Ocular Trauma Classification Research Articles

Pattern of ocular trauma in Benghazi eye hospital, Benghazi, Libya

Abstract Background: This study was conducted to determine the pattern of ocular trauma in Benghazi- Libya. Methods: All cases of ocular trauma admitted to Benghazi eye hospital from January 2011 to August 2012 were retrospectively reviewed for open- or closed-globe injury (OGI or CGI). Data extracted included age, sex, residence, initial and final visual acuity (VA), cause and treatment of injury. The injuries were classified by Ocular Trauma Classification System. Results: Out of the 805 patients, there were 540 patients (67.0%) with Closed Globe Injury and 254 patients (31.5%) with Open Globe Injury and 11 patients (1.3%) with mixed trauma. Conclusion: This analysis shows a pattern of eye injury largely similar to reports from other parts of the world. Eye injury affected mainly younger age groups and road traffic accidents were the most common cause.

Epidemiology of Adult Open Globe Injury.

The aim of this study was to evaluate the epidemiology and outcomes of adult open globe injuries (OGI) in the eastern part of Turkey. The retrospective study included all the patients who were diagnosed with OGI (436 eyes in 425 patients) at our clinic between 1997 and 2015. The OGI patients aged over 16 years were included into the study. Open globe injuries were classified according to the Ocular Trauma Classification. Age, gender, medical history, time between trauma and hospital admission, and mechanism of injury were recorded for each patient. The incidence of OGI in adults was found to be 3.40/100,000, with 5.00/100,000 in males and 1.67/100,000 in females. Open globe injuries were mostly seen in the age group of 17 to 29 years and in October and November. The patients included 79.5% males and 20.5% females. Intraocular foreign body was detected in 99 (22.7%) eyes. A strong, linear, negative correlation was found between the Ocular Trauma Classification values and final visual LogMAR (rp = -0.602, P = 0.0001). The most common mechanism of injury was occupational accident (38.4%). Open globe injuries remain a serious public health problem, resulting in significant vision loss. Open globe injuries are mostly seen in the young, middle-aged, and male working population. Additional preventive measures should be taken for the individuals in these groups.

Retrospective study of ocular trauma in Mansoura Ophthalmic Center

Aim The aim of the study was to conduct an epidemiological study of ocular trauma cases presented to the Mansoura Ophthalmic Center, Mansoura College, regarding patient age, sex, and job, the reason for trauma, and kind of ocular injuries. Patients and methods This research is dependent on hospital discharge sheets, studies from the emergency room setting or population-based interviews. It is a retrospective epidemiological study that includes all patients presenting with ocular injuries to the Mansoura Ophthalmic Center (Mansoura College) throughout the period from January 2012 to June 2015. Within this study, we examined retrospectively 1134 patients presenting with eye injuries. Patient’s collected data included age, sex, address, occupation, duration of presentation, reason for trauma, site to trauma, and kind of injuries. The reason for injuries was differentiated into blunt or sharp. Based on the site of eye injuries, the data were classified into three groups: work-related injuries, home-related injuries, and street-related injuries. The examination sheet for the hurt eye was acquired, and information was recorded based on the standardized classification of ocular trauma. Results The study incorporated 1134 patients presenting with eye injuries within a period of 3.5 years (from January 2012 to June 2015). Most instances (80.4%) of ocular trauma occurred in male patients, who had an average chronological age of 25 years (varying from 1 to 80 years). Factory employees represent 36.2% of the total injury cases. Farmers represented 2.5% of hurt individuals. Students represented 18.5% of hurt individuals. Motorists constituted 1.4%. Housewives constituted 7.2% of injury cases. Individuals without any jobs constituted 34.2% of cases. Within this study, there was no delay in presentation to the hospital in 788 (69.5%) cases. However, 268 (23.6%) patients demonstrated delay greater than 24 h to 1 week, and 78 (6.9%) patients demonstrated delay in excess of 7 days. Workplace injuries constituted 36.7% of cases, road-related injuries 31.9% of cases, and home injuries 31.4% of cases. Blunt objects represented 36.3% of eye injury cases. Sharp objects represented 63.7% of eye injury cases. There have been 852 (75.1%) closed-globe injuries and 282 (24.9%) open-globe injuries. Conclusion In Egypt, ocular trauma is an issue, as it is a significant reason for blindness. This research was targeted at determining factors that are characteristics of ocular trauma, so that they can aid in reducing its prevalence in Egypt.

