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Anjum Cheema, Norman Medow; Ruptured Globes at Montefiore: Causes and Effects. Invest. Ophthalmol. Vis. Sci. 2014;55(13):5471.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate the visual outcomes of ruptured globe repairs and determine prognostic indicators.
Retrospective chart review of all ruptured globe repairs performed at Montefiore Medical Center from 2008 until 2012 with available postoperative visual acuity. Data extracted from charts included age at injury, date of injury, mechanism of injury, site of injury, presence or absence of tissue loss, preoperative visual acuity, visual acuity at last follow up, length of follow up, and subsequent surgeries. Patients with light perception (LP) or no light perception (NLP) vision were excluded from the calculation of average preoperative and postoperative visual acuity.
Twenty eight cases with a mean age of 41.2 years (range 2 to 91 years) were included in the analysis with a mean follow up period of 13.5 months. Average visual acuity overall improved from 20/160 preoperatively to 20/50 at last follow up, with 8 patients (28.6%) suffering from LP or NLP vision. 10 patients (35.7%) retained visual acuities of 20/40 or better, 7 patients (25%) had visual acuities between 20/50 and 20/150, and 11 patients (39.3%) had visual acuities of 20/200 or worse. Blunt injuries had a greater likelihood of LP or NLP vision on presentation compared to sharp injuries (54.5% vs 0%, p = 0.004). Scleral and corneoscleral injuries were more likely than corneal injuries to result in final LP or NLP vision (50% and 100% vs 15% respectively, p = 0.017). Tissue loss occurred in 11/28 cases (39.2%), with a trend to a greater chance of final LP or NLP vision when compared to cases without tissue loss (45.5% vs 12.5%, p=0.08). Overall 12 patients (42.9%) underwent a secondary surgery, with only 1 patient (3.6%) requiring an enucleation.
Primary repairs were highly successful in salvaging open globes, as well as retaining useful vision in the majority of cases. Scleral injuries, corneoscleral injuries, blunt injuries, and the presence of tissue loss resulted in a larger percentage of LP or NLP vision.
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