light Perception, CGI = Closed Globe Injury, VA = Visual Acuity, BCVA = Best Corrected Visual Acuity, IAP = Indian Academy of Pediatrics, IOL = Intraocular Lens, IGATES = International Globe and Adnexal Trauma Epidemiology Study, IOP = Intraocular Pressure, CART = Classification and Regression Tree, USA = United States of America

Effect of legislation and changing trends of Diwali ocular firecracker injuries in Northern India.

OBJECTIVE:The objective of this study is to study the impact of temporary legislation implemented during Diwali on ocular firecracker injuries in Delhi-National Capital Region (NCR) region.MATERIALS AND METHODS:In this retrospective study, records of the patients presenting with ocular firecracker injury during 10 days of Diwali (prediwali, Diwali and 8 days postdiwali) from 2014 to 2019 were retreived from the medical record section. Clinico-demographic profile, relevant history pertaining to the use of firecracker, and details of eye examination, namely presenting visual acuity (VA), laterality and classification of injury based on Birmingham Eye Trauma Terminology System were noted.RESULTS:Six hundred and sixty-seven eyes of 646 patients were recruited. The median age of patients was 14 years (R = 3–65 years) and male: Female ratio was 4.9:1. Majority of patients (57.7%; n = 373) were from outside Delhi. Most of them were open globe injuries (66.8%). In 55.4% (n = 356) eyes, presenting VA was perception of light to finger counting close to face and 28% (n = 180) eyes could not perceive any light. A significant reduction was noted in the number of ocular firecrcaker injuries after regulation (preregulation [2014–2016] n = 456; postregulation [2017–2019] n = 211; [P = 0.01, t-test]). During preregulation period, presenting VA was worse than 1/60 in significantly higher number of eyes (85.5%; n = 376) than post regulation (78.8%, n = 160) (P = 0.03, Chi-square test).CONCLUSION:Although temporary legislation seems to be effective in reducing ocular firecracker injuries (52.7% reduction) in NCR, uniform implementation of stricter laws nationwide is essential to further minimize the problem.

Pediatric Open Globe Injury in Central China.

PurposeTo describe the characteristics, managements, and outcomes of pediatric open globe injury (OGI) in central China.MethodsRetrospective chart review of pediatric diagnosis in patients with OGI between 2017 and 2020 at Henan Eye Hospital. Four hundred and one eyes of the patients younger than 17 years were included in this study. Open globe injury was classified according to the Birmingham Eye Trauma Terminology system (BETT). Age, sex, history, cause, month of trauma, treatment received, and outcomes were recorded. Visual acuity was documented according to standard visual acuity chart (decimals).ResultsFour hundred and one eyes of patients were included in the study. The mean age was 6.6 ± 3.4 years with the range from 8 months to 16 years. Open globe injuries (OGIs) occurred most frequently in the 2–8 year age and significant male predominance was noted (70.8%). The incidence of pediatric OGIs was lowest in summer months while it increased in the winter months. The most common type of pediatric OGI was penetration (89%). Scissors/knife accounted for 22%, followed by pen/pencil (15.2%), and wood/bamboo sticks (14.5%) of all the pediatric OGIs. Among the injuries, the most frequently involved is the zone I (76.1%). Initially, 70.8% of the eyes received primary debridement and wound closure without any additional intervention, while only one eye has no possibility of anatomical reconstruction when it received an evisceration. After the initial management, 198 eyes received subsequent operation, including 44 eyes that underwent cataract removal + intraocular lens (IOL) implantation, and 24 eyes underwent IOL implantation. Finally, over 6 months of follow-up, 129 eyes (32.2%) got visual acuity (VA) of 0.3–1.5 and, 63 eyes (15.7%) got VA of 0.01–0.25, while 11 eyes (2.7%) were eviscerated.ConclusionThis study showed that pediatric OGIs in central China are most seen in 2–8-year age group with significant male predominance. Scissors/knife, pen/pencil, and wood/bamboo sticks accounted for over half of all cases. Pediatric OGIs often result in significant vision loss. In some severe cases (2.7%), evisceration was ultimately performed. We should call on the public to pay more attention to their children and build a safer environment for them.