Clinical profile of medicolegal cases presenting to the eye casualty in a tertiary care center in India.

Purpose:The purpose of this study was to analyze the clinical profile of medicolegal cases (MLCs) presenting to the eye casualty in a tertiary care hospital.Materials and Methods:Retrospective review of records. The cases were grouped according to the Ocular Trauma Classification Group classification system.Results:Out of 188 MLCs, 164 (87.2%) were male. Mean age (±standard deviation) was 31.6 (±12.7) years. Age ranged from 7 to 75 years. Twenty-six (13.8%) patients had bilateral involvement. The fist was the most common mode of injury, which was seen in 109 (58%) cases. A total of 27 (14.3%) patients had associated extraocular injury. No evidence of ocular or orbital trauma (malingering) could be found in 13 (7%) patients. Mechanical trauma was present in 169 (90%) patients with injury to globe in 129 (69%) patients and injury to lid or orbit without damage to the globe in 40 (21%) patients. Chemical injury was observed in 6 (3%) patients. Closed globe injury (CGI) was seen in 116 eyes and open globe injury (OGI) was noted in 29 eyes. The most common type of injury, zone, pupil, and grade of injury in CGI were Type A or contusion (79%), Zone I (72%), Pupil B (absence of relative afferent pupillary defect) in 95%, and Grade A [visual acuity (VA) ≥20/40] in 68% of the eyes, respectively. The most common type of injury, zone, pupil, and grade of injury in OGI were Type B or penetrating (48%), Zone II (38%), Pupil B (59%), and Grade D (VA 4/200-light perception) (42%), respectively.Conclusions:The most common form and mode of ocular injury in MLC were closed globe injury and fist, respectively. The most common type of injury in CGI and OGI was contusion and penetrating injury, respectively.

Wound-related complications and clinical outcomes following open globe injury repair.

Careful surgical management of traumatic wounds is important in open globe injury repair. This study examines the clinical outcomes following repair of open globe injuries with particular focus on wound-related issues. Retrospective, cohort study of consecutive open globe injuries presenting to a tertiary referral eye hospital from 1 January 2009 to 31 December 2011. A total of 267 eyes of 263 patients, mainly male (82.5%) with a mean age of 44.8 (range: 4-97) years. Average follow up was 6.9 months. All cases classified according to Ocular Trauma Classification Group. Visual outcomes, risk factors for and rates of postoperative complications and endophthalmitis. There were 83 globe ruptures, 182 penetrating and 2 perforating eye injuries, of which 43 cases had intraocular foreign body. Factors contributing to final visual acuity (VA) <6/60 were poor presenting VA (odds ratio [OR] = 16.0, 95% confidence interval [CI]: 4.81-53.1), globe rupture (OR = 4.64, [1.99-10.8]), retinal detachment (OR = 3.40, [1.19-9.74]) and age ≥50 (OR = 2.45, [1.05-5.74]). Wound leak occurred in 44 eyes (16%). Of these, 18 (41%) proceeded to re-suturing. Factors contributing to wound leak were stellate-shaped wound (OR = 3.28, [1.39-7.73]) and delayed presentation (OR = 2.80, [1.02-7.71]). Ten eyes (3.7%) developed endophthalmitis. Factors associated with endophthalmitis were delayed presentation (OR = 8.91, [1.71-46.6]), microbial keratitis (OR = 12.5, [1.85-85.0]) and lens capsule breach (OR = 12.4, [1.85-83.1]). Wound leak is an important postoperative complication of open globe injury repair. Delayed presentation is an important risk factor for postoperative wound leak and endophthalmitis. Prompt and meticulous wound management of open globe injury may reduce these complications.

