September 2016
Volume 57, Issue 12
Open Access
ARVO Annual Meeting Abstract  |   September 2016
Outcomes of Open Globe Injury Repair in an Underserved Population at a Level I Trauma Center: The Los Angeles County + University of Southern California (LAC+USC) Experience
Author Affiliations & Notes
  • Sun Young Lee
    Ophthalmology , Keck Eye Institute, Univ of Sthrn California, Los Angeles, California, United States
  • Dagny Zhu
    Ophthalmology , Keck Eye Institute, Univ of Sthrn California, Los Angeles, California, United States
  • Nitish Mehta
    Ophthalmology , New York University, New York City , New York, United States
  • Jesse L Berry
    Ophthalmology , Keck Eye Institute, Univ of Sthrn California, Los Angeles, California, United States
  • Footnotes
    Commercial Relationships   Sun Young Lee, None; Dagny Zhu, None; Nitish Mehta, None; Jesse Berry, None
  • Footnotes
    Support  Unrestricted Grant from Research to Prevent Blindess, New York, NY 10022
Investigative Ophthalmology & Visual Science September 2016, Vol.57, 6397. doi:
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      Sun Young Lee, Dagny Zhu, Nitish Mehta, Jesse L Berry; Outcomes of Open Globe Injury Repair in an Underserved Population at a Level I Trauma Center: The Los Angeles County + University of Southern California (LAC+USC) Experience. Invest. Ophthalmol. Vis. Sci. 2016;57(12):6397.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : As the single largest healthcare provider in Los Angeles County, LAC+USC Medical Center treats dozens of medically underserved patients with open globe injuries (OGI) each year. Few studies have addressed OGI outcomes in indigent populations and the challenges that they present. We sought to identify factors predictive of final visual outcome, secondary complications, and overall compliance in this unique urban population.

Methods : A retrospective chart review of patients who underwent surgical repair of OGI from Jan 2009 to Dec 2014 at LAC+USC Medical Center was performed. 59 eyes with OGI were identified. Data was collected in accordance to the Birmingham Eye Trauma Terminology System (BETTS). Statistical analyses were done using chi-square and t-tests.

Results : Of the 59 eyes with OGI, 47% were classified as zone I, 22% zone II, and 31% zone III. The most common type of injury was penetrating (54%), following by rupture (25%), intraocular foreign body (15%), and perforating (5%). Mean age of patients was 39 years. The majority were male (85%) and Latino (76%). 20% of patients presented to the ophthalmologist >24h after initial injury. 19% of patients had complex social histories including incarceration, mental illness, or substance abuse. Visual acuity was no better than hand motion in 35 eyes (59%) pre-op and 28 eyes (47%) post-op. Presence of hyphema, uveal prolapse, traumatic cataract, vitreous hemorrhage, and retinal detachment were associated with poorer final visual outcome (P<0.05). Zone III injury, globe rupture, and hyphema were associated with no light perception vision (n = 10 eyes or 18%) (P<0.01). There were 4 cases (7%) of endophthalmitis. Mean follow-up time was 328 days, but 16 patients (27%) were lost to follow-up within 1 month.

Conclusions : Hyphema, uveal prolapse, traumatic cataract, vitreous hemorrhage, and retinal detachment were all factors predictive of poorer final visual outcome. In particular, zone III injury, globe rupture, and hyphema were associated with severe vision loss. Coexisting social factors, delayed patient presentation, and poor follow-up were common in this population and likely associated with poorer outcomes seen.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.

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