Search

Purpose: To evaluate the visual outcomes and identify prognostic factors in patients with ocular bird beak injuries treated at a tertiary eye care center in South India., Methods: We conducted a comprehensive analysis of patients with bird beak injuries, considering factors such as age, gender, mode of injury, and size of laceration. The affected eyes underwent detailed examinations using slit-lamp biomicroscopy, and B-scan ultrasonography was performed to assess the status of the posterior segment. Postoperatively, the best-corrected visual acuity (BCVA) was measured at the last follow-up visit., Results: Our findings demonstrated significant improvements in visual outcomes, including BCVA and uncorrected visual acuity (UCVA), over a follow-up period ranging from 1 week to 3 years (p < 0.05). No significant changes were observed in endophthalmitis, intraocular pressure (IOP), lens status, or retinal abnormalities during the study duration., Conclusion: This retrospective study highlight the potential for favorable long-term visual improvement in patients with ocular injuries caused by bird beaks and emphasize the importance of timely intervention. Delayed surgical treatment and the requirement for multiple surgeries within the first week were found to negatively impact visual acuity. Hence, it is crucial to raise public awareness, particularly in rural areas, to prevent these potentially devastating injuries and ensure early intervention for optimal visual recovery., Competing Interests: Declaration of competing interest no conflicting relationship exists for any author., (Copyright © 2024. Published by Elsevier Ltd.)

Purpose: To assess and compare the rate of endophthalmitis and visual outcomes in cases of open globe injuries (OGIs) without intraocular foreign bodies repaired within and greater than 24 hours from the time of injury., Design: A retrospective review of 2002 cases of OGIs presenting to a single institution., Participants: Patients with OGIs were admitted and managed according to a standardized protocol., Methods: The impact of timing of repair was assessed among those undergoing OGI repair within (i) 24 hours, (ii) 25 to 36 hours, and (iii) greater than 36 hours from the time of injury., Main Outcome Measures: Rates of endophthalmitis and postoperative visual acuity of logarithm of the minimum angle of resolution (logMAR) 1.3, logMAR 1.0, and logMAR 0.3 at 180 days and 1 year after open globe repair., Results: A total of 1382 patients with OGIs met our inclusion criteria, of whom 75% were male with an average age of 41 years. Maximal zone of injury was zone I for 420 patients, zone II for 488 patients, and zone III for 474 patients. A total of 84% of all OGIs underwent repair within 24 hours from the time of injury, 9% from 25 to 36 hours, and 7% greater than 36 hours. Average preoperative visual acuity was hand motion. Risk factors associated with repair performed greater than 36 hours from the time of injury included female sex (P = 0.042). Endophthalmitis was associated with time to repair greater than 36 hours (P = 0.049) but not with 25 to 36 hours or zone of injury (P = 0.111). Time to repair had no significant impact on visual acuity outcomes., Conclusions: Although repair of OGIs within 24 hours is the current standard of care, this study found no statistically significant difference in rates of endophthalmitis or visual outcomes in eyes undergoing repair within 24 hours of injury compared with repair extending to 25 to 36 hours. Endophthalmitis rates did increase after 36 hours. We recommend urgent repair of OGIs, but in certain circumstances, it may be reasonable to delay repair beyond 24 hours to optimize operating conditions., Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references., (Copyright © 2024 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Purpose: The objective is to investigate trends in cases of motor vehicle accident-associated (MVA-associated) ocular trauma in which the patient was the driver of the motor vehicle., Methods: The study utilizes data from the 2007-2014 National Trauma Databank (NTDB), a national trauma registry. Status as the driver of the motor vehicle was identified using E-Codes from the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). Trauma diagnoses were identified using D-Codes from the ICD-9-CM. Statistics were performed using IBM SPSS Version 23., Results: We identified 49,660 cases of ocular trauma secondary to an MVA with a 25.3% increase in injuries over the 8-year time period. Men comprised 68.6% (34,057) of cases. Orbital floor fractures (OFFs) were the most commonly observed ocular injury, occurring in 17,647 (35.5%) cases. There were 2,787 cases of open globe injury (OGI) with the highest proportion of cases in the 65 + age group (6.5%). OGIs were seen in 3.0% of cases with OFFs vs. 7.1% in those without. Drivers under 18 were more likely to have optic pathway/cranial nerve injuries (4.4%) and ocular/adnexal contusions (41.2%) than adult drivers. The mortality rate was 4.3% and was highest in the 65 + age group (9.4%)., Conclusion: Men and young adults comprised the majority of cases of MVA-associated ocular trauma. OFFs were seen in approximately one-third of cases of ocular trauma. OGIs were less commonly observed when a concurrent OFF was observed. Though the overall mortality was 4.3%, there was significant variation by age group., Competing Interests: Declarations Conflict of interest The authors declare no competing interests. Ethics approval This study adhered to the tenets of the Declaration of Helsinki and received exemption by the Rutgers University Institutional Review Board due to non-human determination according to the National Bureau of Economic Research., (© 2024. The Author(s).)

Purpose: The aim of this study was to investigate the predictive factors for evisceration or enucleation surgery after open globe injury (OGI) and to investigate the effectiveness of the ocular trauma score (OTS) in predicting the outcome., Method: Data from 380 patients who underwent OGI repair were retrospectively analyzed. The eyes of 31 patients who underwent evisceration or enucleation after OGI repair and who were followed up for at least 6 months were included in the study. Demographic characteristics, presence of rupture, penetrating injury, endophthalmitis, retinal detachment and afferent pupillary defect were evaluated and OTS was calculated. The etiology of OGI, the interval between OGI repair and evisceration, the presence of eyelid and canalicular laceration, orbital fractures, prolapsed choroidal tissue, and the presence of foreign bodies were also analyzed. The size of the sphere after evisceration/enucleation, the need for revision surgery and the time to revision surgery were evaluated., Results: Of the 380 patients, 31 (8.15%) underwent evisceration or enucleation after OGI. 19 of 31 patients underwent evisceration after primary repair of OGI, 10 patients underwent evisceration without OGI repair; 1 patient underwent enucleation after OGI repair and 1 patient underwent enucleation without OGI repair. The mean OTS was 37.95 in the group with evisceration/enucleation after OGI repair and 29.55 in the group without repair. The mean interval between OGI and evisceration was 2.4±5.9 (0-13) months. The etiology of 10 (32.2%) OGIs were traffic accidents, 9 (29%) were penetrating trauma with cutting or penetrating instruments, 8 (25.8%) were blunt trauma, and 4 (12.9%) were gunshot wounds. The mean follow-up time was 38.9±23.59 (6-72) months. There was no significant difference in OTS according to age, gender, affected side and etiology. Although OTS was lower in patients with additional injuries than in those without, the difference not statistically significant. There was a statistically significant decrease in OTS from zone 1 (cornea and limbus) to zone 3 (posterior to 5mm from the limbus) (P=0.015, r=-0.433)., Conclusion: The decision and consent for evisceration/enucleation after an open globe injury is very difficult for both patients and physicians. We believe that the presence of the injury in zone 3 and the presence of rupture are poor prognostic factors and that an OTS below 49 could be a risk factor for evisceration/enucleation. In conclusion, the OTS could be an objective parameter that provides an objective idea of visual rehabilitation and prognosis and helps in decision making for further surgery., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Intraocular foreign bodies (IOFBs) remain a severe complication of ocular trauma commonly encountered worldwide. This literature review aimed to discuss current practice patterns, areas of controversy, and advances in the management of IOFBs. Injuries involving IOFBs carry significant ocular morbidity and management can be extremely challenging. A systematic approach to preoperative evaluation and IOFB surgical management is detailed in this article and should be applied in each case. The location and composition of an IOFB have important implications on surgical approach and timing, especially in cases of toxic metals and vegetable matter. The advantages, disadvantages, and previous literature regarding immediate versus delayed foreign body removal are presented. Surgical approaches are described, with an emphasis on posterior chamber IOFB management and removal via pars plana vitrectomy. Final visual acuity is variable, but approaches have been used to prognosticate outcomes including the Ocular Trauma Score. By synthesizing current IOFB literature, the goal is to provide practitioners with guidance that will maximize the chances of surgical success and patient outcomes., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Ohlhausen, Menke, Begley, Kim, Debiec, Conrady, Yeh and Justin.)

Acinetobacter johnsonii is an uncommon cause of endophthalmitis. This case report describes a 40-year-old male admitted with pain, redness, and vision loss in his right eye after an open globe injury by a steel fragment. Clinical assessment confirmed post-traumatic endophthalmitis with an intraocular foreign body. The patient underwent a vitreous biopsy, lensectomy, vitrectomy, and intravitreal antibiotics, followed by laser photocoagulation and foreign body extraction via the pars plana. Acinetobacter johnsonii was isolated from the vitreous culture. A combination of vancomycin, levofloxacin and ceftazidime was administered, leading to reduced infection and inflammation. Postoperatively at one month, the patients' best-corrected visual acuity had improved to 20/63. The anterior segment exhibited no inflammation, the vitreous cavity was clear, and the retina with hemorrhage and laser treatment remained stable. The one-year follow-up confirmed the continued stability of the ocular condition. Acinetobacter johnsonii , a rare cause of endophthalmitis often linked to trauma or surgery, should be recognized as a possible pathogen in post-traumatic endophthalmitis cases, meriting clinical consideration., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Hu, Huang, Li, Fang, Li and Feng.)

