Ocular Trauma Classification Group Research Articles

Open-globe injuries in Palestine: epidemiology and factors associated with profound visual loss at St. John Eye Hospital, Jerusalem Riyad Banayot St. John Eye Hospital, Jerusalem, Palestine

Background: The purpose was to describe the epidemiology of open-globe injury (OGI) in Palestine and identify the prognostic factors associated with profound visual loss. Material and methods: The current study is a retrospective review of hospital files for 83 consecutive patients with OGI who presented to St. John Eye Hospital, Jerusalem, within 5 years, between 2009 and 2013. Demographic details included age, gender, wound characteristics, and visual acuity (VA). The Ocular Trauma Classification Group was used for wound location, classification, and scoring for each case. Results: We identified 83 OGI that presented to St. John eye hospital. The study group included 62 males and 21 females. The mean age was 16.66 years ± 3.216. The most frequent injuries were playground injuries (59%), followed by workplace injuries (26.5%). Penetrating injuries represented 45.8% of injuries, and rupture globes occurred in 39.8% of cases. The most frequent objects causing injury were metal (31.3%) and stone (20.5%). Kinetic impact projectiles were a statistically significant poor prognostic factor for the visual outcome. Variables that were statistically significant poor prognostic factors for visual outcome included: retinal detachment, macular scar, vitreous hemorrhage. Conclusion: This study showed that the act of demonstration, street injuries, kinetic impact projectiles, zone III injuries, globe disruption, retinal detachment, vitreous hemorrhage, and a poor VA at the first visit are poor prognostic factors for OGI. Recognition of these prognostic factors will help the ophthalmologist evaluate the injury and its prognosis.

Observation and Epidemiology of Ocular Trauma in Children: Hospital based Study

Background: This study was designed to identify the causes, demographic, clinical profile & classify the patients according to the ocular trauma classification group. Method: 60 children of age fifteen year or less, with ocular injury, who had presented to emergency services/out-patient department of the Regional Institute of Ophthalmology (RIO), IGIMS medical college & hospital, Patna (Bihar) were included. Demographic data, nature and cause of injury, duration between injury & presentation to the hospital and diagnosis were recorded. Evaluation of visual acuity, anterior segment and fundus was done. Results: Majority of injuries occurred in children 7yrs and older (64.7%). There were 50 (83.33%) boys and 10 (16.66%) girls. 40 (66.67%) of cases presented within 24hrs of the injury while 20 (33.33%) of cases presented after more than 24 hr after trauma. Rural patients comprised 39 out of 60 (65 %) while urban were 21 out of 60 (35 %). Most of the patients n=36 (60%) belonged to average socioeconomic status fallowed by low socioeconomic status n=20 (33.33%) & high socioeconomic status n=4 (6.67%). Most of the children n=35 (58.33%) were in their primary school. The highest proportion of injuries occurred outside (eg streets, roads, playgrounds, schools) n=40 (66.67 %) followed by home n=20 (33.33%). Conclusions: Eye trauma in children occur most frequently outdoors. Early diagnosis, management and prevention of complications of ocular injuries can be possible by educating parents and children.

Visual outcomes and prognostic factors in open-globe injuries

BackgroundOcular trauma is an important cause of visual loss worldwide. Improvements in our knowledge of the pathophysiology and management of ocular trauma during the past 30 years, in conjunction with advances in the instrumentation and techniques of ocular surgery, have improved the efficacy of vitreoretinal surgery in injured eyes. The aim of the current study was to determine the visual outcomes and prognostic factors of open-globe injuries in the Japanese population.MethodsRetrospective study of 59 eyes of 59 patients presented with open globe injuries between September 2008 and March 2014 at Nagasaki University Hospital was conducted.Demographic factors including age, gender, and clinical data such as cause of injury, presenting visual acuity (VA), location of injury, type of injury, lens status, presence of intraocular foreign body, types of required surgeries, and final VA were recorded. According to the classification of Ocular Trauma Classification Group, wound location was classified into three zones. Chi-square test was used to compare presented data.ResultsOut of the 59 patients, 46 were placed in the Light Perception (LP) group, and 13 were placed in the No Light Perception (NLP) group. Work-related trauma was the most common cause (27 eyes) followed by falls (19eyes). Work-related trauma was common in males (P = 0.004), while falls was significantly common in females (P = 0.00001). Zone III injuries had statistically significantly poor prognostic factor compared to other zones (P = 0.04). All cases of NLP group (100%) presented with rupture globe. Poor VA at first visit (P = 0.00001), rupture globe (P = 0.026), history of penetrating keratoplasty (PK) (P = 0.017), retinal detachment (RD) (P = 0.0001), vitreous hemorrhage (VH) (P = 0.044), and dislocation of crystalline lens (P = 0.0003) were considered as poor prognostic factors.ConclusionPoor VA at first visit, rupture globe, zone III injuries, history of penetrating keratoplasty, RD, VH, and dislocation of crystalline lens were found to be poor prognostic factors. PPV had a good prognostic value in open globe injuries associated with posterior segment involvement.

