Management Of Open Globe Injury Research Articles

Management of open globe injury: a narrative review.

Open globe injuries are a significant global cause of visual loss, including unilateral and bilateral blindness. Prognosis is predicted by injury severity, with lower presenting visual acuity and more posterior injuries associated with poor visual outcomes, although even the most severely injured eyes with no perception of light vision may regain some visual function. In addition to severity of the primary injury, the secondary injuries and complications causing poor outcomes include proliferative vitreoretinopathy (PVR) and endophthalmitis. Endophthalmitis is common after open globe injury, affecting up to 16.5% of patients. Systemic antibiotic prophylaxis is commonly used, with a limited evidence base, while intraocular antibiotics are less commonly used but have stronger supporting evidence of efficacy. Endophthalmitis rates are also reduced by prompt primary repair, which may also support recovery of visual acuity. PVR is not prevented or treated by any pharmacologic interventions in current clinical practice, but the incidence of post-traumatic PVR may be reduced by early vitrectomy within the first 4-7 days after injury. Ocular trauma training is often limited in Western ophthalmic surgical training programmes, and patients with ocular trauma often require the input of multiple subspecialists. In this context, it is important that patients have an overview and coordination of the different aspects of their care, with ownership by one lead clinician.

Development, comparison, and internal validation of prediction models to determine the visual prognosis of patients with open globe injuries using machine learning approaches

IntroductionOpen globe injuries (OGI) represent a main preventable reason for blindness and visual impairment, particularly in developing countries. The goal of this study is evaluating key variables affecting the prognosis of open globe injuries and validating internally and comparing different machine learning models to estimate final visual acuity.Materials and methodsWe reviewed three hundred patients with open globe injuries receiving treatment at Khatam-Al-Anbia Hospital in Iran from 2020 to 2022. Age, sex, type of trauma, initial VA grade, relative afferent pupillary defect (RAPD), zone of trauma, traumatic cataract, traumatic optic neuropathy (TON), intraocular foreign body (IOFB), retinal detachment (RD), endophthalmitis, and ocular trauma score (OTS) grade were the input features. We calculated univariate and multivariate regression models to assess the association of different features with visual acuity (VA) outcomes. We predicted visual acuity using ten supervised machine learning algorithms including multinomial logistic regression (MLR), support vector machines (SVM), K-nearest neighbors (KNN), naïve bayes (NB), decision tree (DT), random forest (RF), bagging (BG), adaptive boosting (ADA), artificial neural networks (ANN), and extreme gradient boosting (XGB). Accuracy, positive predictive value (PPV), recall, F-score, brier score (BS), Matthew correlation coefficient (MCC), receiver operating characteristic (AUC-ROC), and calibration plot were used to assess how well machine learning algorithms performed in predicting the final VA.ResultsThe artificial neural network (ANN) model had the best accuracy to predict the final VA. The sensitivity, F1 score, PPV, accuracy, and MCC of the ANN model were 0.81, 0.85, 0.89, 0.93, and 0.81, respectively. In addition, the estimated AUC-ROC and AUR-PRC of the ANN model for OGI patients were 0.96 and 0.91, respectively. The brier score and calibration log-loss for the ANN model was 0.201 and 0.232, respectively.ConclusionAs classic and ensemble ML models were compared, results shows that the ANN model was the best. As a result, the framework that has been presented may be regarded as a good substitute for predicting the final VA in OGI patients. Excellent predictive accuracy was shown by the open globe injury model developed in this study, which should be helpful to provide clinical advice to patients and making clinical decisions concerning the management of open globe injuries.

Management of Open Globe Injury Followed by Cataract Traumatic and Corneal Laceration in a 37-year-old Man. A Case Report

Introduction : Ocular trauma is the most common cause of visual impairment and unilateral vision loss. According to the Birmingham Eye Trauma Terminology, ocular trauma consists of Open Globe Injury and Closed Globe Injury. Open globe injury is a full-thickness eyewall wound due to a laceration or occult rupture. Damage to the cornea and lens are among the most common types of ocular trauma.
 Case Illustration : This case report involves a 37 year-old-man who presented with complaints of pain and visual impairment in the left eye for the past month. The symptoms appeared after accidentally getting hit by a bamboo branch. Upon examination, the patient had a visual acuity of 1/300 in the left eye, ciliary injection (+), non-spherical pupil, and normal intraocular pressure on palpation. On slit lamp examination, a 7mm corneal laceration with a scar formation and a lens mass in the eye's anterior chamber.
 Discussion : In this case, the open globe injury resulted in visual impairment due to corneal laceration and traumatic cataracts. The trauma occurred one month before the examination, and the corneal laceration had already formed a leukoma. The patient underwent corneal repair and vitrectomy, extracapsular cataract extraction using the ECCE technique, and intraocular lens implantation.
 Conclusion : The prognosis of ocular trauma depends on the severity of the injury to the eye structures, the time between the injury and surgery, the preoperative visual acuity, the mode of injury, and the patient's age. The OTS scoring system can predict the final visual acuity outcome in such cases.