Evaluation of surgical outcome in open globe injuries in a tertiary ophthalmological centre

Aims: To evaluate the clinical presentations and surgical outcome in patients with open globe injuries in a tertiary ophthalmological centre in Bharatpur Eye Hospital, Bharatpur. Methods: Seventy nine patients with ocular injury who underwent surgery were included in the study. The type of injury, surgical interventions and final visual outcome were recorded. The period of study was from 2012 May to 2013 May. Results: Injury was mild in 48 (60.8 %), moderate in 17 (21.5 %) &amp; severe in 14 (17.7 %) cases (International Ocular Trauma Classification). Forty six (58.2 %) cases had only primary repair, 27 (34.2 %) had associated lens extraction, 12(15.2 % )had vitrectomy, 2 (2.5 %) had retinal detachment surgery, one (1.3 %) had intra-ocular foreign body removal, one (1.3 %) evisceration. Thirteen 16.5 %) cases underwent secondary procedures. Final vision was 6\18 or better in 20 (25.3 %), 6\18-6\60 in 14 (17.7 %) and &lt;6\60 in 15 (18.9 %) cases. 10 (12.7 %) cases developed phthisical changes. Conclusion: Present analysis reveals that open globe injuries can present in varying severity &amp;though the overall prognosis is grave, prompt surgical intervention can result in better visual outcome. Journal of College of Medical Sciences-Nepal, 2013, Vol-9, No-2, 9-14 DOI: http://dx.doi.org/10.3126/jcmsn.v9i2.9678

Visual and anatomic outcomes of golf ball-related ocular injuries

To investigate the characteristics and prognoses of golf ball-related ocular injuries (GROIs) using standardized terminology, classification, and scoring systems. Twenty-two GROI patients were assessed using the Birmingham Eye Trauma Terminology, Ocular Trauma Classification Group (OTCG) classification, and Ocular Trauma Score. Globe preservation and final visual acuity (FVA) were assessed according to the injury severity categorical designation. Fourteen patients were injured on golf courses and eight on driving ranges. Nine patients (40.9%) had open-globe injuries (five ruptures (22.7%), four penetrating injuries (18.2%)). All rupture cases required enucleation, whereas penetrating injury cases did not (the FVA ranged from 20/100 to no light perception). In open-globe injuries, wearing glasses protected against rupture (P=0.008). Thirteen patients sustained closed-globe injuries that were accompanied by lens subluxation (38.5%), choroidal rupture (30.8%), macular commotio retinae (38.5%), and traumatic optic neuropathy (7.7%). Twelve (54.5%) patients had orbital wall fractures. The mean number of related surgeries required was 1.5±1.7 across all patients. Eyes with GROIs had devastating FVA and globe preservation status, especially those with open-globe injuries. Observing golf rules and improving driving-range facilities are essential for preventing GROIs. Protective eyewear may reduce ocular damage from GROIs, especially globe rupture.

The Usage of Ocular Trauma Scoring in the Visual Prognostic Evaluation of Traumatic Eye Injury

