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Carolyn P. Graeber, Susan K. Gelman, Ilyse D. Haberman, Jenna H. Friedenthal, Christopher Baker, Shantan Reddy; Traumatic Ruptured Globes at a City Hospital in Manhattan from 2006 to 2010. Invest. Ophthalmol. Vis. Sci. 2011;52(14):5585.
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© ARVO (1962-2015); The Authors (2016-present)
Ruptured globes (RGs) are the source of significant visual morbidity and can ultimately lead to loss of the eye. This study aims to identify the characteristics of RGs at an urban Level I trauma center and to identify factors that are correlated with better visual outcomes and greater change in pre-operative visual acuity (pre-OVA) versus post-operative visual acuity (post-OVA).
The charts of consecutive RGs that were seen in the Bellevue Hospital between April 2006 and June 2010 were retrospectively reviewed with New York University Internal Review Board approval. Pre-OVA, post-OVA, and change in visual acuity (measured in LogMar) were compared with numerous factors to determine predictors of better post-operative results.
Of 41 RGs seen during the study interval, 31 (74%) were men, 20 (49%) were right eyes, 40 (98%) were traumatic (20 blunt trauma, 20 penetrating trauma, and 1 due to corneal pathology), and 4 (9.8%) were enucleated or eviscerated. Loss of the eye was not significantly correlated with location of the rupture (p=0.171).Visual acuity improved significantly after surgical repair (2.85 vs 2.13 LogMar, p=0.001). Patients with pre-OVA of count fingers or better had better post-OVA (0.46 vs 2.65 LogMar, p<0.001) and had greater change in pre-OVA versus post-OVA than those who had hand motion or worse (1.41 vs. 0.50 LogMar, p=0.035).Mean follow-up was 4.0 months, with 11 patients (27%) being lost to follow-up after 1 week. Patients who were lost to follow up had worse best corrected post-OVA than those that were not (3.36 vs. 1.80 LogMar, p<0.001) and their change in pre-OVA versus post-OVA trended toward less change than those who were not (p=0.067).
Surgical repair of ruptured globes at an urban Level I trauma center resulted in significant improvement in vision. Patients with better pre-OVA had both a greater change in vision and a better overall visual outcome than those that had low pre-OVA. Patients with poor vision after repair were less likely to follow up and had less change in their vision. Patients with pre-OVA of hand motion or worse should be counseled about guarded visual prognosis. Given their propensity for loss to follow up, patients with poor post-OVA should be counseled about the importance of follow up since post-operative complications such as infection and sympathetic ophthalmia can cause both further vision loss and loss of the eye.
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