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Introduction: Ocular trauma is one of the leading causes of treatable visual morbidity and blindness. Paediatric ocular injury accounts for 8 to 14% of total injuries in children. Ocular trauma in children differs from that in adults in terms of the objects involved in causing injury, as well as the evaluation and management protocols. Aim: To understand the causes, locations, contributing factors, and patterns of paediatric ocular trauma, along with its short-term visual outcomes in a tertiary care centre, Andhra Pradesh. Materials and Methods: This descriptive study was conducted at the Department of Ophthalmology, Great Eastern Medical School and Hospital (GEMS), Srikakulam, Andhra Pradesh, India, over a period of six months, from August 2023 to January 2024. A detailed history regarding the cause of injury and any systemic injuries was recorded. The demographic profiles of all patients were noted in terms of age, sex, location of injury, nature of the object causing injury, time of presentation, and treatment. A comprehensive ocular examination was performed, which included visual acuity assessment, slit lamp examination and fundus examination. All patients were managed according to established treatment protocols. Follow-up appointments were scheduled at one week, three weeks, six weeks, and three months. Results: In the present study, a total of 31 children under the age of 15 years were included. The mean age of presentation was 9.94±3.91 years. Most ocular injuries occurred in the age group of 11-15 years, accounting for 17 (54.83%) of cases. Regarding the location of injury, the most common site was the home, representing 15 (48.38%) of incidents. The object most frequently causing injury was a wooden stick, which constituted 7 (22.58%) of cases. Out of the 31 children, 25 (80.64%) presented with closed globe injuries, while 6 (19.35%) had open globe injuries, indicating that closed globe injuries were more common. The visual acuity was converted to log Minimum Angle of Resolution (MAR) units, with the mean preoperative Best-corrected Visual Acuity (BCVA) being 1.0726±0.7038 log MAR units. The mean postoperative BCVA after three months was 0.5720±0.6275 log MAR units. Linear regression analysis conducted between preoperative visual acuity and postoperative BCVA showed an r-value of 0.7681 and a p-value of

Abstract 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

Introduction: Ocular trauma is one of the leading causes of treatable visual morbidity and blindness. Paediatric ocular injury accounts for 8 to 14% of total injuries in children. Ocular trauma in children differs from that in adults in terms of the objects involved in causing injury, as well as the evaluation and management protocols. Aim: To understand the causes, locations, contributing factors, and patterns of paediatric ocular trauma, along with its shortterm visual outcomes in a tertiary care centre, Andhra Pradesh. Materials and Methods: This descriptive study was conducted at the Department of Ophthalmology, Great Eastern Medical School and Hospital (GEMS), Srikakulam, Andhra Pradesh, India, over a period of six months, from August 2023 to January 2024. A detailed history regarding the cause of injury and any systemic injuries was recorded. The demographic profiles of all patients were noted in terms of age, sex, location of injury, nature of the object causing injury, time of presentation, and treatment. A comprehensive ocular examination was performed, which included visual acuity assessment, slit lamp examination and fundus examination. All patients were managed according to established treatment protocols. Follow-up appointments were scheduled at one week, three weeks, six weeks, and three months. Results: In the present study, a total of 31 children under the age of 15 years were included. The mean age of presentation was 9.94±3.91 years. Most ocular injuries occurred in the age group of 11-15 years, accounting for 17 (54.83%) of cases. Regarding the location of injury, the most common site was the home, representing 15 (48.38%) of incidents. The object most frequently causing injury was a wooden stick, which constituted 7 (22.58%) of cases. Out of the 31 children, 25 (80.64%) presented with closed globe injuries, while 6 (19.35%) had open globe injuries, indicating that closed globe injuries were more common. The visual acuity was converted to log Minimum Angle of Resolution (MAR) units, with the mean preoperative Best-corrected Visual Acuity (BCVA) being 1.0726±0.7038 log MAR units. The mean postoperative BCVA after three months was 0.5720±0.6275 log MAR units. Linear regression analysis conducted between preoperative visual acuity and postoperative BCVA showed an r-value of 0.7681 and a p-value of <0.001, indicating a significant positive correlation. Conclusion: According to the present study, the most common location of injury was found to be the home, suggesting that increased supervision at home could be beneficial. Early identification and intervention will help prevent ocular morbidity in children. [ABSTRACT FROM AUTHOR]

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 (R2 = 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. [ABSTRACT FROM AUTHOR]

IntroductionThis study aimed to analyse the clinical characteristics of open globe injury (OGI) in children under six.MethodsA retrospective analysis was conducted on the medical data of children with OGI admitted to the Eye Center of the Second Hospital of Jilin University, China, between 1 January 2012 and 31 December 2020.ResultsThe study included 106 children, with 61 males (57.5%) and 45 females (42.5%), and the mean age was 4.14 ± 1.58 years. Injuries predominantly affected the right eye (53.8%). Sharp objects were the leading cause of injuries (56.6%). Most wounds (91.5%) occurred in zone I, and penetrating trauma was the most common injury type (64.2%). The concomitant OGI findings included traumatic cataracts (47.2%), iris prolapse (53.8%), endophthalmitis (22.4%), vitreous prolapse (17.0%), retinal detachment (5.7%), eyelid laceration (7.5%), and orbital fractures (1.9%). Univariate analysis showed that wooden materials (p = 0.045), needles (p = 0.045), postinjury admission time (p