Aim of this study was to investigate the visual prognostic value of ocular trauma score (OTS) in traumatic eye injuries. A hundred and fourteen patients with the ocular trauma, which were underwent surgery between January 2008 and January 2012 at Firat University Hospital Clinic of Ophthalmology, were included in the study. The medical records of the patients were reviewed retrospectively. Similarly to the OTS study group, patients were divided into five groups based on their visual acuity (no light perception (NLP), light perception / hand movements (LP/HM), 1/200-19/200, 20/200-20/50, 20/40 and up) at the presentation. Ocular trauma classification was made according to the Birmingham Eye Trauma Terminology (BETT). The variables used in ocular trauma score (initial and final visual acuity, rupture, endophthalmitis, perforation, retinal detachment, afferent pupillary defect) were evaluated for each patient individually. A numerical value (raw number) was assigned to each of these variables. Numerical values related to the OTS variables were converted into OTS categories and the possible or expected visual outcome and prognosis were obtained. The percentages of the eyes in each category in the OTS study were compared with those of the eyes in our study. The average follow–up duration of patients was 10 months (range 5-12 months). The average age of patients was 24,7± 21,3 (1-86) years. Of the 27 (24%) were females and 87 (76%) were males. When we compared the table of distribution of final visual acuities in all OTS categories, in our group, NLP ratios were significantly lower in category 1 and 2 (p=0.0017, p=0.00009, respectively), whereas LP/HM ratios in categories 1, 2 and 3were significantly higher in our group than in the OTS study (p=0.00002, p=0.001, p=0.000001, respectively). When we compared final visual acuities in each categories of our study and the OTS study, in our study, 20/200 to 20/50 and 20/40 and over ratios in categories 2 and 3 were significantly lower than those in the OTS study, (p=0.00003, p=0.003, p=0.000001, respectively). 20/200 to 20/50 ratio in category 4 in our group was significantly higher than that in the OTS group (p=0.000001), whereas 20/40 and over ratio in category 4 in our study group was significantly lower than that in the OTS group, (p=0.000001, respectively). Ocular trauma scoring might provide information about visual outcomes of injury and categorical evaluation of traumatic ocular injuries at initial examination.

Prediction of visual outcomes after open globe injury in children: A 17-year Canadian experience

To analyze the predictive value of ocular trauma scoring systems for open globe injury in children, to determine risk factors for poor visual outcome, and to assess circumstances under which trauma occurs. The medical records of patients <18 years of age who presented with open globe injuries from January 1992 to December 2009 were examined retrospectively. Information recorded included demographic profile; date, time, and place of injury; cause and extent of injury; complications; and final best-corrected visual acuity. Injuries were classified by Ocular Trauma Classification Group guidelines. A total of 131 patients were included. Final best-corrected visual acuity was ≥20/40 in 74 patients (56.5%) after mean follow-up of 24.8 months. Injuries occurred more commonly in boys (98/131), and 45% of injuries occurred in children aged ≤5 years (P = 0.001). Injuries were more common indoors (P = 0.003), in the afternoon (P < 0.001), and on Saturdays and Mondays (P = 0.004). Multiple regression analysis identified risk factors for final best-corrected visual acuity <20/40: age <5 years, injuries with retrolimbal involvement, wound length >5 mm, globe rupture, vitreous hemorrhage, and retinal detachment (P < 0.05). Visual outcomes after pediatric open globe injury in this study compare favorably to results reported previously. Knowledge of weekly fluctuations in occurrence may help guide development of prevention strategies. Age <5 years is an independent risk factor for a poorer outcome. The ocular trauma score is useful in assessing prognosis after pediatric open globe injury.