Purpose: We explored the associations between socioeconomic status, as evaluated by the Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry Social Vulnerability Index (SVI), and characteristics of open globe injury (OGI) in a Level I trauma center during the COVID-19 pandemic., Methods: Retrospective review of electronic medical records of patients who underwent OGI evaluation and repair at Harborview Medical Center between March/2017 and March/2021. Demographic data and patient characteristics were recorded. The SVI was obtained based on the patient's home address. Patients were grouped into the "historical" (pre-COVID) cohort, including dates from March 2017 - March 2020, and the "COVID" cohort, including dates from March 2020 - March 2021., Results: 318 patients (77.4% male) were included. Average ± S.D. age (years) and SVI scores were 44.7 ± 22.7 and 0.413 ± 0.195, respectively. SVI scores were significantly higher (more vulnerable) during the COVID-19 pandemic compared to years prior (p = 0.017), however when compared to scores for the same patients prior to the pandemic, no difference was found (p = 0.609). There was no significant difference between intentional and non-intentional trauma, work-related injuries, OGI type, presence of endophthalmitis, or ocular trauma score (p ≥ 0.293). Still, significantly fewer motor vehicle-associated (MVA) OGIs occurred during the pandemic (p = 0.041)., Conclusions: Patients with OGI during the COVID-19 pandemic had higher SVI scores, however when considering the overall effect of the pandemic, our findings are likely reflective of the societal changes at large. There was no identifiable impact on the mechanisms or characteristics of ocular injuries, except for fewer MVA injuries., (© 2024. The Author(s), under exclusive licence to Springer Nature B.V.)

Purpose: To explore patient and surgeon characteristics for open globe injury repairs (OGRs) and rates of subsequent operations., Methods: Using a retrospective cohort design, eyes of patients ≥18 years who underwent OGR among 100% Medicare Fee-For-Service dataset from 2011 to 2020 were included. Current Procedural Terminology (CPT®) codes were used to identify OGR. Patient characteristics were reported, and surgeon characteristics were stratified by sex and compared using Chi-square and Student's t-test. Overall rate of subsequent operations was reported, and trends of subsequent operations over time were assessed using Cochrane-Armitage trend test., Results: A total of 16,576 patients with a mean age of 73.89 years (±12.89) underwent OGR. Most patients were White (79.68%, n  = 13,207) and 49.44% ( n  = 8196) were female. More patients resided in a rural area (18.71%; n  = 3102) relative to surgeon location (4.51%, n  = 748; p  < 0.001). A total of 5,898 surgeons performed these OGRs with 77.33% ( n  = 4,561) male and 22.67% ( n  = 1,337) female surgeons. Male surgeons performed most of the OGRs (76.35%, n  = 12,655; p  < 0.001). On average, a surgeon performed a single OGR annually (Mean: 1.08 ± 1.04; Range: 0.11-40). Among all OGRs, 51% (8,452/16,576) had ≥1 subsequent operations in median 29 days (IQR: 10-86), which increased during the last decade from 47% to 51% ( p  = 0.008)., Conclusion: Geographic and workforce disparities in ocular trauma warrant future investigation. Further studies can also assess the reasons for increase in the incidence of subsequent procedures after OGR over time.

The purpose of this study was to examine how demographics, etiology, and clinical examination findings are related to visual outcomes in subjects with open globe injury (OGI) across a large and generalizable sample. A retrospective cohort analysis was performed using data collected from the electronic medical records of four tertiary university centers for subjects with OGI presenting from 2018 to 2021. Demographic information, injury mechanisms, clinical exam findings, visual acuity (VA) at presentation and most recent follow-up were recorded. In subjects with bilateral OGIs, only right eyes were included. A modified ocular trauma score (OTS) using presenting VA, the presence of perforating injury, OGI, and afferent pupillary defect was calculated. The risk of subjects' demographic characteristics, ocular trauma etiology, clinical findings and modified OTS on the presence of monocular blindness at follow-up were assessed using univariable and multivariable regression models. 1426 eyes were identified. The mean age was 48.3 years (SD: ± 22.4 years) and the majority of subjects were men (N = 1069, 75.0%). Univariable analysis demonstrated that subjects of Black race were 66% (OR: 1.66 [1.25-2.20]; P < 0.001) more likely to have monocular blindness relative to White race at follow-up. OTS Class 1 was the strongest predictor of blindness (OR: 38.35 [21.33-68.93]; P < 0.001). Based on multivariable analysis, lower OTS category (OTS Class 1 OR: 23.88 [16.44-45.85]; P < 0.001) moderately predicted visual outcomes (R 2  = 0.275, P < 0.001). OGI has many risks of poor visual outcome across patient groups that vary by demographic category, mechanism of injury, and clinical presentation. Our findings validate that a modified OTS remains a strong predictor of visual prognosis following OGI in a large and generalizable sample., (© 2024. The Author(s).)

We describe a case of globe rupture due to a forklift accident. A 64-year-old man presented to the ophthalmology hospital shortly after the jaws of a forklift struck his left eye. The left eye was shrunken with a full-thickness scleral laceration. B-scan ultrasonography revealed a hypotonic eyeball with antero-posterior shrinkage. We promptly performed scleral suturing to maintain the ocular shape. The patient's intraocular pressure improved to 7.1 mmHg, and visual acuity was limited to light perception. Despite this, intraocular hemorrhage in the anterior chamber persisted, and an electroretinogram demonstrated poor response to light. Subsequently, the patient underwent a vitrectomy with silicone oil tamponade to address the vitreous hemorrhage, proliferative membranes, and retinal detachment. However, proliferative vitreoretinopathy with tractional retinal detachment progressed postoperatively, resulting in the loss of light perception. Ocular trauma caused by forklifts accident is rare; however, the strong external forces they exert can cause severe and irreversible visual impairment. Therefore, it is necessary for forklift operators and other concerned individuals to exercise caution to prevent forklift-related ocular trauma. Moreover, ophthalmologists should be aware of the dangers of forklift-related ocular trauma and treatment and management of the same., Competing Interests: The authors report there are no competing interests to declare., (© 2024 The Authors.)

Purpose: To identify clinical characteristics of injured eyes associated with visual recovery in patients with open globe injuries (OGIs) and presenting with no light perception (NLP) vision., Design: Retrospective chart review., Subjects: All patients presenting to Massachusetts Eye and Ear with OGI and NLP vision from January 1999 to March 2022., Methods: Manual data extraction to collect patient demographic characteristics, preoperative, intraoperative, and postoperative characteristics of OGI injury, laceration versus rupture, history of intraocular surgery, time from injury to repair, timing of vitrectomy, lensectomy, choroidal drainage, and silicone oil placement, visual acuity (VA) at last follow-up, and subsequent B-scan ultrasound findings of retinal detachment, choroidal hemorrhage, vitreous hemorrhage, and disorganized intraocular contents. Patients with >1 week of follow-up and a documented VA at most recent follow-up were included. Exclusion criteria included age <10 years. Multivariable regression was performed., Main Outcome Measures: Visual acuity recovery defined as light perception or better in patients with OGI and initial NLP vision., Results: One hundred forty-seven eyes with NLP vision after OGI were included. Twenty-five (17%) eyes regained vision at last follow-up. The majority of patients recovered light perception vision (n = 15, 60%) followed by 20/500 or better (n = 5, 20%), hand motions (n = 3, 12%), and counting fingers (n = 2, 8%). Most injuries were zone III (n = 102, 69%) and presented with rupture (n = 127, 86%). The mean time from OGI to surgical repair was 0.85 ± 1.7 days. B-scan was obtained in 104 (71%) cases. Pars plana vitrectomy was performed in 9 eyes (6%) with NLP at time of vitrectomy. Disorganized intraocular contents on B-scan (odd ratio, 0.170; 95% confidence interval, 0.042-0.681; P = 0.012) was the only clinical variable significantly associated with visual recovery, corresponding to a lack of visual improvement., Conclusions: Recovery of vision in OGI with NLP vision at presentation cannot be predicted based on presenting clinical features. B-scan findings of disorganized intraocular contents after initial OGI repair was the only factor negatively associated with vision recovery in this patient population. Therefore, all eyes presenting with an OGI and NLP vision should undergo primary repair in hopes of subsequent visual recovery., Financial Disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article., (Copyright © 2024 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Background: Open globe injuries (OGIs) are a leading cause of monocular blindness worldwide and require prompt intervention to prevent proliferative vitreoretinopathy (PVR) and endophthalmitis when serious intraocular damage occurs. The management of OGIs involves initial wound closure within 24 hours, followed by vitrectomy as a secondary surgery. However, there is a lack of consensus regarding the optimal timing of vitrectomy for maximizing visual outcomes. This meta-analysis aimed to investigate whether early or delayed vitrectomy leads to better outcomes in patients with OGIs., Methods: This review was conducted based on PRISMA guidelines. The Medline, Embase, Scopus, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov databases were searched (October 23, 2023). Clinical studies that used vitrectomy to manage OGIs as early (within 7 days) or delayed (8-14 days) interventions were included. Randomized controlled trials (RCTs) and non-RCTs were appraised using the Cochrane risk of bias and JBI tools, respectively., Results: Eleven studies met the inclusion criteria and were included in the quantitative analyses. There were 235 patients with OGIs who received early intervention and 211 patients who received delayed intervention. The retina was reattached in 91% and 76% of the patients after early and delayed intervention, respectively. Traumatic PVR was present in 9% and 41% of the patients in the early and delayed groups, respectively. The odds of retinal reattachment after vitrectomy were greater in the early group (OR = 3.42, p = 0.010, 95% CI=1.34-8.72), and the odds of visual acuity ≥ 5/200 were 2.4 times greater in the early group. The incidence of PVR was significantly greater in the delayed surgery group (OR = 0.16, p < 0.0001; 95% CI=0.06-0.39), which also required more than one vitrectomy surgery., Conclusion: Early vitrectomy results in better postoperative visual acuity, a greater proportion of retinal reattachment, and a decreased incidence of PVR., Competing Interests: The authors declare no conflicts of interest in this work., (© 2024 Quiroz-Reyes et al.)