Miguel A Quiroz-Reyes,1 Erick A Quiroz-Gonzalez,2 Miguel A Quiroz-Gonzalez,2 Virgilio Lima-Gómez3 1Retina Department. Oftalmologia Integral ABC, Affiliated with the Postgraduate Studies Division at the National Autonomous University of Mexico, Mexico City, Mexico; 2Department of Ophthalmology. Oftalmologia Integral ABC, Affiliated with the Postgraduate Studies Division at the National Autonomous University of Mexico, Mexico City, Mexico; 3Retina Department. Hospital Juarez de Mexico, Mexico City, MexicoCorrespondence: Miguel A Quiroz-Reyes, The Retina Department of Oftalmologia Integral ABC, affiliated with the Postgraduate Studies Division at the National Autonomous University of Mexico, Mexico City, Mexico, Email drquiroz@prodigy.net.mxBackground: 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.Keywords: open globe injury, early vitrectomy, delayed vitrectomy, wound repair, traumatic proliferative vitreoretinopathy, vitrectomy timing

Abstract 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.

Purpose: to evaluate the features and outcomes of penetrating keratoplasty in combined opto-reconstructive surgery for combat eye injury and its complications.Patients and methods. The study enrolled 17 eyes (16 men) aged 34.00 ± 12.51 years, divided into 2 groups: I — with inflammatory diseases of the anterior segment, complicated combat eye injury (4 eyes), II — with open eye injury (OGI, 13 eyes). Patients underwent examination to reveal and localize damaged intraocular structures and intraocular foreign bodies (IOFB), determine the prognosis of visual functions, as well as impression cytology. In all cases penetrating keratoplasty was performed, as well as complex of vitreoretinal surgery if it was needed. In the postoperative period, visual acuity, the timing of epithelialization, and graft transparency were assessed. Period of observation was 4,5 ± 2,1 months.Results. Group I had severe keratouveitis, when intraocular structures were intact also as electrophysiological parameters. The presence of mucosal cells was determined in 50 % of cases. The number of surgery was 2.00 ± 0.82. Graft epithelialization was completed in 38.99 ± 35.43 days. Postoperatively all grafts had transparent retention and complete epithelialization, also as had high visual acuity (0.25 ± 0.10) was noted. Group II had damaged several intraocular structures and varying electrophysiological parameters. The epithelial phenotype was corneal all over. The average number of surgical treatments was 3.00 ± 1.48. The time of graft epithelialization was significantly less — 17.66 ± 8.69 days (p = 0.014). Corrected visual acuity ranged from zero (30.77 %) to 0.3 (0.08 ± 0.11) and was significantly less than in group I (p = 0.018). The parameters that correlated low visual acuity were aphakia, the level of electrical sensitivity, the number of surgical interventions, and the age of patients.Conclusions. Penetrating keratoplasty functional results prognosis is better in group with infectious complications of combat eye injury with reduced cornea transparency than in patient with open globe injury. Besides light perception and conducting structures (retina, optical nerve) lesion, optico-reconstructive surgery in open globe injury often leads to single-chamber formation in silicone filled eye, which significantly worsens the functional prognosis of treatment.

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.

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. [ABSTRACT FROM AUTHOR]

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.

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.

Background Childhood ocular trauma has major consequences since it can lead to lifelong blindness and visual impairment. Purpose The aim of this study was to assess the burden of pediatric ocular trauma and to identify its important determinants. Patients and methods This prospective study included all individuals (N=124) less than 18 years old who experienced eye injuries and sought treatment at the Outpatient or Emergency Services of the Department of Ophthalmology, Government Medical College, Jammu, India. The collected data included a detailed history of the injury, including systemic factors. The demographic and clinical information, such as age, sex, urban or rural residence, injury date and time, and previous treatments were also recorded. Results A total of 523 children (0–18 years old) with a mean age of 10.96±0.24 years were included in the study. Among these, 124 (23.71%) children with a mean age of 9.86±1.23 years had ocular injuries. The highest incidence of ocular trauma (68.54%) was observed in the 6–12-year-old age group. Boys accounted for the majority of cases (74.19%), and rural children were disproportionately affected (69.35%). Open globe injuries were more prevalent (62.9%) than closed globe injuries (25.0%). Perforating corneal injuries were the most common type of open globe injury (70.51%), while bat/ball injuries (38.70%) and falls (22.58%) were the leading causes of closed globe injuries. Zone I injuries were the most frequent location for both open and closed globe injuries. The Ocular Trauma Score was used to predict the injury severity, demonstrating an accuracy of 80%. The visual acuity data were available for 63 (57.79%) children at the initial presentation. Among these, 14 (22.22%) had no light perception, 23 (36.51%) had light perception, and 26 (41.27%) demonstrated a best-corrected visual acuity of 0.2±0.1 (0.1–0.3). At the final follow up at 6 months, five (7.94%) eyes experienced a vision of no light perception attributed to optic nerve avulsion, one (1.59%) eye retained light perception, two (3.17%) eyes demonstrated counting fingers acuity, and 55 (87.3%) eyes achieved a best-corrected visual acuity of 0.8±0.6 (range: 0.8 to ≥0.9). Conclusion The current study highlighted the substantial impact of pediatric ocular trauma, with a focus on open globe injuries and prevalent risk factors. The observed improvement in visual acuity underscores the significance of timely intervention, yet the 7.94% incidence of monocular blindness signals the ongoing need for targeted prevention strategies in this vulnerable population.