The application of clinical registries in ophthalmic trauma-the International Globe and Adnexal Trauma Epidemiology Study (IGATES).

Ophthalmic trauma is a leading cause of preventable monocular blindness worldwide. The prevalence of ophthalmic trauma varies considerably based on geographic location, socio-economic status, age groups, occupation, and cultural practices such as firework celebrations. Clinical registries are known to be valuable in guiding the diagnosis, management, and prognostication of complex diseases. However, there is currently a lack of a centralized international data repository for ophthalmic trauma. We draw lessons from past and existing clinical registries related to ophthalmology and propose a new suitable international multicenter clinical registry for ophthalmic trauma: the International Globe and Adnexal Trauma Epidemiology Study (IGATES). IGATES is hosted on a secure web-based platform which exhibits user-friendly smart features, an integrated Ocular Trauma Score (OTS) prognosis calculator, efficient data collection points, and schematic graphical software. IGATES currently has 37 participating centers globally. The data collected through IGATES will be primarily used to develop a more robust and improved ophthalmic trauma prognostic classification system, the Ocular Trauma Score-2 (OTS-2), which builds on previous systems such as the Birmingham Eye Trauma Terminology System (BETTS) and Ocular Trauma Score (OTS). Furthermore, IGATES will act as a springboard for further research into the epidemiology, diagnosis, and management of ophthalmic trauma. Ultimately, IGATES serves to advance the field of ophthalmic trauma and improve the care that patients with ophthalmic trauma receive.

Clinical Characteristics, Visual Outcomes, and Prognostic Factors of Open Globe Injuries.

Background and Objectives: Open globe injuries (OGI) remain an important cause of visual impairment and loss, impacting all ages. A better understanding of the factors influencing visual outcomes is important in an attempt to improve the results of the treatment of OGI patients. The author aimed to contribute to this knowledge with the analysis of clinical characteristics, prognostic factors, and visual outcomes of their cohort of OGI patients. Materials and Methods: A retrospective medical record review was performed for 160 patients (161 eyes) who sustained an open globe injury between January 2015 and December 2017 and presented to the Hospital of Lithuanian University of Health Sciences. Data analyzed included age, sex, type, cause, place of OGI, initial visual acuity (VA), final best-corrected visual acuity (BCVA), and tissue involvement. Open globe injuries were classified using the Birmingham Eye Trauma Terminology (BETT) and Ocular Trauma Classification System (OTCS). Univariate analysis was conducted to evaluate the prognostic factors. Results: The mean age of the patients was 41.9 years. The male-to-female ratio was found to be 8.4:1. The home was the leading place of eye injury (59.6%), followed by an outdoor environment (14.3%) and workplace (11.8%). Penetrating injury accounted for 43.5%, followed by intraocular foreign body injury (39.1%) and globe rupture (13%). Overall, 19.5% of patients regained a good final vision of ≥0.5, but for 48.1% of them, eye trauma resulted in severe visual impairment (BCVA ≤ 0.02). In the univariate analysis, a bad visual outcome of less than 0.02 was correlated with bad initial VA, iris dialysis, hypotony, vitreous hemorrhage, and vitreous prolapse at presentation. Phthisis bulbi was correlated with eyelid laceration, iris prolapse, iris dialysis, hyphema, vitreous prolapse, vitreous hemorrhage, and choroidal rupture at initial examination. Conclusions: Open globe injury remains an important preventable cause of ocular morbidity. This study provides data indicating that open globe injuries are a significant cause of visual impairment in our research group.