Background/aim: To assess the refractive outcomes of secondary intraocular lenses (IOL) in patients with traumatic aphakic eyes with corneal penetrating injury and compare different corneal curvature measurement methods., Methods: Patients with unilateral penetrating eye injuries underwent corneal wound repair and cataract extraction, followed by secondary IOL implantation. Corneal curvature measurements were taken on the contralateral healthy eye (Group A), from the affected eye before removing corneal sutures (Group B), or after suture removal (Group C). The refractive outcomes were compared among the three groups., Results: The study included 261 eyes. The Mean Absolute Error (MAE) in Group C (0.99 ± 0.85 D) was significantly smaller than that in Group A (1.87 ± 1.71 D) and Group B (1.37 ± 1.20 D) (both P < 0.001). Moreover, the percentage of eyes with IOL prediction errors within ± 0.50 D in Group C (40%) was higher than that in group A (21.7%) (OR = 2.364, 95%CI: 1.272-4.392, P = 0.006) and group B (28.0%) (OR = 1.714, 95%CI: 0.948-3.099, P = 0.073), and the percentage of eyes with IOL prediction errors within ± 1.0 D in Group C (90.9%) was higher than that in group A (67.9%) (OR = 4.758, 95%CI: 2.131-10.626, P < 0.001) and group B (75.0%) (OR = 3.370, 95%CI: 1.483-7.660, P = 0.003) as well., Conclusions: In traumatic aphakic eyes with corneal sutures, IOL power calculation based on the corneal curvature of the injured eye after removing the corneal sutures yields the best refractive outcomes., (© 2024. The Author(s), under exclusive licence to Springer Nature B.V.)

Introduction: Open 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 Methods: We 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., Results: The 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., Conclusion: As 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., (© 2024. The Author(s).)

Purpose: The study aims to assess if Zone 1 globe injuries hold a favorable prognosis for all situations, including wound dehiscence, or just primary traumatic injuries., Methods: Retrospective cross-sectional chart review of patients who underwent open globe repair from 1/1/2019 to 12/1/2020 at an urban hospital setting was evaluated for final visual outcomes, associated ocular pathology, long-term complications, and need for further surgeries., Results: Fifty-eight eyes were identified-38 primary trauma and 20 dehisced wounds (11 penetrating keratoplasties, five clear corneal incisions, one laceration, one extracapsular cataract extraction, one radial keratotomy, and one tectonic graft). Dehisced wounds had more posterior segment pathology vs primary trauma, i.e., hemorrhagic choroidal, vitreous hemorrhage, retinal detachment, choroidal effusion (all 20% vs 2.63%, 5.26%, 5.26%, and 0%, respectively), vitreous prolapse (20% vs 2.63%), and uveal prolapse (80% vs 36.84%). Dehisced wounds had more traumatic aphakia (40% vs 0%) and dislocated lenses (15% vs 0%). Primary trauma was more likely to have traumatic cataracts (55.26% vs 10%) or no lens changes (44.74% vs 25%). About 10% dehisced wounds required enucleation (0% primary trauma). Cataract/secondary intraocular lens surgery was performed in 34% of the primary traumas (10% in dehisced wounds). Primary traumas achieved 20/40 vision or better in 44.74% (10% dehisced wounds). About 7.89% of patients with wound dehiscence ended with no light perception (none in primary trauma)., Conclusion: Zone 1 open globe injuries due to wound dehiscence may exhibit worse prognosis compared to primary trauma open globe injury. More important than the zone of injury may be the source., (© 2024. The Author(s), under exclusive licence to Springer Nature B.V.)

The standard of care for open globe injuries is prompt surgical closure, as delay in repair is a reported risk factor for post-traumatic endophthalmitis and is associated with worse visual outcomes. This article serves as a review of the current management and outcomes of open globe injuries repaired greater than 24 hours from the time of injury, specifically evaluating the rates of endophthalmitis in cases with and without intraocular foreign bodies, visual outcomes and rates of primary enucleation or evisceration.

Purpose To report six ocular injury cases caused by unlicensed fireworks and subsequent complications at a level 1 trauma center in the setting of coronavirus disease 2019 (COVID-19)-related shelter-in-place orders. Observations All six cases occurred between March 2020 and July 2020 and involved fireworks of non-official use. A majority of subjects were male between the ages of 17 and 53 years old. Ocular trauma presented as the following: Case 1 is a 17-year-old male who sustained a left-sided corneal abrasion and small intraocular foreign body after a firework exploded in his hand. Case 2 is a 47-year-old male who presented with a right globe rupture after being struck with a projectile from a neighborhood fireworks display. Case 3 is a 36-year-old male with corneal abrasion, traumatic iritis, and commotio retinae after a firework injury in the setting of alcohol use. Case 4 is a 35-year-old male who presented with left lid injury, corneal abrasion, and hyphema after being struck by a firework with evidence of penetrating eye trauma on subsequent exams. Case 5 is a 53-year-old male who developed bilateral subconjunctival hemorrhages and a partial-thickness corneal laceration after a firework exploded in his left hand. Case 6 is a 48-year-old woman who sustained bilateral corneal stromal foreign bodies while cooking after a firework exploded near her vicinity. Conclusions and importance Fireworks are a preventable cause of mortality and long-term ocular morbidity. The index of suspicion for open globe injuries related to fireworks should be high given the mechanism of injury. These presenting cases at a level 1 trauma center and safety net hospital may be an unforeseen by-product of COVID-19 lockdowns. Our findings are relevant to trauma centers and safety net hospitals with large cases of firework injuries. Further initiatives to improve awareness of the dangers of fireworks should be prioritized to limit harms for all community members., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Jiro et al.)

Topic: This study reports the effect of systemic prophylactic antibiotics (and their route) on the risk of endophthalmitis after open globe injury (OGI)., Clinical Relevance: Endophthalmitis is a major complication of OGI; it can lead to rapid sight loss in the affected eye. The administration of systemic antibiotic prophylaxis is common practice in some health care systems, although there is no consensus on their use., Methods: PubMed, CENTRAL, Web of Science, CINAHL, and Embase were searched. This was completed July 6, 2021 and updated December 10, 2022. We included randomized and nonrandomized prospective studies which reported the rate of post-OGI endophthalmitis when systemic preoperative antibiotic prophylaxis (via the oral or IV route) was given. The Cochrane Risk of Bias tool and ROBINS-I tool were used for assessing the risk of bias. Where meta-analysis was performed, results were reported as an odds ratio. PROSPERO registration: CRD42021271271., Results: Three studies were included. One prospective observational study compared outcomes of patients who had received systemic or no systemic preoperative antibiotics. The endophthalmitis rates reported were 3.75% and 4.91% in the systemic and no systemic preoperative antibiotics groups, a nonsignificant difference (P = 0.68). Two randomized controlled trials were included (1555 patients). The rates of endophthalmitis were 17 events in 751 patients (2.26%) and 17 events in 804 patients (2.11%) in the oral antibiotics and IV (± oral) antibiotics groups, respectively. Meta-analysis demonstrated no significant differences between groups (odds ratio, 1.07; 95% confidence interval, 0.54-2.12)., Conclusions: The incidences of endophthalmitis after OGI were low with and without systemic antibiotic prophylaxis, although high-risk cases were excluded in the included studies. When antibiotic prophylaxis is considered, there is moderate evidence that oral antibiotic administration is noninferior to IV., Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article., (Copyright © 2023 American Academy of Ophthalmology. All rights reserved.)

