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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. A retrospective review of 2002 cases of OGIs presenting to a single institution. Patients with OGIs were admitted and managed according to a standardized protocol. 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. 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. 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. 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. Proprietary or commercial disclosure may be found after the references. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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]

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. [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]

PurposeMethodsResultsConclusionTo explore patient and surgeon characteristics for open globe injury repairs (OGRs) and rates of subsequent operations.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.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).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. [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.

In this report, we wanted to present a case showing how surgical difficulties were managed in the removal of a metallic intraocular foreign body accompanied by posterior pole perforation. A 43-year-old male patient sustained an accidental penetrating injury to his left eye while working. Biomicroscopic examination revealed a foreign body entry site and iris prolapse at the corneascleral junction in the inferotemporal quadrant, while fundus examination revealed a vitreous hemorrhage covering the optic disc and macula. Computed tomography showed an intraocular foreign body perforating the posterior pole between the optic disc and the macula and localizing between the globe and the retrobulbar area. A retrobulbar injection involving epinephrine was administered to the patient under general anesthesia at the beginning of the surgery to reduce intraoperative bleeding and prevent the intraocular foreign body from escaping into the retrobulbar space. Following the closure of the primary wound with 10.0 nylon, a standard three-port-25-gauge pars plana vitrectomy was performed and the intraocular foreign body was captured by advancing through the posterior pole defect with ERM forceps. The 6*5 mm sharp-edged intraocular metallic foreign body was removed through a 6 mm pars plana incision. The procedure was terminated by injecting silicone oil into the vitreous cavity. At the last visit 8 months after surgery, best-corrected visual acuity was 20/80. In the management of intraocular metallic foreign body injuries perforating the posterior pole, preoperative retrobulbar injection of an anesthetic agent involving epinephrine can be very useful in removing the foreign body and ensuring intraoperative hemostasis. [ABSTRACT FROM AUTHOR]

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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]

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. 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. 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. 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) [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.

Globe injury is an important cause of vision loss worldwide. Compared with closed ocular trauma, open globe injury has a worse prognosis and greater harm to individuals and society. This article reviewed the definition, classification, epidemiology, condition, diagnosis, treatment, prognosis, complications and prevention of open globe injury, in order to provide reference for the prevention, control, diagnosis and treatment of open globe injury in clinical work. [ABSTRACT FROM AUTHOR]

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]

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. [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]

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. Single-center retrospective cohort study. A total of 258 eyes with Z3 OGIs. 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. 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. 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). 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. Proprietary or commercial disclosure may be found after the references. [ABSTRACT FROM AUTHOR]

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 (R2 = 0.701, P < 0.001) and OTS (R2 = 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. [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

Purpose: To evaluate the visual outcome of traumatic cataract surgery secondary to open globe injury (OGI) and to investigate the factors affecting visual prognosis. Materials and Methods: The medical records of 46 eyes which underwent traumatic cataract surgery secondary to OGI between July 2002 and April 2013 were reviewed retrospectively. Demographic features, detailed history of OGI and ophthalmological examination were obtained and the factors affecting the final visual acuity (VA) were analyzed. Results: The mean follow-up was 68±56 (range 6-213) months and the mean age was 25±17.5 (range 1-70) years. The most common type of OGI was penetrating injury seen in 33 (71.7%) eyes. Location of wound was zone I in 32 (69.6%) eyes. Forty-three (93.5%) eyes had intraocular lens (IOL) implantation with IOL in the bag in 31 (72.1%) eyes. The most common performed surgical technique was phacoemulsification in 24 (52.2%) eyes, followed by aspiration in 18 (39.1%) and intracapsular cataract extraction in 4 (8.7%) eyes. There was a significant positive correlation between the initial and final best corrected visual acuity (BCVA) (r=0.332; p=0.024). No difference was observed in the final BCVA regarding the type of injury (p=0.387), surgical techniques (p=0.77) and location of IOL (p=0.565). The eyes with wound in zone I had better final BCVA than zone III (p=0.028). Conclusion: Initial VA is a significant prognostic factor for final VA in traumatic cataract patients. Also, zone I injury is associated with better visual prognosis. The type of OGI, surgical technique and location of IOL are not prognostic factors influencing the final visual outcome. [ABSTRACT FROM AUTHOR]