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V.Y. Bunya, E.J. Cohen, C.J. Rapuano, K.M. Hammmersmith; A Review of Corneal Lacerations . Invest. Ophthalmol. Vis. Sci. 2004;45(13):4859.
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Background: Trauma, including corneal lacerations, is the most common cause of unilateral blindness in the United States. Purpose: To evaluate demographics, initial presentation, clinical course, and outcomes of patients with corneal lacerations and associated anterior segment trauma. Methods: A retrospective chart review of patients admitted to Wills Eye Hospital with a corneal laceration from January 1, 2001 to December 31, 2001 was performed. The Mann–Whitney test was used to compare continuous variables and the Exact Fisher test was used to compare dichotomic variables. Visual outcome was divided into two groups with poor visual outcome defined as VA 20/200 or worse, and good visual outcome defined as VA 20/100 or better. Results: Twenty–nine patients were identified, with an age range of 3–77 (mean 30). There was a male predominance (86%) over females (14%). Racial demographics showed 62% were Caucasian, 31% were African–American, and 7% were Hispanic. Injuries most commonly occurred at home (34%) and in the workplace (34%), followed by outdoor activities (24%), and finally in motor vehicle accidents (10%). Mean follow–up was 11 months (range 1 week–32 months). Thirteen percent of patients were lost to follow–up before 1 month. There was one case of endophthalmitis (3.4%) caused by Bacillus cereus. Patients in the poor outcome group were more likely to have anterior chamber flattening (56% in the poor outcome group compared to 42% in the good outcome group). Individuals with a good outcome had statistically significant better initial visual acuity on presentation than those with a poor outcome (p= 0.01). Subjects with traumatic cataract on presentation were associated with a poor outcome (p= 0.01). Non–statistical differences were observed between the good outcome group compared with the poor outcome group regarding laceration distance from the center of the visual axis (median: 3.1 mm vs. 1.2 mm, p= 0.22), size of the laceration (median: 3.5 mm vs. 4.5 mm, p= 0.12) and the presence of a foreign body (23.1% vs. 44.4%, p=0.38). Of those patients with follow–up at 3–7 months, 60% had a good outcome while 40% had a poor outcome (n=15). At 1 year or more of follow–up, 50% had good visual acuity and 50% had poor visual acuity (n =10). Conclusions: In this study, corneal lacerations requiring hospitalization were more likely to occur in young, Caucasian males. The most common setting of these injuries was in the home. Poor outcome was associated with anterior chamber shallowing. In addition, patients with a traumatic cataract on initial exam were more likely to have a poor visual outcome. Good visual outcome was associated with a better initial visual acuity on presentation.
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