Purpose: To independently validate the retinal detachment (RD) after open globe injury (OGI) score (RD-OGI Score) as a clinical prediction model for estimating the risk of RD after OGI, and to characterize outcomes of RD stratified by RD-OGI risk category., Design: Retrospective, multi-institutional cohort study., Subjects: A validation cohort of 236 eyes with OGI managed at two U.S. academic institutions from 2017-2021 was compared to the predictions of the RD-OGI Score model and to the derivation cohort of 893 eyes with OGI used to develop the RD-OGI Score model., Methods: RD-OGI Scores were calculated and patients were stratified into three risk groups (low, moderate, and high) for analysis. The incidence of RD in the validation cohort was used to calculate standard performance metrics to evaluate predictive accuracy of the RD-OGI Score., Main Outcome Measures: Area under the curve (AUC), sensitivity, specificity, and accuracy of the RD-OGI Score; anatomic success (retina attached or detached) and best corrected visual acuity (BCVA) at last follow-up., Results: In the validation cohort, 92 of 236 eyes (39%) developed RD after OGI. The RD incidence predicted by the RD-OGI Score was strongly correlated with actual RD incidence in the validation cohort (Spearman ρ= 0.92, P<0.001). The RD-OGI Score demonstrated a high discriminativeness with the validation cohort (AUC= 0.84, 95% CI: 0.79-0.89). An RD-OGI Score of 2.5 was found to have 73% accuracy, 93% sensitivity, and 60% specificity for predicting no RD (RD-OGI <2.5) versus RD (RD-OGI ≥2.5). Median BCVA at last follow-up for successfully reattached eyes was comparable for high risk (∼20/380) and moderate risk (∼20/300) eyes (P>0.99), but both were significantly worse compared to low risk eyes (∼20/25 Snellen) (P=0.010)., Conclusions: The RD-OGI Score reliably predicts the risk of developing RD after OGI. In eyes that develop RD, a higher RD-OGI Score is strongly correlated with a greater risk for poor functional and anatomic outcomes. An RD-OGI Score ≥2.5 identifies eyes at substantial risk for RD and adverse outcomes and may serve as a useful cutoff for guiding referral to a vitreoretinal surgeon after primary globe closure., (Copyright © 2023. Published by Elsevier Inc.)

Purpose: To evaluate the occurrence and outcome of open globe injury during state-mandated COVID-19 stay-at-home orders compared to historical averages at a tertiary medical center in Portland, Oregon., Methods: Open globe injury between January 1, 2015 and December 31, 2020 was identified using relevant procedure codes. The number of injuries, mechanism of trauma, and short-term outcomes of globes repaired during the study period of March 23, 2020 to July 6, 2020 when stay-at-home orders were in effect were compared to a cohort from the same 15-week time frame in 2015-2019. We also evaluated injuries occurring throughout 2020 as compared to the prior 5 years., Results: 263 consecutive open globe injuries were identified between January 2015 and December 2020. While Oregon's stay-at-home orders were in effect, we observed a significant increase in the number of open globe injuries treated compared to the prior 5 years (p = .004). Twenty-four cases identified during the study period represent a 2-fold increase over the 2015-2019 average of 11.8 globe repairs during the same 15-week time period. Visual acuity < 20/200 at 6 months (p = .008) and secondary enucleation (p < .001) were more frequent during stay-at-home orders, and severity of injury as calculated by the Ocular Trauma Scores (OTS) was higher. Time-to-repair was similar between the two cohorts., Conclusion: At our center, there was an increased number and severity of open globe injury during the period of mandatory COVID-19 stay-at-home orders. Visual acuity outcomes and risk for secondary enucleation were poorer compared to the reference cohort. Abbreviations: Ocular Trauma Score (OTS), Open globe injury (OGI), Emergency department (ED), Oregon Health and Science University (OHSU).

Purpose: To determine the factors affecting the visual outcome after surgical repair of limbal corneal lacerations at a tertiary eye care center in South India., Methods: A retrospective analysis of patients diagnosed with limbal tears between 2011 and 2021 was conducted. Demographic information such as age, gender, cause of injury, and size of the laceration was recorded. Comprehensive ocular examination was performed, including gentle B scan evaluation whenever not contraindicated for detailed posterior segment evaluation. Only those cases with a minimum follow-up of one year were included. Postoperative best-corrected visual acuity, intraocular pressure (IOP), cornea clarity, and integrity of the wound at last follow-up were noted., Results: Out of the 20 patients, 15 (75%) were males and 5 (25%) were females. The mean age was 42.6 ± 22.4 years. All 20 patients had a penetrating injury, with four (20%) injured by a stick, two (10%) by an iron rod, three (15%) due to road traffic accident (RTA), three (15%) by glass, and eight (40%) with other nonspecific objects [two (10%) with needle, two (10%) with elastic rope, two (10%) with bangle, and two (10%) with metal]. The average time between the injury and the surgery was 48 hours (2 days). Four (20%) patients underwent a second surgery within a week of repair. After limbal tear repair, at final follow-up at 3 years, 7 (35%) had VA worse than 20/800, 3 (15%) had VA between 20/100 and 20/800, and 10 (50%) achieved VA better than 20/80., Conclusion: Preoperative visual acuity (VA), mode of injury, and size of wound affect the final visual outcome after surgical repair of limbal corneal laceration. Preoperative VA and mode of injury were statistically significant even in the multivariate analysis., Competing Interests: None

Purpose: This study aims to investigate trends and risk factors associated with work-related ocular injuries occurring in adults aged 19-64 using the National Trauma Databank (NTDB)., Methods: In this retrospective, cross-sectional study, the NTDB was used to collect all patients with an ICD-9 code of work-related ocular trauma from 2007 to 2014. Demographic data and risk factors collected included age, gender, race, setting, machinery, and mechanism. Descriptive statistics, univariate, and logistic regression multivariate analyses were conducted., Results: Between 2007 and 2014, 234,983 cases of work-related trauma were identified, of which 11,097 (5.7%) cases involved ocular trauma. The mean age of patients was 40.7 years (SD = 12.2), and the majority of patients (93.7%) were male. Most injuries occurred in an industrial facility, and the most common injuries were orbital floor fractures (OFFs), ocular contusions, open wounds to the adnexa, and open globe injuries (OGIs). OFFs most commonly involved a concurrent fracture of another facial or skull bone. Male gender (RR = 1.22; CI 1.09-1.38), accidental falls (RR = 1.50; CI 1.41-1.60), trauma from falling objects (RR = 1.34; CI 1.21-1.48), involvement in an unarmed fight (RR = 1.63; CI 1.39-1.91), assault by a blunt object (RR = 1.59; CI 1.31-1.91), and injury caused by animals (RR = 1.63; CI 1.30-2.02) were risk factors for OFFs. Patients with OFFs were less likely to have a concurrent OGI (RR = 0.27; CI 0.23-0.32). On the other hand, injuries occurring in industrial facilities (RR = 1.29; CI 1.11-1.51) and injuries with a loose foreign body striking the eye or adnexa (RR = 1.54; CI 1.28-1.84) were risk factors for OGI. The most common causes of work-related ocular trauma were accidental falls, motor vehicle accidents, and accidentally being struck in the eye. The mean length of hospital stay was 6.56 days (SD = 10.82); 36.7% of patients required ICU admission, and the overall in-hospital mortality rate was 2.8%., Conclusion: The majority of work-related ocular trauma occurred in men, most commonly in industrial locations. Accidental falls were the most common identified cause of trauma. OFF was the most common ocular injury; 80% of OFF cases involved additional facial and skull fractures. Patients with OFFs were less likely to have a concurrent OGI compared with patients without OFFs., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: The urgency with which to repair open globe injuries is a debated topic that lacks grounding in longitudinal visual outcomes data. We aim to test the association between primary repair timing and visual recovery potential following OGI., Subjects/methods: We performed a retrospective cohort study of medical records from a US academic medical center (7/2017 to 11/2021). We included all patients with a principal diagnosis of OGI, a documented date and time of injury, presentation, repair, and ≥ 3 months of complete follow-up data on visual outcomes. We excluded those with prior OGI in the same eye. We also tested the correlation of injury to repair time (ITR) in hours with best corrected visual acuity (BCVA, in logMAR units) at last follow-up in the general cohort and select subpopulations and the impact of repair delay on visual improvement over the follow-up period., Results: One hundred twenty-nine patients with OGI were analyzed (91 patients with ≥ 3 months of follow-up). The majority were male (105/129, 81%) with a median age of 45 years. Most OGI involved zone 1 (57%), followed by zone 3 (24%), and zone 2 injuries (19%). Median ocular trauma score (OTS) was 60 (IQR 37-70); mean presenting BCVA was logMAR 1.9 (median 2.3, IQR 1.0-2.7). Median ITR was 22 h (IQR 15-30 h, range 5-199 h). ITR time did not significantly correlate with final BCVA (n = 91, β = - 0.003, 95% CI - 0.009-0.002, P = 0.233), nor did it significantly increase the odds of developing ocular complications or requiring secondary ocular surgeries (OR 0.985, 95% CI 0.967-1.002, P = 0.085). Additionally, the rate of BCVA improvement over subsequent months of follow-up did not significantly differ based on ITR time. Presenting BCVA (R 2  = 0.701, P < 0.001) and OTS (R 2  = 0.477, P < 0.001) significantly correlated with final BCVA, independent of repair delays., Conclusions: In this cohort of OGI patients, repair timing does not significantly correlate with final BCVA, and delays beyond 24 h do not significantly correlate with worse visual recovery potential. Repair time alone should be emphasized to a lesser extent as a prognosticator of visual potential, in favor of significant predictors such as the ocular trauma score and presenting visual acuity., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Introduction: This retrospective cohort study presents the epidemiology of severe firearm-related ophthalmic injury and the level of ophthalmology involvement in the multidisciplinary management of head-and-neck gunshot injuries., Methods: A retrospective study identified 207 patients with firearm-related injuries involving the head and neck treated at an Academic Tertiary Care Institution from 2010 to 2020., Results: Ophthalmology consulted on 29% of patients with head-and-neck firearm injuries. At least one of the services managing facial trauma (plastic surgery and otolaryngology) consulted on 71.5% of cases ( P < 0.001). Of patients evaluated by ophthalmology, 93.3% survived to discharge; 78.2% of patients who were not evaluated survived to discharge ( P = 0.009). Ophthalmology consulted on all patients with open globe injury (10.6%) ( P < 0.001), all of which were evaluated by the facial trauma service ( P = 0.002), 77.3% by otolaryngology ( P = 0.42), 50% by neurosurgery, 36.4% by plastic surgery, 13.6% by orthopedic surgery, and 4.5% by vascular surgery. Ophthalmology consulted on 76.5% of patients with orbital fracture (32.9%) ( P < 0.001); 83.8% were evaluated by the facial trauma service ( P = 0.006), 69.1% by otolaryngology ( P = 0.014), 54.4% by neurosurgery, 27.9% by plastic surgery, 10.3% by orthopedic surgery, and 2.9% by vascular surgery. For patients with orbital fractures, 92.3% survived when ophthalmology was consulted ( P = 0.698); 43.8% survived when not consulted ( P = 0.001)., Conclusions: Firearm-related injuries of the head and neck frequently involve ocular and orbital structures, often causing serious vision-threatening injuries. Multispecialty management is common and early ophthalmology specialist evaluation and co-management are indicated to best identify ophthalmic injuries., Competing Interests: There are no conflicts of interest., (Copyright: © 2023 Journal of Emergencies, Trauma, and Shock.)