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Objective: To evaluate the accuracy of the Classification and Regression Tree (CART) model in prognosticating visual outcomes of patients with open-globe injuries Methods: This was a retrospective, single-center, cohort study of patients with open-globe injuries seen over a two-year period. Purposive sampling of hospital medical records was done to collect data from both in- and out-patient cases. The CART algorithm was utilized to determine the predicted visual outcome for each case, and the accuracy of prognostication was measured by computing for sensitivity, specificity, positive predictive value, and negative predictive value. The area under the receiver operating characteristic curve was used to check its discriminatory capability. Results: A total of 65 eyes (65 patients) with the following diagnoses based on the Birmingham Eye Trauma Terminology (BETT) classification were included: penetrating eye injury (n=58), globe rupture (n=2), and intraocular foreign body (n=5). Majority were male patients (81.5%) in the 17-39 year age group (40%). The sensitivity and specificity of CART were 100% (95% CI 93.6 to 100%) and 77.8% (95% CI 40 to 97.2%), respectively, with an overall accuracy of 96.9% (95% CI 89.3 to 99.6%). Area under the curve (AUC) was statistically significant at 0.89 (95% CI 0.79 to 0.95), indicating that the CART model can discriminate vision survival versus no vision. Conclusion: The CART model demonstrated high accuracy in prognosticating visual outcomes after an openglobe injury in the local setting. It may be used as a helpful tool to guide treatment decisions in open-globe injuries. [ABSTRACT FROM AUTHOR]

Open-globe injuries (OGI) can lead to significant visual impairment. The Ocular Trauma Score (OTS) is the most widely recognized tool for predicting visual outcomes. This review aimed to identify prognostic factors and assess the effectiveness of the OTS in predicting visual outcomes. Twenty-one articles published on PubMed and Google Scholar were analyzed. Initial visual acuity and the zone of injury were found to be the most significant prognostic factors for OGI. Other significant prognostic factors include retinal detachment/involvement, relative afferent pupillary defect, vitreous hemorrhage, vitreous prolapse, type of injury, hyphema, lens involvement, and duration from incidence of OGI to vitrectomy. Of the 21 studies evaluated, 11 investigated the effectiveness of OTS. Four studies concluded that OTS was effective overall, while six studies suggested that it was only useful in certain OGI categories. Thus, there is a need for further research to develop an optimized ocular trauma prognosticating system. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to evaluate the Iranian ophthalmologists’ knowledge of prescribing prophylacticantibiotics to patients with open globe injury (OGI) in Iran.Methods: In this cross-sectional study, we utilized a questionnaire to evaluate the ophthalmologists’ knowledgeabout prescribing antibiotics as prophylaxis. This survey was conducted in Tehran and its suburbs. Thequestionnaire included demographic information as well as ophthalmologists’ knowledge levels. Cronbach’salpha 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 was13.04±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 eyesurgeries (3.21±1.49), diagnosis and treatment (2.84±0.944), and the effects of ocular antibiotics as well as theirproper dosage (2.96±2.35). There was no significant relationship between some demographic information suchas sex, working hours, workplace, and the number of studied articles (p>0.05). In addition, ophthalmologistswith 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 prescribingprophylactic antibiotics in OGI.

Key Clinical Message Traumatic crystallin lens dislocation is a common complication following open globe injuries. Wound repair, lensectomy, and prophylactic antibiotic administration are essentials in the management.

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. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to determine the epidemiology and clinical features of pediatric traumatic open globe injuries in our region. Materials and Methods: Medical records of patients under the age of 18 who were diagnosed with open globe injury between January 2012 and December 2022 were retrospectively reviewed. Demographic data of the patients such as age, gender, time of injury, area of injury, type of injury, and cause of injury were recorded. Initial and final visual acuity and ocular findings at admission were recorded. Factors associated with final visual acuity were evaluated. Results: The m ean a ge o f t he patients w as 7 .62 ± 4.22 years. The majority of the patients were male (n=28, 66,7%). The right eye was the most injured (n=30, 71.4%). The initial visual acuity of approximately 72.5% (n=29) of the patients was worse than 20/200. And the final visual acuity of 50% of the patients (n=20) was below 20/200. The most common type of injury was penetrating trauma (n=18, 42.9%). The region with the highest trauma was Zone I (n=30, 71.4%). The most traumatic materials were metallic objects (n=13, 31%). The most common accompanying clinical finding was lens damage (n=18, 42.9%). Iris damage, lens damage, hyphema, vitreous hemorrhage, retinal detachment, endophthalmitis, type of injury, material causing the injury, and injury area were significantly associated with final vision. Conclusion: In our region, open globe injuries were mostly observed in boys under 12 years in the pediatric age group. Penetrating and cutting metallic objects seem to be the most important cause of trauma. Parents and all caregivers should be informed of the seriousness of open globe injuries to prevent possible injuries. [ABSTRACT FROM AUTHOR]

Intra Ocular Foreign Bodies (IOFB) associated with open globe injuries are a significant cause of vision loss. This review article was planned to evaluate the newer modalities of diagnosis and management of IOFB as well as the complications associated. A PubMed search for “intraocular foreign body” with the terms “imaging,” “removal,” “management,” “prognosis,” “complications/sequelae,” along with “open globe injury,” “ocular trauma,” “penetrating ocular injury,” “perforating ocular injury,” and “post-traumatic endophthalmitis” was made. Both the authors independently assessed the studies obtained. Incorporation of newer techniques in diagnosis and management have resulted in better visual outcomes.

