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E. M. Salcone, M. T. Andreoli, C. M. Andreoli, C. Kloek; Extracapsular Cataract Extraction Wound Rupture in Trauma: Demographics and Outcomes. Invest. Ophthalmol. Vis. Sci. 2007;48(13):5457.
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Our aim was to evaluate the frequency, demographics, and clinical outcomes of ruptured large-incision (nucleus expression) extracapsular cataract extraction (ECCE) wounds due to trauma. These outcomes may be useful in counseling patients as well as in risk-stratification based on presentation after injury.
In a retrospective case series study, all ruptured globe injuries presenting to the Massachusetts Eye and Ear Infirmary from January 2000 to July 2006 were reviewed. Characteristics evaluated include age, gender, final best-corrected visual acuity, mechanism of injury, ocular events during the initial repair and recovery period, and final clinical outcome of the globe.
42 of 641 total ruptured globes between 1/1/2000 and 7/1/2006 were ruptured ECCE wounds (6.6%). Of all open-globes over the age of 65, over a third were ECCE wound ruptures (39/109; 36%). The mean age of traumatic ECCE wound dehiscence was considerably higher than that of all ruptured globe injuries (83.42 vs. 43.18; p<0.002)). Twice as many women experienced ECCE wound dehiscence as men (28 vs.14). 27 of 42 ECCE wound ruptures occurred secondary to fall (64%). 86% were due to all forms of blunt injury (including fall) and only 2 ECCE ruptures occurred during a motor vehicle accident. Best corrected visual acuity (BCVA) outcomes were as follows: 9 of 38 ECCE wound ruptures (24%) had a BCVA outcome of 20/400 or better, and 76% had count fingers vision or worse (no follow-up data available on 4 patients). Conversely, of the 587 non-ECCE ruptured globes for which final BCVA is available, 61% had a final visual outcome of 20/400 or better and 39% had finger-counting vision or worse. Of note, 64% of ECCE ruptured globes had associated retinal pathology.
Ruptured ECCE wounds comprise a significant percentage of ruptured globes in the elderly population. These injuries occur most commonly in elderly women and frequently result from a fall. Compared to visual outcomes of all other open-globes, visual outcomes in ECCE ruptured globes are poor, with only a quarter of cases seeing better than 20/400. Despite the limbal location of ECCE wounds, a majority of cases had associated retinal pathology, likely explaining the poor visual outcome in this subset of patients.
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