PATTERN OF OCULAR TRAUMA AND VISUAL OUTCOME IN PATIENTS ATTENDING NATIONAL REFERRAL EYE HOSPITAL OF ERITREA

Background: Ocular trauma has been a significant disabling health problem and a leading cause of visual loss in lower-middle-income countries. These injuries have many diverse costs including human suffering, long-term disabilities, loss of productivity, and economic hardship. This study was aimed to describe the pattern of ocular trauma, its visual outcome, and the overall epidemiology of ocular trauma in all patients presenting to Berhan Eye Hospital, Asmara, Eritrea. Methods: A prospective observational study was conducted on ocular trauma patients who presented to Berhan Eye Hospital for the open globe, closed globe, and peri-orbital trauma from September – November 2018 after ethical approval from the Ministry of Health, Eritrea. Data on demography, initial and final visual acuity, type of injury as well as its outcome were collected using U.S Eye Injury Registry checklist. The types of injuries were classified according to Birmingham Eye Trauma Terminology System (BETTS), SPSS Version 22 was used. Results: Ocular trauma accounted for 1.94% of the total patients attending the outpatient department (OPD) and emergency during the studied period. Of the studied 280 participants, 218 (77.9%) patients were below 40 years of age. The male to female ratio was 2.4:1. Closed globe injuries accounted the highest 205 (73.21%) followed by the open globe injuries 75 (26.79%). Home and industrial premises were the main places where ocular injuries occurred in the participants. Conclusions: Ocular trauma affects mainly the younger age group. Blunt objects trauma in the eye are more common in low resource settings. Ocular trauma is an important cause of monocular blindness which can be prevented with early intervention and health promotion.

Pediatric ocular trauma: A prospective cohort study on the globe rupture subgroup of open globe injuries

Purpose: This work attempts to investigate the clinical profile as well as consequences of globe rupture, which constitutes a key subclass of open globe ocular trauma, in pediatric patients as per the Birmingham Eye Trauma Terminology System.

Pediatric ocular trauma: A prospective cohort study on the globe rupture subgroup of open globe injuries

Purpose: This work attempts to investigate the clinical profile as well as consequences of globe rupture, which constitutes a key subclass of open globe ocular trauma, in pediatric patients as per the Birmingham Eye Trauma Terminology System.

Outcomes Following Pars Plana Vitrectomy for Severe Ocular Trauma.

Purpose To investigate outcomes and presenting characteristics for subjects undergoing pars plana vitrectomy for ocular trauma.MethodsRetrospective study of 113 patients who underwent pars plana vitrectomy for severe ocular trauma at [name deleted to maintain the integrity of the review process] between 1999 and 2018. Data were collected on age, gender, initial and final visual acuity (LogMAR), mode of injury, type of injury, number of surgeries performed, follow-up duration, type of tamponade, presence of phthisis, and retinal detachment. The Birmingham Eye Trauma Terminology System (BETTS) was employed.ResultsWe identified assault and contusion injuries to be the most common mode and type of ocular injury in our cohort. Furthermore, through follow-up we noted a varied number of operations required by patients presenting with ocular trauma and a statistically significant improvement in visual acuity from 1.73 (0.86) LogMAR to 1.17 (1.03; p 0.01) LogMAR. A statistically significant difference in final visual acuity was also noted between BETTS classified type of injury groups (p 0.01). Notably, only 7.3% and 8.2% of patients developed phthisis or a persisting retinal detachment, respectively, during follow-up.Conclusion Our study demonstrates that ocular trauma requiring pars plana vitrectomy can require a varied number of operations with a guarded visual prognosis. However, a small percentage will proceed to develop phthisis following intervention.

Epidemiological findings of childhood ocular trauma in a public hospital in Colombia

BackgroundEye injury is a serious worldwide public health problem that may cause blindness. In children, blindness has functional impact and psychosocial implications. As indicated in many worldwide studies, identification of risk factors associated with the socio-cultural context may prevent eye injuries. The objetive of the study is to describe the sociodemographic and epidemiological characteristics of pediatric eye injury and its effects on ocular structures in a public hospital from Colombia.MethodA retrospective cross-sectional study was carried out between January 1, 2015, and December 31, 2017, in a tertiary public hospital of a medium-sized city located in the Northeast of Colombia. Children under 15 years old with trauma to the eyeball or its adnexa were included. The Birmingham Eye Trauma Terminology System (BETTS) was used. Eye burns and Ocular adnexa were also included.Results61 cases of eye injuries were recorded, 67.21% (41 cases) of which were males. 57.37% (35 cases) corresponded to closed-globe injuries both contusion and lamellar laceration. Visual acuity fluctuated between 20/20 and 20/40. 14.75% (9 cases) were open-globe injuries while 50% (4 cases) were penetrating trauma. 27.86% of the injuries (17 cases) did not directly compromise the eyeball, 58.82% (10 of these cases) of which corresponded to eyelid wounds, and neither of those had visual acuity information.ConclusionThe study showed that the majority of eye injuries in children under 15 years old, from a public hospital in the Northeast of Colombia, are closed globe, caused by blows, and occur in males.