Open-globe injuries (OGI) can lead to significant visual impairment. The Ocular Trauma Score (OTS) is the most widely recognized tool for predicting visual outcomes. This review aimed to identify prognostic factors and assess the effectiveness of the OTS in predicting visual outcomes. Twenty-one articles published on PubMed and Google Scholar were analyzed. Initial visual acuity and the zone of injury were found to be the most significant prognostic factors for OGI. Other significant prognostic factors include retinal detachment/involvement, relative afferent pupillary defect, vitreous hemorrhage, vitreous prolapse, type of injury, hyphema, lens involvement, and duration from incidence of OGI to vitrectomy. Of the 21 studies evaluated, 11 investigated the effectiveness of OTS. Four studies concluded that OTS was effective overall, while six studies suggested that it was only useful in certain OGI categories. Thus, there is a need for further research to develop an optimized ocular trauma prognosticating system.

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.

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.

Tuangprot Porapaktham,1 Janejit Choovuthayakorn,1 Onnisa Nanegrungsunk,1 Phichayut Phinyo,2– 4 Krittai Tanasombatkul,2,3 Nawat Watanachai,1 Paradee Kunavisarut,1 Voraporn Chaikitmongkol,1 Direk Patikulsila1 1Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; 2Clinical Epidemiology and Clinical Statistics Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; 3Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; 4Musculoskeletal Science and Translational Research (MSTR), Faculty of Medicine, Chiang Mai University, Chiang Mai, ThailandCorrespondence: Janejit Choovuthayakorn, Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, 110 Intavaroros Road, Maung, Chiang Mai, 50200, Thailand, Tel +66 53 935512, Fax +66 53 936121, Email janejit.c@cmu.ac.thPurpose: 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.Keywords: open globe injury, visual outcomes, characteristics, no vision survival

Introduction: Work Related Eye Injuries (WREI) constitute majority of eye injuries affecting younger age group. Trauma mainly affects people from lower socioeconomic background. People having workplace related eye injuries have an added financial burden. Challenges with respect to workplace related eye injuries include lack of occupational safety and health cover, lack of related information about pattern and exact incidence and management protocols. Aim: To study epidemiological profile, risk factors and predictors of visual outcome in occupational eye injury patients. Materials and Methods: This prospective observational/cohort study was conducted in Department of Ophthalmology, at Rajiv Gandhi Medical college and CSM Hospital, Kalva, Thane between October 2020 to February 2022. Study population included 42 patients having occupational eye injuries. After obtaining written informed consent, detailed history regarding their occupation, mode of injury and awareness and history of use of any Protective Eye Device (PED) at the time of injury was noted. Best Corrected Visual Acuity (BCVA), detailed anterior segment examination and fundus examination was done. Ocular injury was classified as Open Globe Injury (OGI) or Closed Globe Injury (CGI) and ocular trauma scale was calculated. Patients were treated medically or surgically as indicated and followedup next day and subsequently BCVA was noted and progress at each follow-up till six months was recorded. Factors related to good visual outcome (better or equal to 6/24) and bad visual outcome (visual acuity worse than 6/24) were identified. Continuous variables were described as the mean and variation of each observation from the mean value (Standard deviation) represented as mean±SD (analysed using independent t-test). Univariate analysis was done for identifying factors associated with bad visual outcome and p-value of <0.05 was considered significant. Results: Forty-two patients were included in study (40 males and 2 females). There were 21 patients each in OGI and CGI. Most commonly affected were construction workers-15 (35.72%). A total of 45% workers had access to PED at workplace but none of them used them. Univariate analysis showed open-globe injury, Zone-1 injury, presence of iris prolapse, traumatic cataract, vitreous prolapse/RD were related to bad visual outcome (<6/24). At six months, the median logMAR BCVA improved significantly from logMAR 0.8 to 0.18 (0-1.3) (p=0.0002). Conclusion: Occupational ocular trauma is commonly seen in younger males. Poorer visual outcomes are associated with OGI and Zone-1 injuries, presence of iris prolapse, traumatic cataract, vitreous prolapse/retinal detachment. Lack of use of protective eye gear was universally noted along with its unavailability in many places. Conducting regular educational programs on ocular safety at workplaces, sensitising the workers and their employees regarding the hazards of ocular trauma and strict implementation of mandatory use of eye protective devices is recommended. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Traumatic crystallin lens dislocation is a common complication following open globe injuries. Wound repair, lensectomy, and prophylactic antibiotic administration are essentials in the management. [ABSTRACT FROM AUTHOR]

AIM:To investigate the factors affecting patients with post traumatic infectious endophthalmitis(PTIE)relieving from blindness.METHODS: A retrospective study was conducted on 169 patients(169 eyes)with PTIE from January 2010 to December 2020 in the department of ophthalmology, the Affiliated Hospital of Nantong University. After treatment of intravitreal injection of antibiotics(IVIA)and/or pars plana vitrectomy(PPV), the patients were divided into the getting rid of blindness group(103 eyes)and unilateral blindness group(66 eyes)according to the last follow-up of best correct visual acuity(BCVA)≥0.05. The factors affecting the patients to get rid of blindness were analyzed.RESULTS: The rate of relieving from blindness was 53.5%. Univariate analysis showed that BCVA before treatment ≥ hand movement, no retinal detachment, fundus grade of endophthalmitis < grade 3 and no strong virulence of infected microorganisms were beneficial for patients to get rid of blindness(P