Video-based surgical curriculum for open-globe injury repair, VI: other trauma sequelae.

As one of the most severe forms of ocular trauma, open-globe injury (OGI) causes significant vision loss. Timely and meticulous repair of these injuries can improve patient outcomes. This video-based educational curriculum is intended to serve as an efficient yet comprehensive reference for OGI repair. We hope that these video-based articles help surgeons and trainees from around the world find answers to specific surgical questions in OGI management. The curriculum has been divided into six separate review articles, each authored by a different set of authors, to facilitate a systematic and practical approach to the subject of wound types and repair techniques. The sixth article highlights special considerations in the management of open-globe injuries and their sequelae, including management of traumatic cataracts and trauma to the iris.

Reliability of open globe injury repair surgical videos on the internet for resident education

Introduction This study aimed to assess quality of surgical training videos for management of open globe injury (OGI) on online platforms. Material and Methods Twenty-three websites with surgical training videos were queried using the search keyword “open globe repair.” Video content characteristics and quality assessment scores using Sandvik score, Health on the Net Foundation Code of Conduct (HON code), mDISCERN scoring, and global quality score (GQS) were recorded. To evaluate the relevance of the surgical videos to the surgical procedure, steps were analyzed as per the Ophthalmology Surgical Competency Assessment Rubric (OSCAR) for Open Globe Surgical Management. Results One hundred and twenty-three videos were evaluated, and 63 analyzed. Majority videos were uploaded by solitary ophthalmologists (53/63; 84.13%). Mean video quality score (VQS) and GIS scores were 6.55 ± 1.59 and 7.95 ± 1.39, respectively. Mean mDISCERN, GQS, HON Code and Sandvik scores for all the videos were 2.87 ± 1.07, 3.77 ± 1.08, 5.14 ± 1.67, 12.06 ± 1.84, respectively. Videos with background audio and descriptive subtitles had significantly better quality ( p < 0.05). All Quality assessment scores showed a statistically significant ( p < 0.000) positive correlation with each other. On linear regression analysis, number of video likes, comments and views had a significant ( p < 0.05) positive relation with quality of video, whereas video length showed a negative relation with different scores. Conclusion Nearly two-thirds of surgical videos showing OGI repair had good quality assessment scores. Consensus guidelines should be developed to guide uploaders as regards the essential features required for good quality surgical videos using a standardized rubric.

Ophthalmic Trauma Correlation Matrix (OTCM): a potential novel tool for evaluation of concomitant ocular tissue damage in open globe injuries.

To introduce a novel tool to investigate the correlation between concomitant injuries and primary open globe injury (OGI) in the setting of ophthalmic trauma, the "Ophthalmic Trauma Correlation Matrix" (OTCM). Retrospective cohort review, performed at a tertiary referral eye care center in Eastern Nepal, involving all eyes with OGI meeting the inclusion criteria from 2015-2018. Clinical data including details of primary injury, concurrent injuries, and clinical course were noted from hospital medical records. A correlation matrix chart was devised using matrix correlation and Pearson's correlation coefficient. This chart was then used to evaluate the association of the various injuries in the setting of OGI. A total of 109 eyes with OGI were included. Majority of the eyes (78, 71.6%) had zone I injuries, while most of the eyes (66, 60.6%) had penetrating injury. The most frequent concomitant injuries in all zones of OGI were traumatic lens injury (77, 70.64%), followed by hyphema (48, 44.03%), and vitreous hemorrhage (35, 32.11%). The most common concomitant injury associated with zone I was hyphema (0.873), while traumatic subluxation/cataract (0.894) and vitreous hemorrhage (0.972) were commonly associated with zone II and III, respectively. OTCM could be a useful tool to manage injuries related to the primary ocular injury. This additional information will aid in the prognostication, planning, and management of OGI and potentially prevent repeat surgeries and inadequate treatments.