Purpose: Open globe injuries (OGIs) are categorized by zone, with zone 3 (Z3) comprising wounds > 5 mm beyond the limbus. Outcomes of Z3 OGIs are highly heterogeneous. Open globe injuries with far posterior Z3 (pZ3) wounds were hypothesized to have worse visual and anatomic outcomes., Design: Single-center retrospective cohort study., Participants: A total of 258 eyes with Z3 OGIs., Methods: A retrospective review of Z3 OGIs treated at a tertiary center over 12 years. Wounds ≥ 10 mm posterior to the limbus were defined as pZ3. Outcomes were compared between pZ3 and anterior Z3 (aZ3) eyes., Main Outcome Measures: Visual acuity on a logarithm of the minimum angle of resolution (logMAR) scale. Secondary outcomes included anatomic outcomes, development of retinal detachment and proliferative vitreoretinopathy, and the number of secondary surgeries., Results: A total of 258 Z3 OGI eyes with > 30 days follow-up were assessed; 161 (62%) were pZ3. At 3-month follow-up, pZ3 OGIs were more likely to exhibit no light perception (pZ3: 38%; aZ3: 17%; P < 0.003), lack count fingers vision (pZ3: 72%; aZ3: 43%; P < 0.002), and fail to read a letter on the eye chart (pZ3: 83%; aZ3: 64%; P < 0.001). The visual acuity distribution at 3 months was significantly worse for pZ3 compared with aZ3 injuries (P < 0.004). Similar results were found at final follow-up. Multiple linear regression showed that pZ3 location was independently associated with worse visual acuity (β = 0.29, 95% confidence interval [CI], 0.09-0.50, P < 0.006) in addition to presenting acuity, age, vitreous hemorrhage, uveal prolapse, and afferent pupillary defect. Far posterior wounds injuries were more likely to develop retinal detachments (pZ3: 87%; aZ3: 71%; P < 0.01) and proliferative vitreoretinopathy (pZ3 66%; aZ3 47%; P < 0.03). Patients with pZ3 OGIs were significantly more likely to reach poor anatomic outcome (phthisis, enucleation, need for keratoprosthesis) compared with patients with aZ3 OGI (pZ3: 56%; aZ3: 40%; P < 0.03)., Conclusions: Posterior OGI extension independently portends worse visual and anatomic outcomes. The effect on visual outcome was durable and clinically relevant compared with established predictors of OGI outcomes. Application of these findings improves the prognostic precision and will guide future research efforts to optimize surgical decision-making in severe OGI cases., Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references., (Copyright © 2022 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Purpose: To evaluate the epidemiological features of open globe injury (OGI) in a tertiary ophthalmic center in the south of Iran., Methods: The medical files of pediatric patients diagnosed with OGI between March 2014 and March 2019 were reviewed retrospectively. Demographic data, laterality, time of injury, cause of trauma, location and mechanisms, complications, and the involved tissues, visual acuity, type of operation, and antibiotic therapy were all analyzed. Data were processed using the SPSS., Results: In total, 110 eyes of 108 patients were included. Ages < 7 years comprised 49.1%, 7-12 years 26.4%, and 13-18 years 24.5% of cases. Of the 108 patients, 76 (70.3%) were males. No significant difference between right versus left eyes was seen. The incidence of OGI was lowest in winter and highest in spring, and it had more prevalence on the weekends. Sharp objects were the most common cause of OGI in ages < 7 years, while blunt objects, accidents and falls, and guns and fireworks were more prevalent in older children. Home was the most common place of injury overall. The most common type of injury was penetrating trauma. Upon arrival, most of the children had a visual acuity < 0.1 decimal. Primary wound closure was the most prevalent type of surgery done predominantly within 24 hr from admission time., Conclusion: Ages < 7 years and male gender were the most common age and sex of pediatric OGI, respectively, and sharp objects were the predominant etiology. Early management and primary repair are essential for prevention of complications such as endophthalmitis and amblyopia., Competing Interests: The authors declare that they have no conflict of interest., (Copyright © 2023 Azimi et al.)

Purpose Children represent approximately one-third of patients with serious ocular injuries. Our study evaluates associations between race and socioeconomic status in presentation and outcomes of pediatric and adolescent traumatic open globe injuries. Methods We conducted a retrospective chart review of traumatic open globe injuries in pediatric and adolescent patients presenting to Johns Hopkins Hospital and University of Maryland Medical Center between 2006 and 2020. Variables assessed included age, gender, parent-identified race, median household income, mechanism of injury, initial and final visual acuity (VA), and length of follow-up. Results Eighty patients ranging from 4 months to 17.7 years (mean 9.3 years) presented with traumatic open globe injury. Identifications were 28 White (35%), 38 Black (48%), and 5 Hispanic (6%). Initial presenting and final VA, pediatric ocular trauma score (POTS), and length of follow-up did not differ significantly among race, gender, or income. Black patients had higher rates of blunt trauma (odds ratio (OR) 3.81; 95% confidence interval (CI) 0.95-15.24, p = 0.07), uveal prolapse (OR 3.58; 95% CI 1.03-12.43; p = 0.049), and enucleation (OR 10.55; 95% CI 1.26-88.31). Hispanic patients presented at a younger age of 2.8 years mean age vs. 9.9 years (p = 0.004) for others. Conclusion Visual outcomes following traumatic open globe injury were independent of race, gender, or income. However, blunt trauma, uveal prolapse, and enucleation rates were higher in Black patients, and ocular trauma occurred at a younger age in Hispanic patients., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests or personal relationships relating to this work: Research to Prevent Blindness/American Academy of Ophthalmology (FW), Patrick and Catherine Weldon Donaghue Medical Research Foundation (FW), National Institutes of Health (KL2TR003099 (JLA), R43EYE030798 (JLA)), (Copyright © 2022. Published by Elsevier Ltd.)

Introduction: Open globe injury (OGI) is a rare but serious condition that carries with it a high rate of morbidity., Objective: This review highlights the pearls and pitfalls of OGI, including presentation, diagnosis, and management in the emergency department (ED) based on current evidence., Discussion: OGI refers to full-thickness injury to the layers of the eye. OGI can be caused by blunt or sharp trauma, and subtypes include penetration, perforation, intraocular foreign body (IOFB), globe rupture, or mixed types. OGI is more common in males and usually secondary to work-related injury, but in women it is most commonly associated with falls. Emergency clinicians should first assess for and manage other critical, life-threatening injuries. Following this assessment, a thorough eye examination is necessary. Computed tomography (CT) may suggest the disease, but it cannot definitively exclude the diagnosis. While point-of-care ultrasound (POCUS) is highly sensitive and specific for some findings in OGI, its use is controversial due to potential globe content extrusion. Management includes protecting the affected eye from further injury, preventing Valsalva maneuvers that could extrude ocular contents, updating tetanus vaccination status, administering broad-spectrum antibiotics, and ophthalmology consultation for surgical intervention to prevent the sequelae of blindness and endophthalmitis., Conclusion: An understanding of OGI can assist emergency clinicians in diagnosing and managing this sight-threatening traumatic process., Competing Interests: Declaration of Competing Interest None., (Published by Elsevier Inc.)

