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Danielle Trief, Michael Andreoli, Ankoor Shah, Yoshihiro Yonekawa, Christopher Andreoli; Outcomes and characteristics of open-globe injuries with delayed presentation. Invest. Ophthalmol. Vis. Sci. 2013;54(15):4435.
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Open-globe injury (OGI) is a devastating trauma to the eye. Unfortunately, patients with OGI are sometimes unaware of the damage to their eye or these injuries are missed on initial ophthalmic assessment. This study describes outcomes and characteristics of patients with delayed presentation of OGI and compares them to patients who presented early.
Consecutive patients treated for OGI at Massachusetts Eye and Ear Infirmary (MEEI) between January 1, 2000 and April 6, 2009 were reviewed. Cases where the date of injury was unknown were excluded. Patients were divided into an “early group,“ defined as patients who presented within one calendar day of injury, and a “late group,” defined as patients who presented two or more calendar days after injury. These groups were subsequently analyzed for baseline characteristics such as age, gender, visual acuity, zone of injury, and extent of anterior and posterior injury, and for final visual outcomes.
823 OGIs were treated at MEEI, and 3 patients were excluded for unknown date of injury. Of the 820 OGIs reviewed, 58 were late presenters. The mean age was similar between the two groups (42.0 and 42.8 years in the early and late presenters, respectively). Both early and late presenters had a higher proportion of men compared to women (78.9% men in the early and 77.6% men in the late group). Late presenters were more likely to have better acuity on presentation (Median 20/250) compared to early presenters (Median Hand Motions) (P = 0.0028). Late presenters were less likely to have a zone 3 injury (9.3% compared to 31.3%, P < 0.0001) or hyphema (P = 0.0308) than early presenters. However, the late presentation patients were no less likely to be complicated by vitreous hemorrhage (P = 0.0550), choroidal detachment (P = 1.000), retinal detachment (P = 0.1863), or retinal hemorrhage (P = 1.000). The late presenters were more likely to have better post-operative best visual acuities (median of 20/30 compared to 20/50 for the early presenters, P = 0.0328). There were no cases of endophthalmitis among the late presenters.
Patients with late presentation of OGI had better visual acuity and were less likely to have a posterior location of injury. In the setting of trauma, one must always consider the possibility of an OGI, even when the visual acuity is good, and the exam findings are subtle.
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