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, an evolving sub specialty

Most of us commonly see patients with ocular trauma in our daily practice. This may range from a small foreign body on the cornea to a ruptured globe, from a patient presenting with 6/6 vision to a patient with no perception of light. All these patients get treated differently depending upon the part of the country and availability of medical support. All of us have different levels of involvement in treating them. There have been numerous individual reports on ocular trauma. WHO has reported 55 million eye injuries causing restriction of daily activities, of which 1.6 million go blind every day.[1] Vats et al., have reported the prevalence of ocular trauma to be 2.4% of population in an urban city in India. 11.4% of these are blind.[2] In this issue there is an interesting article by Agarwal et al., on visual outcomes in patients with posterior open globe injury. The other aspects that need attention include terminology and classification of ocular trauma [Figs ​[Figs11 and ​and2].2]. Among the standard systems available, Birmingham Eye Trauma Terminology is the one most widely accepted.[3] Figure 1 Present classification of Ocular trauma Figure 2 General classification of Ocular trauma There have also been numerous controversies with respect to classification. There have been classifications approved by International Society of Ocular Trauma, but these are limited to globe injuries and do not include injury to the orbit or adnexa.[3] The classification proposed by Dr Shukla, which is approved by the Ocular Trauma Society of India (OTSI), is a comprehensive classification. In spite of these numerous articles on ocular trauma, we still do not have any estimate of the actual prevalence of ocular trauma in India. The American Society of Ocular Trauma has a United States Eye Injury Registry and the International Society of Ocular Trauma has a World Eye Injury Registry. The Ocular Trauma Society of India has proposed an India Eye Injury Registry for the same. A registry would enable us to measure epidemiology, standardize and evaluation protocols, data collection for treatment outcomes, propose clinical trials, and disseminate information. I would like to once again emphasis on the changing perspectives in ocular trauma and look at ocular trauma as an evolving separate sub-specialty.

Pre-operative variables affecting final vision outcome with a critical review of ocular trauma classification for posterior open globe (zone III) injury

Purpose:To identify pre-operative variables affecting the outcome of posterior open globe (zone III) injuries. Secondary objective was to re-look at the definition or landmarks for zone III injury and its clinical significance for predicting visual prognosis following open globe injury.Materials and Methods:Retrospective review of medical records of all hospitalized patients with surgical repair of open globe injury over last 10 years at a tertiary referral eye care center in Singapore. Out of 172 eyes with open globe injury, 28 eyes (16.3%) with zone III injury was identified and reviewed further. Pre-operative visual acuity (VA) and other variables, extent of scleral wound in reference to rectus insertion, relative afferent pupillary defect (RAPD) and final vision outcome were recorded.Results:Median age was 37 years with male predilection (92.9%). Mean follow-up was 12.9 months. Pre-operative VA was no light perception (NLP) in 16 (57.1%) eyes. Final VA remained NLP in 14 eyes (50.0%). The factors contributing to poor post-operative vision based on univariate regression analysis were the presence of RAPD, poor pre-operative VA, blunt trauma, extent of trauma, associated traumatic cataract, hyphema, vitreous loss and associated vitreo-retinal trauma. Further on, zone III injuries with scleral wound limited anterior to rectus insertion (6 eyes) had better vision outcome than those with injuries extending beyond rectus insertion (22 eyes).Conclusion:Initial VA, blunt ocular trauma, visual axis involvement, loss of light perception, presence of RAPD, traumatic cataract, hyphema, vitreous loss were the important determinants for final visual outcome in patients with zone III injury. Wound extending posterior to rectus insertion has poorer outcome as those limited anterior to rectus insertion. We suggest that there may be a need to relook at zone III injuries with reference to rectus insertion for prognostic significance, and further studies are warranted.

Profile of ocular trauma in industries-related hospital

Introduction:Ocular trauma is a worldwide cause of visual morbidity, a significant proportion of which occurs in the industrial workplace and includes a spectrum of simple ocular surface foreign bodies, abrasions to devastating perforating injuries causing blindness. Being preventable is of social and medical concern.Aim:A prospective case series study, to know the profile of ocular trauma at a hospital caters exclusively to factory employees and their families, to co-relate their demographic and clinical profile and to identify the risk factors.Materials and Methods:Patients with ocular trauma who presented at ESIC Model hospital, Rajajinagar, Bangalore, from June 2010 to May 2011 were taken a detailed demographic data, nature and cause of injury, time interval between the time of injury and presentation along with any treatment received. Ocular evaluation including visual acuity, anterior and posterior segment findings, intra-ocular pressure and gonio-scopy in closed globe injuries, X-rays for intraocular foreign body, B-scan and CT scan were done. Data analyzed as per the ocular trauma classification group. The rehabilitation undertaken medically or surgically was analyzed. At follow-up, the final best corrected visual acuity was noted.Results:A total of 306 cases of ocular trauma were reported; predominantly in 20-40 year age group (72.2%) and in men (75%). The work place related cases were 50.7%and of these, fall of foreign bodies led the list. Visual prognosis was poorer in road traffic accidents rather than work place injuries owing to higher occurrence of open globe injuries and optic neuropathy. Finally, 11% of injured cases ended up with poor vision.Conclusion:Targeting groups most at risk, providing effective eye protection, and developing workplace safety cultures may together reduce occupational eye injuries.