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.

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.

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.

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.

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

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.

Clinical pattern of pediatric ocular trauma in fast developing country

Ocular trauma is a significant problem in pediatric patients. Also, leads to visual loss throughout the world there are no data of pediatric ocular trauma in Arabian Gulf Countries in the current literature. To study the epidemiology, mechanism, causes and outcome of serious ocular trauma requiring hospital admission, in children below 16years of age. A retrospective cohort study. All pediatric patients (up to 16years of age) presenting with ocular injuries to a tertiary care pediatric ophthalmology and Pediatric Accident Emergency Department 1 January 2005 to 30 December 2009. Each file was studied to find out the demographic data, mechanism and cause of injury. The definitions and classifications of ocular trauma in our study were modified from the Ocular Trauma Classification Group guidelines and Birmingham Eye Trauma Terminology Presenting and final visual acuity were recorded along with details of anterior and posterior segment evaluation. Hundred and six files of the children admitted to ophthalmology ward with the diagnosis of ocular trauma between 2005 and 2009 were reviewed. Majority were boys (77.4%). The mean age at admission was 6.63years. A higher incidence of ocular trauma was noted in children above 5years than those below (58.5%). Most number of trauma occurred at home (42.5%, n=45) followed by street (35.8% n=34), school (12.3%, n=13), sporting area (5.7%, n=6). Also, eight patients (8.5%) involved in Road Traffic Accidents (RTA). Closed globe injury occurred more frequently than open globe injury (59.4% vs. 40.6%). Initial visual acuity was more than 6/60 in (55.6%) patients of closed globe while in open globe injury was (37.3%). Final visual acuity was more than 6/18 in (82.5%) patients of closed globe injury group and in (63%) patients of open globe injury group. Severe impairment of vision was found in (11.6%) and blindness (4.7%) only in open globe injury group. Most eye injuries in children are preventable so this reflects the importance of health education, adult supervision and application of appropriate measures that is necessary for reducing the incidence and severity of trauma.

MANAGEMENT OF RETINAL DETACHMENT DUE TO CLOSED GLOBE INJURY BY PARS PLANA VITRECTOMY WITH AND WITHOUT SCLERAL BUCKLING

To investigate the effect of circumferential scleral buckling on the prognosis for patients undergoing pars plana vitrectomy and lensectomy for severe closed globe injury. A total of 33 cases in which pars plana vitrectomy and lensectomy were performed after severe closed globe injury between January 1990 and January 2003 were studied retrospectively. All patients had zone III contusion type injury according to The Ocular Trauma Classification Group criteria. Of the 33 patients, 15 (group 1) also underwent peripheral scleral buckling; 18 did not (group 2). The mean age +/- SD was 34.8 +/- 17.5 years (range, 8-73 years). There were 6 female (18%) and 27 male (82%) patients. The two groups did not differ significantly in terms of preoperative visual acuity (P = 0.76) or postoperative visual improvement (P = 0.46). In groups 1 and 2, 4 (26%) and 3 (17%) patients developed recurrent retinal detachment for which they underwent reoperation. Other postoperative complications were as follows: group 1-phthisis (1 patient; 7%), proliferative vitreoretinopathy (1 patient; 7%), and optic atrophy (1 patient; 7%); group 2, proliferative vitreoretinopathy (2 patients; 11%) and optic atrophy (2 patients; 11%). Circumferential scleral buckling did not appear to offer advantages for patients undergoing pars plana vitrectomy and lensectomy for severe closed ocular injury involving the posterior chamber.

