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J. B. Ciralsky, C. M. Andreoli, M. T. Andreoli, R. Wee, C. E. Kloek; Outcomes and Prognostic Factors in Traumatic Corneal Lacerations. Invest. Ophthalmol. Vis. Sci. 2008;49(13):2345. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
To review the demographics, visual outcomes, and prognostic factors in Zone I (cornea-involving) open globes without scleral extension.
Retrospective review of patients with open globe injuries presenting to the Massachusetts Eye and Ear Infirmary between January 1, 2000 and November 10, 2006. Patients with Zone II or Zone III (scleral involving) injuries were excluded. Of the 632 patients screened, 211 patients (33.4%) were found to have purely Zone I injuries.
Of the 211 patients with Zone I injuries, 181 were male and 30 were female with an average age of 34 years. The most common mechanism of injury involved a projectile (26.1%), followed by a nail (20.2%), blunt force (13.3%), and wood (9.9%). Pre-operative vision measured 20/400 or better in 49.8% and count fingers or worse in 45.0%. Patients attained a best-corrected visual acuity post-operatively of 20/40 or better in 71.6%, 20/400 or better in 86.1% and count fingers or worse in 13.9%. Patients were subdivided into three groups according to post-operative visual acuity: (I) 20/40 or better (II) 20/50-20/400 and (III) count fingers or worse. Subgroup analysis showed that pre-operative visual acuity was a strong predictor of post-operative visual acuity. 52% of group I patients started with 20/150 or better visual acuity; only 31% of group II and 0.07% of group III patients had pre-operative visual acuity of 20/150 or better. Group III patients had a higher incidence of retinal detachments, afferent pupillary defects, hyphemas, and increased intraocular pressure post-operatively. Cataracts were seen in all three groups in similar proportions.
Traumatic open globe injuries are most often associated with significant visual impairment and visual morbidity. In our study of open globes limited to zone I, poor prognostic factors included an afferent pupillary defect, hyphema, retinal detachment, and decreased visual acuity pre-operatively. Surprisingly, our study found that the majority (71.6%) of patients with Zone I open globes achieved a best corrected visual acuity of 20/40 or better as compared to 45.1% of all open globes in our database and 32.4% of open globes involving Zone II or III. Thus, patients with injuries limited to Zone I may carry a less somber prognosis.
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