Clinical characteristics of mechanical ocular injury and application of ocular trauma score

To summarize clinical characteristics of mechanical ocular injury and to analyze the role of ocular trauma score (OTS) in the estimation of final visual acuity. All cases of ocular trauma admitted to the Department of Ophthalmology from January 2009 to December 2010 were retrospectively reviewed. Data extracted included laterality of the injured eye, gender, age, presenting time, cause, ocular trauma classification, initial and final visual acuity. These injuries were classified by ocular trauma classification system (OTCS). We also used the OTS in evaluating the final visual outcome. Comparisons between groups for discontinuous variables were analyzed using rank-sum test. Rank correlation was used in analysis between initial visual acuity and final visual acuity or between final visual acuity and OTS. Chi-square test was used to analyze variables, such as age, cause, type and visual acuity. Comparison of ages between male and female was analyzed by using t-test. Of the 168 eyes, there were 106 open globe injury (OGI) and 62 closed globe injury (CGI). There were 140 males (85.71%) and 22 females (14.29%). Presenting time median of OGI and CGI was 5 h and 10 h respectively, and there was significant difference between these two different injuries (Z = -2.547, P = 0.011). The high-risk age group was the young age group (100 eyes, 59.52%), vs. the middle age group (46 eyes, 27.38%) and the elder age group (22 eyes, 13.10%). Occupation-related injury (70 eyes) was the most common cause and mainly resulted in OGI (54/70). Initial and final visual acuities in CGI were better than those of OGI (χ(2) = 37.847, P = 0.000; χ(2) = 44.428, P = 0.000). Initial visual acuity was correlated with final visual acuity (r = 0.858, P = 0.000). Final visual acuity was significantly correlated with total score (r = 0.870, P = 0.000) and OTS (r = 0.869, P = 0.000). In this group of mechanical ocular trauma patients, male is more common than the female. Main type of injury is OGI and presenting time of OGI is earlier than that of CGI. The high-risk age group is the young. Main cause of injury is occupation-related injury. Initial and final visual acuities in CGI are better than those in OGI. OTS calculated at initial examination may be a useful parameter for the estimation of prognosis.

The clinical character and prognostic indicators for visual outcome of open globe injuries: an analysis of 82 cases

Objective To observe the clinical properties of 82 patients with open globe injuries ( OGIs),and to verify the efficacy of the classification system proposed by The Ocular Trauma Classification Group in predicting the visual outcome of the 82 patients.Method The clinical data of 82 OGIs patients,including the age,sex,visual acuity at admission,type of injury,location of injury and visual outcomes were retrospectively analyzed.A final best corrected visual acuity ＜ 0.1 was considered as poor outcome group and ≥0.1 as another group.The differences in the types of injury,zone location of injury and visual acuity at admission were compared between the two groups.Results The male to female ratio of the 82 patients was 4.41 ∶1.Fifty-nine (71.95％) patients were 21 -50 years old.The first cause of the injury was metallic hardwire.Forty-two (51.22％) of the 82 patients had a visual acuity ≥0.1,with 16 ( 19.51％ )cases having a visual acuity ≥0.5.One patient had no light perception,and one patient had endophthalmitis.No eyes were enucleated.The zone location of the injury and visual acuity at admission were significantly different between the two groups (P =0.027,P =0.025 ),and the injury types were not significantly different(P=0.270).Conclusion Two indicators,the zone location of the injury and visual acuity at admission,in the classification system established by The Ocular Trauma Classification Group have a better predicting effect for the postoperation visual outcome of patients with OGIs. Key words: Injuries, open globe; Visual acuity; Prognostic indicator; Clinical character

