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Elana Meer, Brian Jonathan Nguyen, Sana Bautista, Brendan McGeehan, César A Briceño; Clinical Presentation and Outcomes for Gunshot Wounds to the Orbit. Invest. Ophthalmol. Vis. Sci. 2021;62(8):2634.
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To characterize the clinical presentation, surgical management, long-term complications and outcomes of gunshot wounds to the orbit.
A retrospective chart review was conducted of all cases of gunshot wounds involving the orbit at an academic institution with a level 1 trauma center. Data included patient demographics, clinical presentation and exam over time, surgical intervention, and long-term outcomes. Descriptive statistics were calculated using mean and standard deviation for continuous measures and frequency and percentage for categorical measures. Tests of associations included Fishers exact tests for categorical data, Kruskal-Wallis rank sum tests, ANOVA, and in the case of repeated measures, generalized estimating equations.
88 patients with a history of gunshot wound involving the orbit were included with average age of 32.6 years old. Patient were 85.2% male, 75% African-American, 25% Caucasian, and 5.7% Hispanic. Mean follow up was 8.25 years. While injury varied, 53.4% presented with intracranial injury, 21.6% presented with open globe rupture, 80.7% with orbital fracture, 89.8% with lid laceration, 88.6% with vision loss, 92% with pain, and 76.1% with bullet fragments in the orbit on imaging.Surgery occurred for 59.1% of patients, of which 26.9% underwent primary enucleation, 11.5% evisceration, 44.2% fracture repair, and 17.3% another procedure (craniotomy, complex laceration repair, etc). Long-term complications included abnormal lid or globe position in 26.1% of patients, reduced visual acuity in 55.2%, and persistent pain in 50.6%. Predictors on initial presentation for persistent pain included intracranial injury (p=.003), pain (p=.006), presence of radiographic intraorbital foreign body (bullet/ bullet fragments) (p=.002), abnormal CNV2 sensation (p=.041), and corneal abrasion (p=.031) on clinical exam. Visual acuity improvement over time in individuals who did not receive enucleation or evisceration on presentation was not significant (p = .09). Worsening visual acuity was significantly associated with hyphema, vision loss, and presence of intraorbital foreign body on presentation (p<.05)
To our knowledge, this represents the first, largest clinical epidemiologic study that serves to provide insight into the clinical presentation, surgical intervention, and long-term outcomes of gunshot wounds to the orbit, which will guide both ophthalmologists and trauma physicians
This is a 2021 ARVO Annual Meeting abstract.
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