Purpose: To determine characteristics and factors associated with no vision survival (included no light perception, enucleation, and evisceration) following open globe injury (OGI) and to correlate the proportion of final vision to predictive values of ocular trauma score (OTS)., Patients and Methods: The medical records of consecutive patients diagnosed as OGI between January 2015 and December 2020 were retrospectively reviewed. Data collected included demographics, mechanisms and modes of injuries, ophthalmic presentations, managements, and visual outcomes at the final visit., Results: Three hundred and seventy-one patients with a mean (standard deviation, SD) age of 44.0 (17.4) years were included. Male with workplace injury was the most frequent scenario. High-velocity metallic objects were the predominant causative materials. Following treatments, fifty-six eyes (14.9%) obtained no vision survival. Factors associated with no vision survival following OGI were low presenting vision, globe perforation, larger wound, presence of relative afferent pupillary defect, retinal detachment, and vitreous hemorrhage. Compared to OTS predictive values, eyes in OTS categories 1 and 2 had a lower proportion of no vision survival., Conclusion: This study identified the importance of workplace injuries. Overall, there were comparable final visions between OTS and this study. However, a reduced proportion of no vision survival among severely injured eyes signifies the challenges of OGI management., Competing Interests: Dr Onnisa Nanegrungsunk is speaker for Allergan and Roche; reports support for meeting registration and traveling from Bayer and Novartis; advisory board and speaker for Santen, outside the submitted work. The authors report no other conflicts of interest in this work., (© 2023 Porapaktham et al.)

Introduction: The aim of the study was to report the clinical presentations, management, and factors affecting the outcomes of posterior segment open globe injuries in 2,360 consecutive eyes., Methods: This was a retrospective, consecutive, non-comparative interventional case series. All cases with scleral and corneoscleral wounds presenting to these centers from January 2014 to January 2021 were included. The cases were defined according to the Birmingham Eye Traumatology Terminology system (BETTs) classification. The Ocular Trauma Score (OTS) was applied to the dataset., Results: Mean age of presentation was 36.63 ± 19.92 years (median 35 years). Penetrating trauma accounted for 70.92%, rupture for 18.6%, perforation for 4.60%, and IOFB in 5.88% eyes. In 76.60%, the location of injury involved zone 1 extending till zone 2, while in 23.40% it involved zone 2 and/or zone 3. Vision at presentation was logMAR 3.03 ± 0.99 and at the last visit was logMAR 2.47 ± 1.42 (p &lt; 0.0001). Time interval between presentation to the treatment center and globe repair was 13.93 ± 19.56 h (median 7.60 h). Favorable functional outcomes were seen in 29.20% eyes and favorable anatomic outcomes in 66.90%. Decreasing age at presentation, penetrating injury instead of rupture or perforating injury, a higher OTS, absence of corneal involvement, absence of retinal detachment at presentation, and absence of concurrent orbital fracture were associated with a favorable functional outcome (&gt;20/200). Final visual acuity in logMAR correlated with the OTS value calculated at presentation., Conclusions: In the absence of retinal detachment and orbital fracture, posterior open globe injuries typically have a favorable functional outcome. OTS correlated with the final visual acuity., (© 2023 S. Karger AG, Basel.)

Objective: This study aimed to evaluate the Iranian ophthalmologists' knowledge of prescribing prophylactic antibiotics to patients with open globe injury (OGI) in Iran., Methods: In this cross-sectional study, we utilized a questionnaire to evaluate the ophthalmologists' knowledge about prescribing antibiotics as prophylaxis. This survey was conducted in Tehran and its suburbs. The questionnaire included demographic information as well as ophthalmologists' knowledge levels. Cronbach's alpha was used to determine its validity and reliability. The obtained data were analyzed using SPSS 24.0., Results: Of 192 subjects, 111 (35 women, 76 men) were included. About 65 (58.6%) specialists and 45 (41.4%) subspecialists with different orientations completed the questionnaires. The total knowledge score was 13.04±2.96. The following are the results of ophthalmologists' responses to questions regarding the cornea/scleral injury (1.09±1.72), prophylactic antibiotics administration (2.79±1.11), the infectious agents in eye surgeries (3.21±1.49), diagnosis and treatment (2.84±0.944), and the effects of ocular antibiotics as well as their proper dosage (2.96±2.35). There was no significant relationship between some demographic information such as sex, working hours, workplace, and the number of studied articles ( p> 0.05). In addition, ophthalmologists with less work experience had significantly higher levels of knowledge than those with more work experience., Conclusion: The findings indicated that the majority of ophthalmologists had a basic knowledge of prescribing prophylactic antibiotics in OGI., Competing Interests: The authors declare that they have no conflict of interest.

Purpose: To investigate the prevalence of posttraumatic stress disorder (PTSD) and depression after open globe injury in adults., Methods: A total of 95 participants, 43 adult patients with open globe injury and 52 age-sex similar subjects (control group), were included in this cross-sectional study. Age, gender, education level, occupation, accident history, psychiatric history, trauma type, cause of trauma, and visual acuity were recorded. One to six months after trauma, PTSD and depression symptoms of the participants were evaluated with the Posttraumatic Stress Disorder Questionnaire-Civil Version Scale (PTSD-S) and Beck Depression Inventory (BDI), respectively., Results: Patients with open globe injury had a higher PTSD-S total score than the control group, but not significant (23.67 ± 20.41 vs. 18.56 ± 13.13, p = 0.580). Patients with eye trauma exhibited a much higher prevalence of PTSD compared to the control group (20.9% vs. 3.8%, p = 0.010). Patients with trauma had a significantly higher BDI total score than the control group (12.47 ± 10.08 vs. 7.69 ± 6.10, p = 0.015). Also, patients had a higher rate of depression symptoms than controls (25.6% vs. 7.7%, p = 0.017). A significant positive correlation was observed between PTSD-S and BDI scores in the trauma group (r = 0.720, p < 0.001)., Conclusion: An increased prevalence of PTSD and depression was observed in adults after open globe injury. The significant relationship between PTSD-S and BDI scores indicates that patients with open globe injuries should be questioned in terms of both symptoms. For patients with open globe trauma, a holistic approach with psychosocial assessment in addition to physical intervention would be beneficial., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

The purpose of the study was to evaluate visual outcomes and consider management strategies in the eyes with an intraocular foreign body (IOFB). In a single-center, retrospective case-control study, 36 eyes of 36 patients who suffered from open globe injury (OGI) with IOFB were admitted to the Department of Vitreoretinal Surgery of Medical University of Lublin, Poland from January 2015 to December 2020. Most frequent primary procedure was the pars plana vitrectomy (PPV) with IOFB removal (n = 28). Retinal detachment (RD) developed in nine eyes soon after injury or as a further complication. Recurrent retinal detachment occurred in eight of these nine cases. Final VA 0.1 or better was observed in 21 eyes (58%). Fifteen patients had BCVA of less than 0.1. One eye was not included in the final VA assessment due to the short follow-up period. In 25 out of 28 patients who underwent any kind of pars plana vitrectomy (ppV) a BCVA of <0.4 was observed. The prognosis after an IOFB injury is uncertain due to multiple factors in a peri- and postoperative period. Factors predisposing to poor visual outcomes are: IOFB localization in the posterior segment, retinal detachment, vitreous hemorrhage and prolonged silicone oil tamponade.

Purpose . The goal of this work is to create an active shape model segmentation method based on the statistical shape model of five regions of the globe on computed tomography (CT) scans and to use the method to categorize normal globe from globe injury. Methods . A set of 78 normal globes imaged with CT scans were manually segmented (vitreous cavity, lens, sclera, anterior chamber, and cornea) by two graders. A statistical shape model was created from the regions. An active shape model was trained using the manual segmentations and the statistical shape model and was assessed using leave-one-out cross validations. The active shape model was then applied to a set of globes with open globe injures, and the segmentations were compared to those of normal globes, in terms of the standard deviations away from normal. Results . The active shape model (ASM) segmentation compared well to ground truth, based on Dice similarity coefficient score in a leave-one-out experiment: 90.2% ± 2.1% for the cornea, 92.5% ± 3.5% for the sclera, 87.4% ± 3.7% for the vitreous cavity, 83.5% ± 2.3% for the anterior chamber, and 91.2% ± 2.4% for the lens. A preliminary set of CT scans of patients with open globe injury were segmented using the ASM and the shape of each region was quantified. The sclera and vitreous cavity were statistically different in shape from the normal. The Zone 1 and Zone 2 globes were statistically different than normal from the cornea and anterior chamber. Both results are consistent with the definition of the zonal injuries in OGI. Conclusion . The ASM results were found to be reproducible and accurately correlated with manual segmentations. The quantitative metrics derived from ASM of globes with OGI are consistent with existing medical knowledge in terms of structural deformation., (© 2022 Institute of Physics and Engineering in Medicine.)

