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Nishant G. Soni, Alain Bauza, Jung Hoon Son, Marco Zarbin, Neelakshi Bhagat; Epidemiology And Outcomes Of Open-globe Injuries With Respect To Zone Of Injury. Invest. Ophthalmol. Vis. Sci. 2011;52(14):5581.
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To evaluate the demographics, characteristics, and outcomes of open-globe injuries with respect to zone of injury.
Retrospective cohort study. 310 eyes (309 patients) sustaining open-globe trauma with known zone of injury who presented to University Hospital in Newark, NJ between January 1, 2001 and December 31, 2008 were identified. Zone of injury (Z) was defined as: Z1-involving cornea and limbus, Z2- 5mm or less posterior to the limbus, Z3- >5mm posterior to the limbus.
Of the 309 patients identified, 228 (74%) were male. The mean age was 35.3 ± 20.9 years (1-96). Mean follow-up was 22.8 months (3-108 months). 141 eyes (46%) had Z1 injury, 83 (27%) Z2 injury, and 86 (28%) Z3 injury. 27% of eyes with Z1 injury had a rupture, compared to 45% Z2 and 49% Z3 injury. Work-related causes were common in Z1 injuries (43% of eyes), while Z2 and Z3 injuries most commonly resulted from assault (25% and 44% respectively). An intraocular foreign body was found in 13% Z1, 1% Z2, and 2% Z3-injured eyes, with metal being the most common material in all zones. 12% of eyes with Z1, 19% with Z2, and 23% with Z3 injury presented with aphakia. A cataract was noted within one week of injury in 47%, 30%, and 35% of Z1, Z2, and Z3-injured eyes respectively. Endophthalmitis was slightly more common in eyes with Z1 injuries (4% of eyes). Mean length of hospital stay was greatest for Z3 injury (6.5 days). Mean number of surgeries that an eye underwent was similar in all zones (2.0, 2.1, and 2.3 surgeries in Z1, Z2, and Z3 injuries respectively). Pars plana vitrectomy (PPV) was performed on 30% Z1, 39% Z2, and 49% Z3-injured eyes. Vitreous hemorrhage was the most common indication for PPV in Z1 injuries (45% of Z1 PPV’s). Retinal detachment (RD) was eventually diagnosed in 11% Z1, 27% Z2, and 40% Z3 injuries. Z1, Z2, and Z3-injured eyes had a mean logMAR final BCVA of 1.05, 1.41, and 2.19 respectively. 13% Z1, 21% Z2, and 54% Z3 injuries resulted in a final BCVA of NLP. Enucleation was performed in 9% Z1, 10% Z2, and 36% Z3 injuries.
Z1 injury may be associated with a better visual prognosis than Z2 and Z3 injuries. One-third of eyes with Z3 injury were enucleated. Approximately 50% of eyes with Z3 injuries underwent PPV; RDR was the most common indication for PPV.
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