Ultrasound biomicroscopic evaluation of the traumatized eyes.

To review causes for performing an ultrasound biomicroscopic (UBM) examination in traumatized eyes, to present common UBM findings of 109 eyes with a history of ocular trauma and to compare these findings according to the type of the trauma. A total of 109 eyes with a history of mechanical ocular trauma, which underwent an UBM examination between December 1996 and April 2002, were evaluated retrospectively. All cases were classified according to the criteria of the Ocular Trauma Classification Group and UBM findings were reviewed. For statistical ana- lyses, chi(2) test and Fisher's exact test were used. UBM examinations were performed for the evaluation of the zonules before cataract surgery (49.5%), examination of the anterior segment in the presence of media opacities (32.1%), detection of suspected ocular foreign bodies (10.1%) and the evaluation of ocular hypotony (8.3%). In all, 67 eyes (61.5%) had a closed-globe injury, whereas 42 (38.5%) had an open-globe injury. The most common UBM findings in a closed-globe injury were zonular deficiency (64.2%), angle recession (43.3%), iridodialysis (17.9%), and dislocated lens (16.4%). The most common UBM findings in an open-globe injury were zonular deficiency (54.8%), iridodialysis (26.2%), peripheral anterior synechiae (PAS) (26.2%), and iridocorneal adhesion (19%). Among the common UBM findings, the angle recession was significantly higher (P<0.001) in closed-globe injury group and PAS formation was significantly higher (P<0.05) in open-globe injury group. UBM is particularly superior to other methods in the evaluation of the zonular status, angle recession, cyclodialysis, and the detection of small superficial and intraocular foreign bodies.

Deadly weapon–related open-globe injuries: outcome assessment by the Ocular Trauma Classification System

PURPOSE: To describe mechanisms and injury characteristics influencing visual outcomes in eyes with open-globe injuries caused by deadly weapons and to apply the classification system introduced by the Ocular Trauma Classification Group. METHODS: Two-hundred-twenty-eight eyes of 212 consecutive patients, who were mostly injured in military confrontation, were analyzed. Mechanism and injury characteristics were evaluated for predicting visual outcome according to the recently studied classification system as well as other variables pertinent to this specific clinical setting of severe eye trauma. Final visual acuities were defined as favorable (5/200 or better) or unfavorable (less than 5/200, including enucleation). RESULTS: The mean age of patients was 23 years, and the mean follow-up was 5.7 months. The predictors for favorable visual outcome were type B, grade 1, zone I, and relative afferent pupillary defect-negative injuries. The predictors for unfavorable outcome were type A, grade 5, zone III, and relative afferent pupillary defect-positive injuries. Land mine and hand grenade injuries had the worst outcome among causative agents. Proliferative vitreoretinopathy, comprising 30.4% of postoperative failures, was the most common complication. CONCLUSION: Deadly weapon–related open-globe injuries, especially those associated with land mines and hand grenades, have devastating visual results. Evaluation of trauma mechanism and injury characteristics according to the Ocular Trauma Classification System seems to predict visual outcomes in this series of severe open-globe injuries.

A System for Classifying Mechanical Injuries of the Eye (Globe)

To develop a classification system for mechanical injuries of the eye. The Ocular Trauma Classification Group, a committee of 13 ophthalmologists from seven separate institutions, was organized to discuss the standardization of ocular trauma classification. To develop the classification system, the group reviewed trauma classification systems in ophthalmology and general medicine and, in detail, reports on the characteristics and outcomes of eye trauma, then established a classification system based on standard terminology and features of eye injuries at initial examination that have demonstrated prognostic significance. This system classifies both open-globe and closed-globe injuries according to four separate variables: type of injury, based on the mechanism of injury; grade of injury, defined by visual acuity in the injured eye at initial examination; pupil, defined as the presence or absence of a relative afferent pupillary defect in the injured eye; and zone of injury, based on the anteroposterior extent of the injury. This system is designed to be used by ophthalmologists and nonophthalmologists who care for patients or conduct research on ocular injuries. An ocular injury is classified during the initial examination or at the time of the primary surgical intervention and does not require extraordinary testing. This classification system will categorize ocular injuries at the time of initial examination. It is designed to promote the use of standard terminology and assessment, with applications to clinical management and research stud ies regarding eye injuries.