Pattern of Pediatric Ocular Trauma in Kashan

Background Ocular trauma is a significant health problem in pediatric patients. Objectives The aim of this study was to analyze the characteristics of ocular-trauma-related hospitalization of children in Kashan. Patients and Methods This descriptive, cross-sectional study included 131 children aged less than 16 years with ocular trauma, who were admitted to the Matini Hospital at the Kashan University of Medical Sciences between April 2006 and March 2009. After admission, detailed ocular examination was performed, and their ocular trauma was classified according to the International Ocular Trauma Classification and Birmingham Eye Trauma Terminology systems. Results The mean age of the patients was 7.8 ± 2.2 years (age range, 0–16 years), and the male to female ratio was 5:1. The most common cause of admission was hyphema (38.1%), followed by corneoscleral laceration (27.5%). Ocular trauma most commonly occurred at home (43%), and 69% of the patients presented to the emergency room within 24 h of injury. In 30% of the patients, initial visual acuity at the time of presentation was less than 20/200. Conclusions Ocular trauma is a major cause of unilateral blindness, especially in young boys, and hence, preventive measures and education is required.

Vitreoretinal surgery in the management of war-related open-globe injuries

Ranking among the most severe combat damages, war-related open-globe injuries (WROGIs) are not uniform, so the treatment approaches are sometimes unclear. The essential issue is to define exact indications for time- and resource-intensive vitreoretinal surgery (VRS), known to be an effective procedure for severe posterior segment injuries. We studied WROGI structure, and summarized the experience of specialized ophthalmologic care (SOC) management during local armed conflicts (LACs). This was a retrospective multicenter study that included case series of 203 wounded subjects (314 eyes) with WROGIs sustained during LACs treated in the hospitals of first, second and third echelons of SOC. Ocular trauma was classified according to the International Society of Ocular Trauma (ISOT) classification, and only open-globe injuries (OGI) made up two groups of study: injured eyes that underwent VRS, n = 135, and those eyes on which VRS was not performed, n = 119. Two subgroups according to stages of VRS were also included. We reviewed the demographic characteristics, the time between injury and surgery, the number of stages in which surgery was performed, and initial visual acuity (IVA) at arrival and final visual acuity (FVA), 12 months after surgery. WROGI constituted 65.1 % of all eyes injured. The visual outcomes after VRS were favorable in ruptures of the eye, penetrating WROGIs, intraocular foreign body (IOFB) WROGIs, perforating WROGIs (types A, B, C, D) of grades 1-4. Those WROGIs of grade 5 had poor visual outcomes irrespective of the surgeries. In 19.1% of all cases wherein either the eye wall or eye content were extensively damaged (included types A, C, D, E of grade 5), all attempts to save the eye through reconstructive surgery were unsuccessful and led to enucleation (evisceration). Medical service management in LACs demands to define groups of priority for VRS between the wounded with WROGI during triage at the first echelon of SOC. Multistage VRS determines unfavorable outcomes of the WROGI. Treatment should be determined by diagnosis, and there is a need to introduce a new category into the OGI classification--eye destruction, because only this damage determines the choice of enucleation/evisceration of the eye.