Purpose: To construct a new pediatric ocular trauma score for predicting visual outcome after open globe injuries (OGI) and to compare it to the ocular trauma score (OTS) and pediatric ocular trauma score (POTS)., Methods: This is a retrospective chart review study. For each case, the following data were collected: demographics, mechanism of the injury, initial ophthalmologic findings, presented and last follow-up visual acuity (VA), ocular treatments, and final ocular findings. We then analyzed the risk factors for the poor visual outcome (VA ≤ 20/200), and a modified pediatric ocular trauma score (MPOTS) was constructed accordingly and compared to the OTS and POTS for predicting poor outcome. Finally, a different cohort of pediatric OGIs was used for score validation., Results: Forty-five cases were included, significant predicting factors for poor visual outcome were initial VA ≤ 20/200, zone 2-3 locations of injury, presence of retinal detachment, vitreous hemorrhage, hyphema, and iris prolapse at initial presentation. The calculated Spearman correlation coefficients between each system score and poor visual outcome were OTS 0.56, POTS 0.57, and MPOTS 0.64 (P < 0.001 for all). A total of 71 new cases were used as validation cohort, and calculated Spearman correlation coefficients between each system score and poor visual outcome were: OTS 0.50, POTS 0.51, and MPOTS 0.53 (P < 0.001 for all)., Conclusions: We suggest a new scoring system for predicting poor final visual outcomes after OGI's in children, which is simpler and more clinically suitable for this study population. It was found to be a better predictor of visual outcome in this scenario compared with existing scoring systems., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Aim: To identify risk-factors for developing endophthalmitis following open globe injury (OGI) in children., Methods: Retrospective, single-center, case-control study of children aged <18 years who sustained OGI., Results: Our cohort of 93 eyes consisted of 30 cases (Group A- endophthalmitis) and 63 controls (Group B- no endophthalmitis). Twenty-four eyes (80%) diagnosed with endophthalmitis presented after 24 hours of injury. The presence of central corneal zone-1 injuries (Odd ratio [OR]: 6.64, p= 0.001) and vitreous in wound (OR: 3.53) were associated with the risk of developing endophthalmitis. (p= < 0.05) Additionally the presence of iris prolapse (OR: 4.76) and posterior capsular rupture (PCR) (OR: 5.80) increased the risk of developing endophthalmitis.(p <0.05) . Streptococci was isolated in 15 eyes, Pseudomonas in 3 eyes, and Candida in 1 eye. The visual outcomes at three months were significantly worse in Group A (LogMAR 1.77±1.06) compared to Group B (LogMAR 0.65±0.68)(p<0.05)., Conclusion: Central corneal involvement, vitreous/ iris incarceration and PCR were important risk factors for development of PTE in children.

Purpose: To examine the incidence, clinical findings and management of pellet gun-related ocular injuries that occurred during protests in Kashmir region., Methods: This retrospective study included records from 777 patients diagnosed with pellet gun-related ocular injuries admitted to a tertiary hospital in Srinagar, India, between July and November 2016. By reviewing the clinical records, the following data were collected: demographics, clinical information pertaining to the injury, imaging reports including computer tomography and ultrasonography B-scan, management in the emergency setting, and follow-up treatment., Results: Mean age was 22.3 ± 7.2 years and majority patients were male (97.7%). In terms of laterality, 94.3% and 5.7% of the patients sustained monocular and binocular injuries, respectively. In terms of the nature of injury, 76.3% of the eyes had open globe injury while 23.7% of the eyes had closed eye injury. Emergency surgical exploration was performed in 67.7% of closed globe injuries while emergency primary repair was done in 91.1% of open globe injuries. The vast majority of patients (98.7%) who required surgery underwent surgical intervention on the day of admission or the next day. Final best-corrected visual acuity (BCVA) after treatment was counting fingers or worse in 82.4% of the eyes., Conclusion: Pellet gun-related ocular injuries resulted in significant ocular morbidity, mostly manifesting as open globe injuries. Treatment often required surgical interventions, but despite expeditious management, visual prognosis remained poor for most of the patients., Competing Interests: None

Background: Open globe injury (OGI) is a serious condition that can lead to visual impairment and lifelong sequelae, brain activity of some brain regions would change in patients with OGI., Purpose: To evaluate changes in brain activity associated with unilateral OGI by resting-state functional magnetic resonance imaging (rs-fMRI) and analysis of percentage amplitude of fluctuation (PerAF)., Material and Methods: A total of 22 patients with OGI (12 men, 10 women) and 22 healthy controls (HCs) matched for sex, age, and body weight were enrolled. All patients underwent rs-fMRI scans. Brain activity in the relevant brain regions was assessed with the PerAF method. The ability of PerAF to distinguish patients with OGI from HCs was assessed by receiver operating characteristic (ROC) curve analysis. We also examined the relationship between Hospital Anxiety and Depression Scale (HADS) scores and PerAF signals by Pearson's correlation analysis., Results: PerAF values in amygdala&#95;R and Frontal&#95;Inf&#95;Orb&#95;L/Frontal&#95;Inf&#95;Oper&#95;L were increased whereas that in Cerebellum Anterior Lobe/Cerebelum&#95;8&#95;L was decreased in patients with OGI compared to HCs. The areas under the ROC curve showed that these brain regions could distinguish between patients with OGI and HCs. The PerAF value of amygdala&#95;R was positively correlated with HADS scores., Conclusion: Changes in PerAF in the amygdala&#95;R, Frontal&#95;inferior&#95;Orb&#95;L/Frontal&#95;Inf&#95;Oper&#95;L, and Cerebellum Anterior Lobe/Cerebelum&#95;8&#95;L in patients with OGI may be related to an increased risk of developing psychiatric disorders such as anxiety and depression. PerAF can be used to investigate the neural basis of complications associated with OGI and monitor disease progression.

Purpose: The purpose of this study is to report the demographics and risk factors for undergoing primary enucleation in the setting of acute open globe injury (OGI) in the pediatric population in the USA., Methods: This retrospective, cross-sectional study of pediatric patients with OGIs in the USA between 2002 and 2014 was conducted utilizing data from the National Inpatient Sample Database. Descriptive statistics, chi-square testing, and univariate and multivariable analyses were performed., Results: In the USA, 8944 cases of pediatric OGI were identified between 2002 and 2014 in the NIS Database, of which 344 underwent primary enucleation. Blacks and Asian/Pacific Islanders made up higher proportions of enucleated cases compared to non-enucleated cases. Older age, male sex, being Black or Asian/Pacific Islander, OGI with an intraocular foreign body, rupture type OGI, and concurrent endophthalmitis were identified as risk factors for undergoing enucleation. There was no significant difference in insurance status among enucleated versus non-enucleated cases. Mean length of hospital stay (in days) was almost 3 times higher in enucleated OGIs. By hospital's geographic location, the Midwest hospitals had a greater proportion of enucleated versus non-enucleated cases compared to other regions., Conclusion: Significant demographic differences were identified in OGI patients that underwent primary enucleation versus repair with regard to age, sex, race, the geographic location of hospital admission, mean length of hospital stay, type of ocular injury, and other ocular complications. Most pediatric traumatic enucleations between 2002 and 2014 were reported in teenagers (16-20 age group), in males, and in Blacks., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Purpose: To determine the prognostic significance of various clinical features and surgical techniques concerning anatomical and visual outcomes in shotgun pellet-inflicted ocular trauma., Methods: This prospective follow-up study was done at a tertiary care institute in Kashmir, India. Six hundred sixty-four eyes of 643 patients with firearm pellet-related ocular trauma were followed up for 6 months., Results: Ocular injury involved one eye in 622 (96.7%) patients and both eyes in 21 (3.3%) patients. Open globe injury (OGI) occurred in 451 (67.9%) eyes with perforating injury being the commonest type (248 eyes, 54.9%). For perforating injuries, entry wounds in the cornea and limbus had the worst prognosis. Closed globe injury (CGI) occurred in 213 (32.1%) eyes. An anatomical success rate of 66.3% (n = 250) was achieved for 56.8% (377/664) eyes requiring an average of 2.8 (SD 0.5) surgeries per eye. OGI was associated with poor outcomes in 259 (57.4%) and CGI with good outcomes in 200 (93.9%) eyes. The visual outcome had a significant association with grade and zone of injury both in OGI and CGI, and with the type of injury in OGI (p < .0001 each). Ocular trauma score (OTS) had a significant association with the degree of vision impairment (p < .0001). WHO category 0 visual impairment was seen in 270 (40.7%) eyes, category 1 in 85 (12.8%), category 2 in 35 (5.3%), category 3 in 30 (4.5%), category 4 in 172 (25.9%), and category 5 in 72 (10.8%) eyes irrespective of type of injury at 6 months post-treatment., Conclusions: The perforating injury was the commonest type of injury caused by shotgun pellets. The site of the entry wound in perforating injury had prognostic significance. The outcome was generally poor in OGI and good in CGI., Competing Interests: Declaration of Competing Interest None declared, (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Purpose: It is widely accepted in the field of ophthalmology that closure of open globes within 24 hours of the injury results in the best visual outcomes. This study investigates the time-to-surgery and visual outcomes of open globe injury patients in North Carolina that were transferred to our institution before receiving surgical intervention as compared to those that were not transferred., Patients and Methods: This is a retrospective cohort study using data from UNC Hospitals trauma registry. Demographics, time of injury, final clinical outcomes, time to surgical intervention, and transfer history were extracted and analyzed. The study population includes open globe injury patients of all ages that were seen and treated at our institution from 2005 to 2020. Patients were divided based on transfer history. The transfer group consisted of patients who were transferred from an outside hospital to our tertiary care facility for surgical treatment. The non-transfer group consisted of patients who arrived at our tertiary care facility directly after injury., Results: In total, 238 open globe injuries were evaluated. Of those, 197 were transferred and 41 were not transferred. Compared to non-transfer patients, transfer patients had longer delays between injury and surgery, between presentation at the initial ED and surgery, and between injury and arrival at the tertiary care center. On average, the delay between injury and surgical intervention was 3 hours and 51 minutes longer for transfer patients compared to non-transfer patients. Eight patients in the transfer group were delayed >24 hours due to inter-hospital transfer. Additionally, transfer patients on average suffered from poorer final visual acuities, with an average final visual acuity of 1.84 logMAR in the transfer group and 1.35 logMAR in the non-transfer group., Conclusion: Our study found that inter-hospital transfer leads to significant delays in primary closure of open globe injuries. Injuries that were transferred to a tertiary care center before receiving surgical intervention on average resulted in worse final visual acuities., Competing Interests: The authors report no conflicts of interest in this work., (© 2022 Fernandez et al.)