Epidemiology and Clinical Patterns of Ocular Trauma at a Level 1 Trauma Center in Korea.

BackgroundTo evaluate the patterns of distribution and clinical manifestations of ocular injuries referred to the level 1 trauma center of Pusan National University Hospital (PNUH) in Korea.MethodsWe analyzed 254 of 4,287 patients who were referred to the Department of Ophthalmology at the level 1 trauma center of the PNUH, from January 2016 through December 2018. Data on the incidence of ocular injuries, sex, age, monthly and seasonal distribution, day and time of injury, side of injury, cause, residence of patients, referral time to an ophthalmologist and subsequent examination time, final visual acuity (VA), and complications were obtained from medical records and retrospectively reviewed. The patients were grouped according to their main diagnosis using the Birmingham Eye Trauma Terminology System (BETTS) and Ocular Trauma Score (OTS).ResultsThe incidence of ocular injuries with major trauma was higher in men (n = 207, 81.5%), the median age at time of injury was 54 years, and Pusan recorded the most cases. The incidences of ocular injury were 1.47/100,000, 1.57/100,000, 1.48/100,000 in 2016, 2017 and 2018, respectively. The most common cause was by a motorbike accident, followed by a pedestrian traffic accident and falls. According to the BETTS classification, open-globe injuries represented 4% of cases, closed-globe injuries represented 12.6%, and other injuries represented 83.1%. Open-globe injuries were significantly associated with low final VA (P = 0.01). In the OTS, 79.4% of patients received 4 or 5 points and 13.7% of patients received 1 or 2 points. The patients who received 1 or 2 points in the OTS score showed final VA below hand movement (P < 0.001), except for two patients. Lid laceration and low initial VA were highly correlated with poor final VA (P < 0.001).ConclusionThis is the first study on the epidemiology and clinical manifestations in trauma patients with ocular injuries at a level 1 trauma center. The incidences of ocular injuries with major trauma were about 1.47–1.57/100,000. BETTS, OTS, lid laceration and initial VA were associated with final VA. We expect our study to provide a basis of data for the evaluation, prevention, and management of ocular injuries in patients with systemic trauma.

Clinical characteristics and outcomes of ocular injuries in pediatric patients.

Childhood eye injuries are one of the most common causes of acquired unilateral blindness. In this study, our purpose was to investigate the demographics, etiology, and outcome of pediatric patients with ocular injury. The charts of children with ocular trauma who presented to Baskent University Hospitals, between January 1, 2017 and December 31, 2019 were retrospectively reviewed. All patients who were under 16 years of age were included. Data were collected on age, sex, time of trauma, injury type, associated injuries, treatments, visual impairment, intraocular pressure (IOP), and ophthalmic sequelae. Ocular traumas were classified according to the Birmingham Eye Trauma Terminology (BETT) system. A total of 21 patients were identified. Male-female ratio was 13/8. The mean age of the patients was 8.5±3.4 years. Mean post-treatment follow-up was 8.2±4.3 months. Injury was unilateral in all cases (10 right eye, 11 left eye). Fifteen patients (71.4%) had open globe, and 6 (28.5%) had closed globe injury. Type of injury was rupture in 7 cases, perforation in 5, penetration in 4, and intraocular foreign body in 4. A total of 5 cases were documented to have retinal detachment during the follow-up. Sharp injuries were documented in 11 (64.7%) cases, and blunt in 6 (35.2%). The most frequent finding was hyphema in blunt injury, and corneal laceration in perforating injury. Five patients had choroidal hemorrhage, 3 had commotio retinae, 2 had intravitreal hemorrhage, 1 had subhyaloidal hemorrhage, 1 had macular hole, and 1 had optic nerve avulsion. Lens aspiration was performed in 12 (57.1%) cases, and 2 of them had intraocular lens implantation. In children whose initial vision was able to be taken, 4 had no light perception, 7 had light perception-counting fingers, and 5 had best-corrected visual acuity of 0.05-0.3. At final visit, 61.9% of patients had a VA of 0.05-0.8. Corneal scar or leucoma was observed in 14 (66.6%) cases at last visit. One eye was enucleated due to post-traumatic endophthalmitis that did not respond to treatment. At final visit, IOP <6 mmHg was identified in 2 cases and >21 mmHg in 4. Anterior segment damage is the main cause of visual morbidity in pediatric ocular trauma. Injuries with sharp objects occur twice as often as blunt trauma and reduce vision with residual corneal scarring in about two-thirds of patients. Under-standing the pattern of eye injuries is useful in determining the strategies required to protect children's eye health.

