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Eitan S. Burstein, Douglas R. Lazzaro; Traumatic Eye Injuries in a Large Urban Center. Invest. Ophthalmol. Vis. Sci. 2012;53(14):4956.
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To evaluate the epidemiology, treatment, and outcomes of traumatic ruptured globes at Kings County Hospital Center (KCHC), a level 1 trauma center serving the majority of Brooklyn, NY.
This project focused on ruptured globe repairs that occurred between January 1, 2009 and October 1, 2011. Cases of ruptured globes were obtained by reviewing the OR log book and were described using the Kuhn criteria. Exclusionary criteria eliminated patients with major connective tissue disease, ocular specific structural abnormalities and prior ocular surgery within six months. We adapted criteria from previous case series to investigate various epidemiological data, and also looked at post-repair complications.
A review of the OR logbook disclosed 39 ruptured globe repair surgeries performed in the KCHC operating room between 1/1/2009 and 10/1/2011. Of the 39 eyes, representing 39 individual patients, one patient was excluded due to a previous diagnosis of Fuchs dystrophy. Of the remaining patients, 31/38 (81.6%) were male.The mechanism of injury was deemed violent in 19/38 (50%) of cases, with 7/19 (36.8%) of those resulting from gunshot wounds.Time of emergency department triage was also assessed and disclosed 17/33 (51%) of the patients presenting between the hours of 8pm and 4am.Of 8 patients presenting with an initial visual acuity of NLP, 3 had a primary enucleation and 1 had a secondary enucleation. Post-repair complications were also examined. Complications were broken into regions of occurence- corneal,anterior chamber, and posterior chamber/retinal. Corneal complicationsoccurred in 15% of patients. Anterior chamber complications were seen at a rate of 20.5%, and posterior/retinal complications occurred at a rate of 25.6%.Patients were seen to have multiple segment complications 12.8% of the time.
When compared to an earlier case series performed in a rural setting which disclosed assault as the cause of 9.5% of open globe injuries, our case series found 50% of ruptured globes to be caused as a direct result of violence, a strongly significant difference (p<0.0001). At KCHC, NLP eyes were treated by primary enucleation 37.5% of the time, with a rate of 50% rate for NLP eye enucleation over all. Admission data via the emergency department reveals that the majority of patients (51%) presented to the ED with severe ocular trauma between the hours of 8 PM and 4 AM, a time period during which the fewest number of hospital personnel are available. Current recommenations indicate that primary repair of the globe is most beneficial when performed within the first 24 hours and may even be protective against endophthalmitis. Standardizing the data points necessary for diagnosis and management could help eliminate some of those delays.
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