Objective In this study, we aimed to examine the presence of visual damage due to ocular trauma and assess visual outcomes, and document the clinical spectrum and outcomes following ocular injuries among patients presenting to a tertiary care hospital in rural central India. Methods This was a hospital-based prospective interventional study conducted over a period of two years from August 2019 to August 2021. Patients with ocular injuries attending the casualty and the Ophthalmology department were included in the study after applying the inclusion and exclusion criteria. A detailed and comprehensive ophthalmic examination was performed and visual acuity was noted at the presentation and follow-ups. The patients were followed up at regular intervals, initially at one week and subsequently at three and six weeks. Results The incidence of ocular trauma was highest in the age group of 31-40 years. There were only three patients aged more than 60 years; 15 were in the pediatric age group (1-20 years). The ocular trauma was highest in males (88.33%) than in females (11.67%). The majority of the patients were from rural areas (70%) and 30% were from urban areas. In this study, both eyes were equally involved. The right eye was involved in 45% of patients and the left eye was involved in 55%. Of note, 80% of the patients presented with closed globe injury, and 20% presented with open globe injury. On classifying the open and closed globe injuries into their subtypes, it was observed that the majority of the patients had lid laceration (n=43, 71.67%), followed by corneal penetration in 12 patients (20%), corneal abrasion in three patients (5%), and lid abrasion in two patients (3.33%). While 34 patients presented to the hospital with a history of road traffic accidents (56.67%), accidental trauma (by a wooden stick, hook of a blouse, bangle, etc.) was noted in 17 patients (28.33%), trauma by soil particle and hand pump in five patients (8.33%), and electrical trauma caused by the blast of capacitor in one patient (1.67%). One patient (1.67%) had sustained trauma from a piece of wood while working on the farm and two patients (3.33%) had a trauma because of assault. Thirty-four patients (66.67%) had a history of falls from bikes, and the next most common object causing trauma was a wooden piece/stick (four patients, 6.67%), followed by trauma caused by an iron particle in four patients (6.67%), trauma by stone in three patients (5%), and trauma by hand pump in two patients (3.33%). Conclusion Road traffic accidents were the most common cause of ocular trauma in patients attending this rural hospital in central India. The ocular structures involved and types of ocular trauma play a significant role in determining the visual outcomes in these patients., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Wagh et al.)

Purpose: Open globe injury (OGI) is a serious form of ocular trauma that can significantly lower quality of life post-injury due to comorbidities. This study was designed to investigate how traumatic cataracts and other pre-operative variables affect visual outcomes of OGIs., Methods: A retrospective review was conducted for OGI patient records with presence of traumatic cataracts, visual outcomes, comorbidity data and provider training. Multivariable logistic regression analysis determined if several pre-operative variables including traumatic cataracts, retinal detachment and hyphema were predictive of final visual acuity and need for retinal surgery. Ancillary multivariable analysis was conducted to evaluate if timing of traumatic cataract extraction predicted poor final visual acuity., Results: Multivariable logistic regression analysis did not find traumatic cataract to be an independent predictor of final visual outcome in the open globe injury sample population (n = 102, p = 0.386), but did find retinal detachment (p = 0.008), hyphema (p = 0.035) and scleral laceration (p = 0.009) to be independent predictors of poor final visual acuity. In the subgroup of eyes with traumatic cataract (n = 64), delayed cataract extraction was not found to be an independent predictor of poor final visual acuity (p = 0.156)., Conclusion: Our results suggest that retinal detachment, hyphema, and scleral laceration influence final visual outcome while traumatic cataract does not. Within the subpopulation of patients that received lens extraction, timing of extraction was not found to independently influence final visual acuity., (© 2022. This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply.)

Objective: To identify the epidemiological profile and prognostic factors of open globe injuries that require emergency surgical treatment., Design: Retrospective cohort study., Subjects: Patients with OGI who underwent publicly funded emergency surgical treatment in the Federal District from 2014 to 2018., Methods: Data were collected by reviewing electronic medical records through a questionnaire and tabulated. The statistical analysis was performed in SPSS Statistics 26.0.0.0 (p ≤ 0.05)., Results: A total of 359 records were included, corresponding to 336 eyes of 334 patients (294 males and 40 females). The average age was 32.7 years. The affected eye was the right eye in 165 cases, the left eye in 166 cases, and both eyes in 3 cases. The average time between injury and hospitalization was 75.7 h, and the time between injury and surgery averaged 173.7 h. The injury types were as follows: 197 penetrating; 109 rupture; 19 IOFB; 11 perforating. The injuries were in the following zones: 181 zone I; 82 zone II; 70 zone III. The OTS grades were as follows: 57 were classified as grade 1; 101 were grade 2; 142 were grade 3; 28 were grade 4; and 8 were 5. The most commonly performed surgeries were corneal suture, corneoscleral suture, and evisceration. The most common clinical features were traumatic cataract, herniated iris and hyphema. The following were risk factors for poor prognosis: zone III, time between trauma and surgery > 72 h, rupture injury, retinal detachment, disorganization of the eyeball, endophthalmitis, uveal prolapse, OTS classification 1 or 2, and low initial visual acuity. The following factors predicted a good prognosis: initial VA > 1/200, penetrating injury, OTS 4 and zone II., Conclusions: The high frequency of many of these factors may explain the high rate of severe visual loss found. Injury localization in zone II was identified as a previously unrecognized protective factor against severe visual loss., (© 2022. The Author(s).)

Purpose: To describe the characteristics and correlates of open globe injuries secondary to projectile injury and outcomes following surgical open globe repair at an urban tertiary referral center., Methods: Records of all patients with a history of open globe injury secondary to projectile injury and surgical open globe at a tertiary referral hospital between January 1, 2010 and December 31, 2016 were reviewed. Demographics, type of trauma, wound extent, presence of foreign body, and presenting clinical findings are reported. Outcomes for patients with greater than 6 months of follow-up included additional surgeries, final visual acuity, and clinical findings., Results: Of 214 patients who underwent open globe repair, 73 (34.1%) were due to projectile impact. Mean age was 37.9 years and patients were primarily male (n = 66, P < 0.001). Most injuries resulted in globe laceration (68.5%, P < 0.001), and wound extent was zone 1 (45.2%), zone 2 (20.5%), zone 3 (27.4%), or unknown (6.8%). Associated findings included foreign body (35.6%) and orbital fracture (15%). Of 41 patients with at least 6 months of follow-up, 70% had additional surgeries following their initial surgical repair. Laceration injuries tended to be more anterior (P = 0.002) with better visual outcomes (P = 0.045) than those with globe rupture, and concomitant orbital fracture associated with poor visual outcomes. Overall, 58.5% of patients had 20/40 or better final best-corrected visual acuity., Conclusion: This is the largest report of open globe injury due to projectile impact. Visual prognosis in this population is very good, with most patients achieving better than 20/40 vision in our study., Competing Interests: None