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Ashwinee Ragam, Parisa Emami-Naeini, Alain Bauza, Nishant Soni, Paul Langer, Marco Zarbin, Neelakshi Bhagat; Demographics, Characteristics, and Outcomes of Open Globe Injuries Secondary to Falls. Invest. Ophthalmol. Vis. Sci. 2012;53(14):4966.
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© ARVO (1962-2015); The Authors (2016-present)
To report demographics, clinical characteristics and outcomes of open globe injuries secondary to falls and to analyze prognostic factors affecting visual outcome in these eyes.
Retrospective series. Medical records of all open globe injuries that presented to The University Hospital, Newark, NJ between May 2001 and June 2010 secondary to falls were reviewed. Presenting visual acuity (VA), age, zone of injury, retinal detachment (RD), vitreous hemorrhage (VH), hemorrhagic choroidals (HC), hyphema, endophthalmitis, and afferent pupillary defect were evaluated for their effect on final VA.
85 eyes of 85 patients (50 females) were identified. The mean age was 65.6 years. 54 (64%) patients (39 females) were 65 years or older. 77 eyes endured blunt trauma from falls while 8 had penetrating injuries, mostly from falling on sharp edges of furniture. 31 eyes had zone 1, 27 had zone 2, and 27 had zone 3 injuries.Mean presenting VA in logMAR was 2.393 (Snellen VA range: NLP to 20/80). Mean final VA in logMAR was 2.144 (Snellen VA range: NLP to 20/30); only 16% (13 eyes) had final Snellen VA better than 20/200. Of these 13 eyes, 7 had zone 1 injuries and 6 had zone 2 injuries.RD was noted in 38.8% (33) of eyes within 3 weeks of presentation; 48.5% (16) of these cases had zone 3 injuries. VH was noted in 58.8 % (50) of eyes, HC in 48.2% (41), hyphema in 75.3% (64), and endophthalmitis in 2.4% (2). 15 patients underwent enucleation, 3 of which were primary. Over half of the enucleated eyes had RD, HC and/or hyphema. 37 (43.5%) of 85 eyes required reoperation after the primary open globe repair. 21 patients (24.7%) underwent posterior segment surgeries with an average of 1.76 pars plana vitrectomies (PPVs). RD was found in 27 (71.1%) of these cases, making it the most common reason for a PPV. Overall anatomic success was achieved in 94.1% of patients with RD after multiple PPVs.Presenting VA < 20/400 (p= 0.010) and zone 3 injuries (p= 0.005) were found to be associated with unfavorable visual outcome, defined as Snellen VA worse than 20/400 on multiple regression analysis.
Poor VA upon presentation and zone 3 injuries were most likely to predict poor visual outcome in patients with open globe injuries secondary to falls.
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