Abstract
Purpose :
Ocular trauma is a significant cause of visual loss. Zone 1 injury is considered favorable prognostically compared to more posterior injuries, however, the same favorable prognosis may not be true for dehiscenced corneal wounds. The goal is to determine if this paradigm holds true for all situations, including wound dehiscence, or just primary traumatic injuries.
Methods :
Retrospective chart review of all patients who underwent open globe repair based on CPT codes at University Hospital, Newark, NJ from 1/1/2019 to 12/1/2020. Those with Zone 1 injuries were identified and presenting vision, final visual outcomes, associated ocular pathology, long term complications, and need for further surgeries were reviewed. Zone 1 injuries were defined as all injuries limited to the cornea from limbus to limbus.
Results :
58 eyes were identified- 38 primary trauma and 20 dehisced wounds (11 PKP, 5 clear corneal incisions, 1 laceration, 1 ECCE, 1 RK, 1 tectonic graft). All dehisced wounds were blunt trauma and all primary traumas were projectiles or sharp penetrating injuries. Dehisced wounds had more posterior segment pathology i.e. hemorrhagic choroidal, vitreous hemorrhage, retinal detachment, choroidal effusion (all 20% v 2.63%, 5.26%, 5.26%, and 0% respectively), vitreous prolapse (20% v 2.63%) and uveal prolpase (80% v 36.84%). Dehisced wounds had more traumatic aphakia (40% v 0%) and dislocated lenses (15% v 0%). Primary trauma was more likely to have traumatic cataracts (55.26% v 10%) or no lens changes (44.74% v 25%). 2 dehisced wounds required enucleation, while no primary traumas were enucleated. Cataract/secondary intraocular lens surgery was performed in 34% of the primary traumas (10% in dehisced wounds). Primary traumas achieved 20/40 vision or better 44.74% (10% dehisced wounds). 7.89% patients with wound dehiscence ended NLP (none in primary trauma).
Conclusions :
Dehisced wound patients had poorer visual outcomes as well as a higher rate of posterior segment pathology and expulsion of intraocular contents (lens, vitreous, and uvea). More important than the zone of injury is the mechanism. Ruptured globe as defined by Birmingham Eye Trauma Terminology likely portends poorer prognosis while penetrating and lacerating injuries by the same classification system likely a better prognosis, and as such, we believe that the traditional classification of zone of injury being a predictive factor of visual outcome is outdated.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.