Elise O Fernandez,1 Hannah M Miller,2 Vincent Q Pham,3 David Fleischman2 1School of Medicine, University of North Carolina, Chapel Hill, NC, USA; 2Department of Ophthalmology, University of North Carolina, Chapel Hill, NC, USA; 3College of Medicine, Northeast Ohio Medical University, Rootstown, OH, USACorrespondence: David Fleischman, Department of Ophthalmology, University of North Carolina, 5126 Bioinformatics Bldg #7040, Chapel Hill, NC, 27599-7040, USA, Tel +1 919 966-5296, Fax +1 919 966-1908, Email david8fleischman@gmail.comPurpose: 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.Keywords: eye injury, open globe injury, ocular trauma, surgery, visual outcomes, transfer

Introduction: Work Related Eye Injuries (WREI) constitute majority of eye injuries affecting younger age group. Trauma mainly affects people from lower socioeconomic background. People having workplace related eye injuries have an added financial burden. Challenges with respect to workplace related eye injuries include lack of occupational safety and health cover, lack of related information about pattern and exact incidence and management protocols. Aim: To study epidemiological profile, risk factors and predictors of visual outcome in occupational eye injury patients. Materials and Methods: This prospective observational/cohort study was conducted in Department of Ophthalmology, at Rajiv Gandhi Medical college and CSM Hospital, Kalva, Thane between October 2020 to February 2022. Study population included 42 patients having occupational eye injuries. After obtaining written informed consent, detailed history regarding their occupation, mode of injury and awareness and history of use of any Protective Eye Device (PED) at the time of injury was noted. Best Corrected Visual Acuity (BCVA), detailed anterior segment examination and fundus examination was done. Ocular injury was classified as Open Globe Injury (OGI) or Closed Globe Injury (CGI) and ocular trauma scale was calculated. Patients were treated medically or surgically as indicated and followed-up next day and subsequently BCVA was noted and progress at each follow-up till six months was recorded. Factors related to good visual outcome (better or equal to 6/24) and bad visual outcome (visual acuity worse than 6/24) were identified. Continuous variables were described as the mean and variation of each observation from the mean value (Standard deviation) represented as mean±SD (analysed using independent t-test). Univariate analysis was done for identifying factors associated with bad visual outcome and p-value of

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. [ABSTRACT FROM AUTHOR]

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 hrfrom 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. [ABSTRACT FROM AUTHOR]

Purpose: to develop, experimentally study and evaluate in the clinic the effectiveness of using a 25G handpiece to a permanent operating magnet for IOFB removal.Materials and methods. In the work, we analyzed the results of an experimental study and clinical application of 25 G handpieces. In the experimental part of it, a comparative analysis of magnetic properties was carried out: the force of attraction, strength and topography of the magnetic fields of a standard 25-mm handpiece by V.V. Volkov and 25G caliber handpieces (30, 35, 40, 45 mm long) for a permanent eye magnet. In the clinical part of the work, we analyzed the results of surgical treatment of 57 patients of the ophthalmology clinic with type C OGI (according to the ISOT classification) with localization in the posterior segment of the eye. The mechanism of injury, the area and depth of injury, intraoperative and postoperative complications were analyzed, and the advantages of IOFB removal by a combined method using a 25G tip to a permanent magnet were evaluated.Results. According to the results of our experimental studies, it was revealed: the force of the 25G handpieces is sufficient to fix foreign bodies weighing up to 11 (for a 45 mm handpiece), and the minimum distance at which the magnetic field begins to act around the handpieces is at least 8 mm (data for the longest handpiece 45 mm). A pronounced decrease in the magnetic field strength at the tip surface at a distance of up to 2 mm was revealed. At the stage of using the 25G handpiece in the clinic, when assessing the OTG mechanism, the injuries were distributed as follows: household injury — 47 %, industrial injury — 27 %, road traffic accident — 13 %, combat injury — 13 %. Removal of IOFB was carried out in two versions: transvitreal and combined. IOFB was removed using a 25G permanent eye magnet tip and using a 25G vitreous forceps. During the operation, the following methods of removing IOFB were used: tweezers-tweezers, magnet-tweezers, magnet-magnet. Intraoperatively, in 7 % of cases, there was a slip and fall of IOFB to the fundus. In all cases, an increase in visual acuity was obtained, and in most cases, visual acuity at the time of discharge from the hospital was in the range from 0.05 to 0.1.Conclusion. Removal of magnetic IOFB using a 25 G tip to a permanent magnet allows reliable fixation of IOFB, significantly reduces the risks of intraoperative complications and shortens the duration of surgery.

Abstract 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.