Prognostic Factors and Visual Outcome for Fireworks-Related Burns During Spring Festival in South China

The aim of this study was to evaluate the clinical features and the visual results of fireworks-related ocular burn injuries and to determine the prognostic factors. The authors conducted a prospective observational study of 53 eyes of 46 consecutive patients with fireworks-related ocular injury who visited Zhongshan Ophthalmic Center during the Spring Festival in Southern China. Eyes were graded using an ocular trauma classification system, which included age of the patient. Patients were followed up for a minimum of 5 months. Best-corrected visual acuity at the last follow-up was considered the final visual outcome. Data were analyzed with SPSS version 13.0 (SPSS, Inc., Chicago, IL). Results of statistical tests were considered statistically significant for P < .05. Almost all patients (89.1%) were male with a mean age of 14.3 ± 8.5 years. There was preponderance of young patients, with 63.0% (29) of the patients being younger than 15 years. In addition to their ocular injuries, 23 patients (50.0%) also had eyelid and/or facial burns. The most common initial anterior segment injuries were open-globe injuries (42, 79.3%), conjunctival burns (16, 30.2%), and foreign bodies (18, 34.0%). Others were traumatic cataract, lens subluxation and dislocation, and vitreous hemorrhage. Management after first aid included pars plana vitrectomy (9, 17.0%), aspiration of cataract (18, 34.0%), retinal reattachment (8, 15.1%), and enucleation. Amniotic membrane grafts were used in 11 patients (20.8%) with serious conjunctiva burns and corneal contusions and abrasions who were thought to have a good prognosis. Fireworks-related ocular injuries included a variety of clinical manifestations. Examinations such as B scan, optical coherence tomography, and ultrasound biomicroscopy helped to make a correct diagnosis and plan further treatment. Fireworks-related ocular injuries commonly affect young male subjects of Southern China. Visual outcomes were frequently poor and visually devastating. Laws should be passed to forbid the personal use of fireworks in China, and public education on the sale and use of fireworks should be increased.

Pattern of Pediatric Ocular Trauma in Kashan

Background:Ocular trauma is a significant health problem in pediatric patients.Objectives:The aim of this study was to analyze the characteristics of ocular-trauma-related hospitalization of children in Kashan.Patients and Methods:This descriptive, cross-sectional study included 131 children aged less than 16 years with ocular trauma, who were admitted to the Matini Hospital at the Kashan University of Medical Sciences between April 2006 and March 2009. After admission, detailed ocular examination was performed, and their ocular trauma was classified according to the International Ocular Trauma Classification and Birmingham Eye Trauma Terminology systems.Results:Mean age of the patients was 7.8 ± 2.2 years (age range, 0–16 years), and male to female ratio 5:1. The most common cause of admission was hyphema (38.1%), followed by corneoscleral laceration (27.5%). Ocular trauma most commonly occurred at home (43%), and 69% of the patients presented to the emergency room within 24 h of injury. In 30% of the patients, initial visual acuity at the time of presentation was less than 20/200 (Figure 1).Conclusions:Ocular trauma is a major cause of unilateral blindness, especially in young boys, and hence, preventive measures and education is required.

Epidemiological characteristics and visual outcome after open globe injuries in children

To determine demographic, etiologic, clinical characteristics, visual outcome, and the factors affecting visual prognosis in children with open globe injuries. The medical records of 82 patients under the age of 16 years who presented with open globe injuries from January 1998 to January 2009 were retrospectively examined. Age, sex, involved eye, cause, place of injury, wound location, presenting visual acuity, clinical signs, and final visual acuity were noted. The injuries were classified by Ocular Trauma Classification Group Guidelines and Birmingham Eye Trauma Terminology. Most injuries occurred in boys (54/82). The mean age was 8.4 ± 3.7 years. Most patients (37.8%) were in the 3- to 6-year age group. All patients had a minimum of 6 months' follow-up (mean, 23.9 ± 23.2 months; range, 6-114). Pointed metallic objects were found to be the main causative agents. Injuries occurred most frequently in streets (36.3%), homes (18.7%), leisure areas (15.4%), and schools (7.7%). Factors adversely affecting visual prognosis were poor presenting visual acuity, posterior wound location, low ocular trauma score, retinal detachment, afferent pupillary defect, vitreous prolapse, uveal tissue prolapse, and hyphema. Open globe injuries in children occur most frequently in preschool boys. Prognosis is determined by presenting visual acuity, trauma score, and wound severity and location.