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Ee Lin Ong, Kelvin Zhenghao Li, Catherina Goenadi, Wai Kitt Chee, Eunice Goh, Jason Cheng; Predictors of Visual Outcome in Open Globe Injuries. Invest. Ophthalmol. Vis. Sci. 2016;57(12):6393. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
To identify pre-operative variables which prognosticate final visual outcome of open globe injuries after surgical repair.
A retrospective chart review was performed on consecutive patients who had surgical repair of open globe injuries from January 2010 to June 2015 at a general teaching hospital in Singapore. Univariate logistic regression analysis was performed on the following pre-operative variables: presenting visual acuity (VA), mode of injury, the presence of afferent pupillary defect, retinal detachment or endophthalmitis; time between injury and surgery, number of surgeries, post-operative complications and concomitant involvement of ocular and extraocular structures. Additionally, subjects who had computed tomography (CT) imaging performed at presentation were analysed for its prognostic implications on visual outcomes. Best-corrected visual acuity at 6 months after the injury was taken as the dependent variable.
A total of 83 patients with surgically confirmed open globe injuries were identified. Most injuries were occupational (69.9%), in young male foreign workers (52%) and occurred with penetrating injuries from projectile sources (75.9%). Non-occupational injuries tend to be from blunt trauma during a fall in an older age group (21%). At 6 months post-surgical repair, 53% of patients achieved best-corrected vision of ≥6/12, while visual outcomes remained poor (≤6/36) in 29%. Ocular trauma which was involving the visual axis (p=0.048), or associated with hyphaema (p<0.001), vitreous loss (p=0.003) or endophthalmitis (p=0.027) correlated significantly with visual impairment post-repair. Subjects who presented with poor initial vision (p<0.001) or had multiple surgeries (p=0.006) were also more likely to suffer from poor visual outcomes. Positive identification of open globe injury on radiographic imaging was also associated with poorer visual prognosis. (p=0.016)
Open globe injuries are an often preventable cause of permanent visual impairment, although our results show that VA can still be recover to ≥6/12 in 53% of our cases. Pre-operative variables such as multiple operations, poor initial vision or injuries involving other ocular structures or the visual axis are associated with poor visual outcome. These factors would be helpful for evidence-based assessment of open globe injury and assist in pre-operative prognosis counselling.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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