We report a patient who developed frosted branch angiitis (FBA) and was diagnosed 1 month after the penetrating eye injury (PEI) repair. A 31-year-old male with no systemic comorbidities presented with defective vision following trauma to his left eye while cutting wood. His best-corrected visual acuity (BCVA) was 20/200. Anterior segment examinations showed a zone I full-thickness corneal tear with iris tissue incarceration. There was no clinical evidence of intraocular foreign body (IOFB) or endophthalmitis. He underwent PEI repair with iris abscission on the same day with intracameral moxifloxacin injection. His BCVA on postoperative day 45 was 20/200. Examination showed a resolving vitreous hemorrhage, venous tortuosity, and retinal perivascular infiltration affecting the venules from the posterior pole up to the periphery. He was treated with oral and topical steroids. The clinical signs resolved completely and BCVA improved to 20/20 after 1 month of treatment. FBA can complicate the recovery of eyes after PEI repair, even in the absence of endophthalmitis or sympathetic ophthalmia. A thorough search for IOFB or its tell-tale signs should be done in such eyes.

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.

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.

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. [ABSTRACT FROM AUTHOR]

We report a patient who developed frosted branch angiitis (FBA) and was diagnosed 1 month after the penetrating eye injury (PEI) repair. A 31-year-old male with no systemic comorbidities presented with defective vision following trauma to his left eye while cutting wood. His best-corrected visual acuity (BCVA) was 20/200. Anterior segment examinations showed a zone I full-thickness corneal tear with iris tissue incarceration. There was no clinical evidence of intraocular foreign body (IOFB) or endophthalmitis. He underwent PEI repair with iris abscission on the same day with intracameral moxifloxacin injection. His BCVA on postoperative day 45 was 20/200. Examination showed a resolving vitreous hemorrhage, venous tortuosity, and retinal perivascular infiltration affecting the venules from the posterior pole up to the periphery. He was treated with oral and topical steroids. The clinical signs resolved completely and BCVA improved to 20/20 after 1 month of treatment. FBA can complicate the recovery of eyes after PEI repair, even in the absence of endophthalmitis or sympathetic ophthalmia. A thorough search for IOFB or its tell-tale signs should be done in such eyes. [ABSTRACT FROM AUTHOR]

AIM: To predict final visual acuity and analyze significant factors influencing open globe injury prognosis. METHODS: Prediction models were built using a supervised classification algorithm from Microsoft Azure Machine Learning Studio. The best algorithm was selected to analyze the predicted final visual acuity. We retrospectively reviewed the data of 171 patients with open globe injury who visited the Pusan National University Hospital between January 2010 and July 2020. We then applied cross-validation, the permutation feature importance method, and the synthetic minority over-sampling technique to enhance tool performance. RESULTS: The two-class boosted decision tree model showed the best predictive performance. The accuracy, precision, recall, F1 score, and area under the receiver operating characteristic curve were 0.925, 0.962, 0.833, 0.893, and 0.971, respectively. To increase the efficiency and efficacy of the prognostic tool, the top 14 features were finally selected using the permutation feature importance method: (listed in the order of importance) retinal detachment, location of laceration, initial visual acuity, iris damage, surgeon, past history, size of the scleral laceration, vitreous hemorrhage, trauma characteristics, age, corneal injury, primary diagnosis, wound location, and lid laceration. CONCLUSION: Here we devise a highly accurate model to predict the final visual acuity of patients with open globe injury. This tool is useful and easily accessible to doctors and patients, reducing the socioeconomic burden. With further multicenter verification using larger datasets and external validation, we expect this model to become useful worldwide.

AIM: To elucidate the question of whether the ocular trauma score (OTS) and the zones of injury could be used as a predictive model of traumatic and post traumatic retinal detachment (RD) in patients with open globe injury (OGI). METHODS: A retrospective observational chart analysis of OGI patients was performed. The collected variables consisted of age, date, gender, time of injury, time until repair, mechanism of injury, zone of injury, injury associated vitreous hemorrhage, trauma associated RD, post traumatic RD, aphakia at injury, periocular trauma and OTS in cases of OGI. RESULTS: Totally 102 patients with traumatic OGI with a minimum of 12mo follow-up and a median age at of 48.6y (range: 3-104y) were identified. Final best corrected visual acuity (BCVA) was independent from the time of repair, yet a statistically significant difference was present between the final BCVA and the zone of injury. Severe trauma presenting with an OTS score I (PIII. OGI associated RD was observed in 36/102 patients (35.3%), whereas post traumatic RD (defined as RD following 14d after OGI) occurred in 37 patients (36.3%). OGI associated RD did not correlate with the OTS and the zone of injury (P=0.193), yet post traumatic RD correlated significantly with zone III injuries (P=0.013). CONCLUSION: The study shows a significant association between lower OTS score and zone III injury with lower final BCVA and a higher number of surgeries, but only zone III could be significantly associated with a higher rate of RD.

Abstract Background The goals of this work were to report the demographic characteristics of patients with clinically diagnosed endophthalmitis with or without intraocular foreign bodies (IOFBs) and to analyze the causative microorganisms. Methods A retrospective analysis was conducted on 1257 patients with clinically diagnosed posttraumatic endophthalmitis who were admitted to Zhongshan Ophthalmic Center between January 1, 2013, and August 31, 2020. Results Of the 1257 patients with clinically diagnosed posttraumatic endophthalmitis, 452 (36.0%) patients had IOFBs. Male dominance was more common among the patients with IOFBs than the patients without IOFBs. The average age of the patients with IOFBs was older than that of the patients without IOFBs. The most common microbial pathogens in these two groups were Gram-positive cocci and Gram-negative bacilli. Gram-positive bacilli were more common in the patients with IOFBs than in those without IOFBs (17.9 vs. 9.4%), and Bacillus spp. accounted for 12.6 and 5.5%, respectively. Fungi were less abundant in the patients with IOFBs than in those without IOFBs (8.0 vs. 15.6%). Conclusions Patients with IOFBs were mostly male and older than those without IOFBs. Gram-positive bacilli were more common and fungi were less common in patients with IOFBs than in those without IOFBs.