Global Current Practice Patterns for the Management of Open Globe Injuries

To determine global current practice patterns for the management of open globe injuries and identify areas of variation. Cross-sectional survey. An online survey assessed global management paradigms for open globe injuries from August 2020 to January 2021. Responses were collected from experts at eye trauma centers and emergency departments worldwide who manage ≥1 open globe injury per month. The survey assessed the use/selection of antibiotics and steroids, procedural and imaging decisions, and admission practices for open globe injuries. Responses were received from representatives of 36 of 42 institutions (85.7%), of which 33 (78.6%) had sufficient trauma volume to be included. Included responses were distributed across North America (n=12, 36.4%), Asia (n=12, 36.4%), South America (n=4, 12.1%), Africa (n=3, 9.1%), Europe (n=1, 3.0%), and Australia (n=1, 3.0%). Preoperative systemic antibiotics for open globe injuries were administered by 75.8% (n=25/33) of institutions, while 30.3% (n=10/33) administered preoperative topical antibiotics. Intraoperative ophthalmic antibiotics for open globe injuries were used by 54.5% (n=18/33) of experts. Most institutions also administered postoperative systemic antibiotics (n=23 [69.7%]) and topical steroids (n=29 [87.9%]), although specific medication choices diverged. At 19 responding centers (61.3% of the 31 that had trainees), residents participated in surgical repairs. Many institutions discharged patients after repair, but 54.5% (n=18/33) of locations routinely admitted them for observation. Preferred management practices for open globe injuries vary widely. To ensure the highest standard of care for all patients, evidence-based international guidelines for the treatment of these injuries are needed.

Utility of wound cultures in the management of open globe injuries: a 5-year retrospective review

BackgroundEndophthalmitis after open globe injury can be devastating to vision recovery. As treatment of endophthalmitis is often empiric, some surgeons may obtain cultures at presentation of trauma in anticipation of later infection. This study examines the usefulness of wound cultures obtained during globe repair.ResultsInstitutional Review Board approval was obtained. Medical records were retrospectively reviewed, with 168 open globes included. Cultures of the wound site had been taken in all cases included in this study. Wound cultures were positive in 63% of cases but were not used for clinical decision-making for any patient in this study. Two patients had evidence of endophthalmitis at presentation, with results of vitreous culture matching those from the wound. No patient later developed endophthalmitis after open globe repair.ConclusionsDespite a high rate of wound contamination, few cases of endophthalmitis (1.2%) were seen in this series. In no case did the results of wound culture impact choice of antibiotic prophylaxis or treatment. Cultures obtained at the time of open globe repair were not cost effective in the subsequent management of the injury.

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.

The management of open globe eye injuries: a discussion of the classification, diagnosis and management of open globe eye injuries

Eye injuries occurred in 10% of UK military major trauma cases in Iraq and Afghanistan between 2004 and 2008, with 33% of these eye injuries open globe in nature(1). This article will consider the diagnosis, classification and management of open globe injuries in the role 1/ pre-hospital environment.

Eye trauma during the 2011 Egyptian revolution

Cairo university hospitals are at the heart of Cairo with close proximity to Tahrir (Liberation) square and had received the vast majority of casualties during the Egyptian revolution. The aim of this study was to analyze the eye injuries during the uprising. Retrospective cohort study. Data were obtained from patients' paper records, interview with treating ophthalmologists, and whenever possible patients were interviewed and examined. An electronic medical template had been specially developed for recording these data. Main outcome measures were the flow of patients and their demographics, diagnoses, visual acuities pre and post interventions, investigations and management. Whenever required results were compared at 95 % confidence interval. There were 184 patients (mean age 27.3 ± 9.6 years) with 195 injured eyes of whom 96.7 % were males and 11 patients had both eyes injured. Seventy seven percent of patients had been admitted within 24 h of injury. Open globe injuries comprised 87 % of the eyes of which 147 eyes received 259 imaging investigations. The presenting visual acuities were worse than 3/60 in 72.5 % of eyes which were even worse post interventions and that was significantly dependent on the presenting vision. Wound repair was the primary intervention in 85 % of eyes while 50 % of the secondary interventions were vitrectomies. Presenting visual acuity is a valid prognostic factor in the setting of mass eye casualty. Management of open globe injuries continues to pose difficult challenges especially bilateral ones.

Open globe injuries: factors predictive of poor outcome

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. 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. 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). 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.