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Nicolas Famery, Nicolau Romain, Jean-Louis Bourges, Antoine P Brezin; Perforating wounds observed healthy corneas: a one year observatory report. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):6048.
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Ophthalmic emergencies are numerous pathologies. Some of them impact visual prognosis immediately and need an emergency surgery. Ocular perforating trauma is a part of those emergencies in witch we can found perforating wounds on healthy corneas. There management and there visual outcomes are not well known. We observed this item on a one year period in the ophthalmologic emergency department of Assitance Publique Hôpitaux de Paris (APHP) in Paris (France).
It was a retrospective chart review with all cases of perforating wounds observed on healthy corneas operated between April 1st 2013 and March 31st 2014 in the ophthalmologic emergency department of APHP in Paris (France).
On the observed period, 27562 patients underwent an ophthalmologic examination, 40 eyes had a perforating wound, 29 concerned healthy corneas, 1 file was not available for evaluation. Median age was 33 years old (15 to 96). Sex-ratio was 3/1 (21mens/7womens). There was no predominant side of trauma (14 right eyes/14 left eyes). Eight patients had an ophthalmologic preliminary event. Median size of wound was 4.5mm (±3.8mm). Wound was in the central 3mm of the cornea above 8 corneas (29%), linear for 14 corneas (50%), with extraophthamologic involvement for 27 patients (96%). Average initial visual acuity was 0.32 LogMAR, not countable for 16 patients (57%), in witch 3 no light perception (NLP) (19%). Average follow-up was 138 days (±104.8d). Average final visual acuity was 0.24 LogMAR, not countable for 6 patients (21,4%), in witch the half with NLP. Wounds were sutured with an average of 5.4 stiches (1 to 12), needing of 1.6 surgery per patient, average of 5 appointments in the department. Associated trauma were iris trauma (n=17, 17%), traumatic cataract (n=6, 21%), vitreous issue (n=5, 18%), retinal detachment (n=2, 7%), intravitreous hemorrhage (n=2, 7%), retinal or choroidal bleeding (n=2, 7%), scleral wound (n=8, 29%), intraocular foreign body (n=7, 25%), lid or orbit trauma (n=7, 25%). Endophthalmy was not observed. One evisceration was performed during follow-up.
When the cornea is healthy before traumatism, a perforating wound allow to obtain an average final acuity better than 0.30 LogMAR but can also be responsible for the loss of visual function in 1 case out of 5. This accident is one emergency examination out of 950.
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