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Nishant G. Soni, Alain Bauza, Marco Zarbin, Neelakshi Bhagat; Complications And Visual Outcomes Of Blunt Versus Sharp Trauma In Open-globe Injuries. Invest. Ophthalmol. Vis. Sci. 2012;53(14):4964.
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To evaluate differences in characteristics and outcomes of open-globe injuries caused by blunt versus sharp objects.
Retrospective cohort study. 304 eyes (301 patients) with open-globe trauma that presented to University Hospital in Newark, NJ between July 1, 2001 and June 30, 2010 with a known mechanism of injury were identified. The injury was classified as a rupture if caused by a blunt object and laceration if caused by a sharp object. Lacerations were penetrating if an entrance wound was present and perforating if an entrance and exit wound were both present.
Of 304 eyes identified, 111 (37%) had ruptures, 185 (61%) had penetrating injuries, and 8 (3%) had perforating injuries. Male patients made up 59% of the rupture group and 84% of the laceration group. The mean age for patients with ruptures was 44.1 ± 24.8 years, while that of patients with lacerations was 31.9 ± 15.0. Mean follow-up was 18.1 months (3-88 months) and did not differ between the rupture and laceration groups. An intraocular foreign body was found in 27 (9%) of eyes, all resulting from lacerations. Endophthalmitis was diagnosed in 6 eyes (3%) of 193 with lacerations, but in none of which had ruptures. Zone I injury (limited to the cornea and limbus) occurred in 100 eyes (53%) with lacerations, but in only 35 eyes (32%) with ruptures. The presence of traumatic cataract was similar in ruptures and lacerations, occurring in 19 (39%) of 49 phakic, ruptured eyes and in 70 (42%) of 167 phakic, lacerated eyes. 47 eyes (44%) with a rupture presented with a retinal detachment, compared with only 45 (24%) with a laceration. Eyes with ruptures also presented with vitreous hemorrhage more commonly (56%) than eyes with lacerations (36%). Ruptured and lacerated eyes required similar numbers of surgeries in addition to the primary globe repair (0.98 and 0.84 respectively). Presenting visual acuity was worse in eyes with ruptures (2.32 mean logMAR) than in eyes with lacerations (1.69 mean logMAR). The visual acuity outcome at the patients’ last follow-up visit was also worse for ruptured eyes (1.95 mean logMAR) than for lacerated eyes (1.13 mean logMAR). 43 (39%) rupture injuries resulted in an outcome of NLP vision, compared with only 30 (15%) laceration injuries. All perforating injuries resulted in NLP vision at the last follow-up.
An open-globe injury due to rupture may have a worse visual prognosis than one due to a laceration. Complications such as retinal detachment and vitreous hemorrhage may be more common in ruptures, and endophthalmitis may be more common in injuries due to lacerations.
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