We report and compare 2 cases of open globe injury with foveal damage incurred while mowing. Case 1 is a healthy 67-year-old man presenting with an intraocular metallic foreign body and eye pain in his right eye after using a mower. The foreign body perforated the cornea’s inferior area and damaged the foveal centralis, leading to central scotoma and decreased visual acuity. 27G pars plana vitrectomy was performed, and the final corrected decimal visual acuity was 0.1, but the visual field was preserved, except for the central scotoma. Case 2 is a healthy 50-year-old man presenting open globe injury with an intraocular metallic foreign body while using a mower. The foreign body damaged the fovea and triggered extensive retinal detachment. One month after surgery, proliferative vitreoretinopathy occurred, requiring additional surgery. The final corrected decimal visual acuity dropped to 0.05, resulting in an extensive visual field defect. Both cases of eye trauma were caused by mower injury, but the visual function outcomes differed with the size of the foreign body and the injury severity at the time of onset. Mower eye trauma is preventable, and efforts to educate users on safety measures are needed.

Vivek Paulbuddhe,1 Sujit Addya,1 Bharat Gurnani,2 Dheerendra Singh,3 Koushik Tripathy,4 Rohan Chawla5 1Department of Vitreoretina, ASG Eye Hospital, Guwahati, 781006, Assam, India; 2Department of Cornea, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Pondicherry, 605007, Puducherry, India; 3Department of Retina, ASG Eye Hospital, Bhopal, 462016, Madhya Pradesh, India; 4Department of Vitreoretina, ASG Eye Hospital, Kolkata, 700058, West Bengal, India; 5Department of Ophthalmology, All India Institute of Medical Sciences, New Delhi, 110029, IndiaCorrespondence: Koushik TripathyDepartment of Vitreoretina, ASG Eye Hospital, 149, BT Road, Kolkata, 700058, West Bengal, IndiaTel +913325632222Email koushiktripathy@gmail.comAbstract: Sympathetic ophthalmia is a rare bilateral diffuse granulomatous panuveitis that usually results from surgical or penetrating trauma to one eye. The symptoms range from impaired near vision to pain, photophobia, and loss of visual acuity. Anterior segment manifestations include bilateral acute uveitis with mutton-fat keratic precipitates and posterior segment findings include vitritis, multifocal neurosensory retinal detachment, choroiditis, optic nerve edema, and Dalen–Fuchs nodules. The diagnosis is clinical. Ancillary investigations include fundus fluorescein angiography, indocyanine green angiography, optical coherence tomography (OCT), ultrasound B scan, and autofluorescence imaging. The management options include corticosteroids (topical and systemic) as the first line along with immunomodulatory therapy started at the presentation of the disease. Recent advances include imaging with OCT-angiography, enhanced depth imaging-OCT (EDI-OCT, choroidal vascular index/CVI), targeting IL-23/IL-17 pathway, and use of biologics for the management of this rare entity. Recent advances in early diagnosis and prompt treatment has led to improved final visual outcomes in both the sympathizing and exciting eye. This review is aimed at giving a comprehensive overview of sympathetic ophthalmia along with a special emphasis on current treatment strategies and recent advances.Keywords: ocular trauma, inciting eye, exciting eye, corticosteroids, open globe injury, infliximab, adalimumab

AIM: To investigate the patterns and outcomes of open globe injuries in the elderly population in Iran. METHODS: In this retrospective cross-sectional chart review, medical records of 248 patients (aged 60y and more) with the diagnosis of open globe injury from 2006 to 2016 were reviewed. Demographic features, type, and mechanism of open globe injury, ocular trauma score (OTS), visual acuity before and after treatment, the zone of injuries, and the associated injuries found at the presentation or thereafter were documented. RESULTS: A total of 248 eyes of 248 patients were included. The mean age was 69.2±5.8y (range: 60-90y). Male/ female ratio was about 3:1 (187 vs 61). The three most common causes of injury were falling (25.2%), sharp objects (18.9%), and tree branches (13.9%). Penetrating injury accounted for most of the geriatric ocular trauma (50.4%), followed by globe rupture (40.3%), intraocular foreign body (IOFB; 7.3%), and perforating injury (2.0%). The median raw OTS for the population was 60.5 and the most common OTS class was 3. The injuries tend to affect zone I more than zone II and zone III. The only predictor of final visual acuity was the class of OTS (P

Abstract 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.