Visual outcome in patients operated for traumatic cataract: A prospective hospital based study

Ocular trauma is the commonest cause of uniocular cataract in young individuals.Aim of this study was to quantify the visual outcome in terms of visual acuity after removal of traumatic cataract and implantation of an IOL. A prospective study was done in department of ophthalmology at a tertiary care teaching hospital of Andhra Pradesh. The Birmingham Eye Trauma Terminology System was used to classify ocular trauma. All patients underwent for detailed clinical history and ocular examinations including visual acuity, slit lamp biomicroscopy, direct/indirect ophthalmoscopy and a B-Scan ultrasonography etc. Patients were followed up for 3 months postoperatively. The data was analyzed using suitable statistical tests.Out of total 65 patients, 77% patients were males and 30.7% were less than 20 years of age. 66.2% patients sustained penetrating trauma while 33.8% got blunt injury. 9.2% cases had some degree of vision (6/30 to 6/120). After three months of surgery, 76.9% patients had visual acuity of &amp;#62;6/18. The difference in visual outcome at 3rd month evaluation between blunt and penetrating ocular injury was statistically insignificant (p=0.813). The younger age was significantly associated with better visual acuity (p=0.016). Patients receiving foldable IOL showed statistically better result (p=0.0231) as compared to rigid IOL.Traumatic cataract occurs mostly in young, active males who are mostly illiterate. IOL is the treatment of choice. Younger age of the patient, early surgery, implantation of foldable lens in intact capsular bag are favorable factors for achieving good visual acuity (&amp;#62;6/18).

Ocular injuries incurred by Israeli defense forces during low-intensity conflicts

BackgroundTo describe ocular injuries sustained by Israeli Defense Forces (IDF) soldiers during low-intensity conflicts from 1998 to 2017, and to evaluate the use of protective eyewear. MethodsRetrospective analysis of data retrieved from two tertiary Israeli medical centers and the military trauma registry. The analysis included all IDF soldiers with ocular injuries who were referred to these centers between 1998 and 2017. Data on injury type, the use of protective eyewear, and interventions were retrieved and analyzed. Additional data regarding the use of protective eyewear and ocular injuries in 108 patients with head and neck injuries in one operation was analyzed. ResultsA total of 126 soldiers, all males, mean age 22 (SD 5.3) years, sustained ocular injuries during low-intensity conflicts and treated at one of the two participating medical centers. Blast was the most common type of injury (n = 70/126, 56%), followed by shrapnel (n = 37/126, 29%) and gunshot wound (n = 12/126, 9%). The Birmingham Eye Trauma Terminology System (BETTS) injury pattern disclosed lamellar laceration (n = 34/126, 27%), intraocular foreign body (n = 27/126, 21%), penetrating (n = 10/126, 8%), and perforating (n = 7/126, 6%) injuries. Average VA improved from 20/140 at presentation to 20/60 after surgical or conservative intervention, the median VA improved from 20/40 to 20/30 (P < 0.001). Forty-nine patients (49/126, 39%) had poor visual outcome. The mean follow-up lasted 22 (SD 31) months. The use of protective eyewear was correlated with better initial VA(20/30 vs 20/217, P = 0.07). Among 108 patients with head and neck injuries, there was a higher rate of ocular injuries in the group of patients who did not use protective eyewear (n = 26/73, 36% vs n = 4/35, 11%, P = 0.016). ConclusionsOcular injuries are common occurrences in low-intensity conflicts. The use of protective eyewear significantly reduces these injuries and should be mandatory. Level of EvidenceIII, prognostic