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Rita D Page, Sumeet Gupta, Zeynel A Karcioglu; Risk factors for poor prognosis in patients with penetrating globe injury. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):6047.
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© ARVO (1962-2015); The Authors (2016-present)
To identify the risk factors that are predictive of poor prognosis in penetrating globe trauma.
This retrospective case series evaluated 103 eyes that had been surgically treated for an open globe injury from 2007 to 2010 at the Eye Clinic of UVA. There were 64 eyes with at least 6 months of follow-up. The patient population was mostly male (74.1%); age range was 3-88 years. We collected demographics and details of the initial examination, primary repair, office visits, and subsequent surgeries. Four risk factors [pre-operative best-corrected visual acuity (pre-op BCVA), ocular trauma score (OTS), zone of injury (ZOI), and time lapsed between injury and primary repair (TL)] and three outcomes [final best-corrected visual acuity (final BCVA), monthly rate of additional surgeries (MRAS), and enucleation] were identified for analysis. Data were analyzed via univariate and multivariate Spearman rank correlations and univariate and multivariate logistic regression.
The patients underwent a total of 159 surgeries, with an average of 2.5 surgeries per patient (range 1-7). 7 patients (10.3%) ultimately underwent enucleation. Pre-op BCVA was positively associated with MRAS, final BCVA, and enucleation. Calculated OTS was negatively associated with the outcome variables. No association was found between TL and ZOI with the outcome variables. Further age and predictor variable adjusted analyses showed pre-op BCVA to be independently positively associated with MRAS (p=0.008) and with final BCVA (p<0.001), while calculated OTS was independently negatively associated with final BCVA (p<0.001), but not uniquely associated with the MRAS (p=0.530).
A poor pre-op BCVA is associated with poorer visual acuity outcomes, more additional surgeries, and a higher rate of enucleation. A lower ocular trauma score signifies a more significant injury and is predictive of a worse visual acuity outcome. Zone of injury and time lapsed between injury and repair were not predictive of outcomes. For an open globe patient’s prognosis, pre-op BCVA and OTS are the factors that are most predictive of outcomes.
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