Abstract Background Eye injury is a serious worldwide public health problem that may cause blindness. In children, blindness has functional impact and psychosocial implications. As indicated in many worldwide studies, identification of risk factors associated with the socio-cultural context may prevent eye injuries. The objetive of the study is to describe the sociodemographic and epidemiological characteristics of pediatric eye injury and its effects on ocular structures in a public hospital from Colombia. Method A retrospective cross-sectional study was carried out between January 1, 2015, and December 31, 2017, in a tertiary public hospital of a medium-sized city located in the Northeast of Colombia. Children under 15 years old with trauma to the eyeball or its adnexa were included. The Birmingham Eye Trauma Terminology System (BETTS) was used. Eye burns and Ocular adnexa were also included. Results 61 cases of eye injuries were recorded, 67.21% (41 cases) of which were males. 57.37% (35 cases) corresponded to closed-globe injuries both contusion and lamellar laceration. Visual acuity fluctuated between 20/20 and 20/40. 14.75% (9 cases) were open-globe injuries while 50% (4 cases) were penetrating trauma. 27.86% of the injuries (17 cases) did not directly compromise the eyeball, 58.82% (10 of these cases) of which corresponded to eyelid wounds, and neither of those had visual acuity information. Conclusion The study showed that the majority of eye injuries in children under 15 years old, from a public hospital in the Northeast of Colombia, are closed globe, caused by blows, and occur in males.

Asad F Durrani,1 Peter Y Zhao,1 Yunshu Zhou,1 Michael Huvard,2 Lyna Azzouz,3 Jason M Keil,3 Stephen T Armenti,1 Vaidehi S Dedania,4 David C Musch,1,5 David N Zacks1 1Department of Ophthalmology and Visual Sciences, W.K. Kellogg Eye Center, University of Michigan, Ann Arbor, MI, USA; 2Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA; 3University of Michigan Medical School, Ann Arbor, MI, USA; 4Department of Ophthalmology, NYU Grossman School of Medicine, New York, NY, USA; 5Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USACorrespondence: David N ZacksDepartment of Ophthalmology and Visual Sciences, W.K. Kellogg Eye Center, University of Michigan, 1000 Wall Street, Ann Arbor, MI, 48105, USATel +1 734-232-8404Email Davzacks@med.umich.eduBackground/Aims: To determine the rate of endophthalmitis and assess risk factors for development of endophthalmitis following open globe injury (OGI).Methods: A retrospective chart review of all patients treated for OGI at the University of Michigan from January 2000 to July 2017 was conducted. Exclusion criteria included intravitreal injection or intraocular surgery in the 30 days prior to injury or less than 30 days of follow-up. A total of 586 out of 993 open globe injuries were included in the study. The main outcome measure was the rate of endophthalmitis.Results: In this study, 25/586 eyes (4.3%) had endophthalmitis. Of these, 12/25 eyes (48.0%) presented with endophthalmitis and 13/25 eyes (52.0%) developed endophthalmitis after globe closure. Multivariate analysis identified time to globe repair (OR 4.5, CI 1.9– 10.7, p = 0.0008), zone I injury (OR 3.6, CI 1.1– 11.0, p = 0.0282), and need for additional surgery (OR 5.5, CI 1.5– 19.7, p = 0.0092) as factors associated with increased risk of developing endophthalmitis. Subconjunctival antibiotic injection at the time of globe closure (OR 0.3, CI 0.1– 0.7, p = 0.0036) was associated with decreased risk of developing endophthalmitis.Conclusion: Prompt globe closure and subconjunctival antibiotics may reduce the risk of endophthalmitis in OGI. Furthermore, our practice of a one-time dose of systemic prophylactic antibiotics, and intravitreal antibiotics if intraocular foreign body (IOFB) removal is delayed, was not found to increase the rate of endophthalmitis.Keywords: endophthalmitis, intraocular foreign body, ocular trauma, open globe injury

Abstract Background To identify prognostic factors determining final visual outcome following open globe injuries. Methods Retrospective case series of patients presenting to Westmead Hospital, Sydney, Australia with open globe injuries from 1st January 2005 to 31st December 2017. Data collected included demographic information, ocular injury details, management and initial and final visual acuities. Results A total of 104 cases were identified. Predictors of poor final visual outcomes included poor presenting visual acuity (p

Introduction: The aim of the study was to describe the characteristics of open globe injury (OGI) and the relationship between the complications and visual outcomes in children with this type of injury. Methods: This was a retrospective chart review of 1,664 children, under the age of 16 years, who were hospitalized for OGI between January 1, 2007, and December 31, 2015. Each patient's age, sex, cause and agent of injury, complications, visual acuity, and classification of ocular trauma were collected for review and analysis. Results: The mean age was 5.6 ± 3.4 years. Right eyes were particularly vulnerable to injury (right eye:left eye ratio = 1.2:1). Traumatic cataract was the most common complication. The average initial and final best corrected visual acuity were logarithm of the minimum angle of resolution (logMAR) 2.04 ± 0.78 and logMAR 1.74 ± 0.88, respectively. Logistic regression analysis showed that hyphema (odds ratio [OR] = 1.850), iris prolapse (OR = 1.702), vitreous hemorrhage (OR = 9.703), retinal detachment (OR = 11.938), endophthalmia (OR = 5.377), intraocular foreign body (OR = 3.346), and initial visual acuity <0.05 (OR = 9.017) were risk factors for visual acuity <0.05 at hospital discharge. Conclusion: OGI was most frequent in preschool children and boys. Right eyes were more vulnerable than left eyes. Poor visual outcomes were associated with hyphema, iris prolapse, vitreous hemorrhage, retinal detachment, endophthalmia, intraocular foreign body, and an initial visual acuity <0.05. [ABSTRACT FROM AUTHOR]