Abstract
Purpose :
To determine the prognostic factors of zone III open globe injuries (OGI) to better guide management and clinical counselling.
Methods :
Retrospective and prospective data was collected from patients from 13 healthcare institutions worldwide through the IGATES registry. Data collected include demographic information, characteristics of the injury, details of management of injury, initial and final visual acuity (VA) as well as other associated injuries. Statistical analysis was then performed to determine the effect of pre-operative factors on final vision outcomes.
Results :
In total, data from 4138 patients (n=4138) were collected. 681 (16.5%) patients suffered from zone III injuries. Of the 681 patients, 558 (81.9%) patients were male. The mean age of the subjects was 32.4±18.5 years. 166 (24.4%) patients had sharps injury, 401 (58.9%) sustained blunt trauma, 63 (9.3%) had mixed injuries and 31 (4.6%) suffered from other injuries. The mean follow-up duration was 24.2±43.1 weeks (range: 0 to 306 weeks). Of the 647 eyes with initial best corrected visual acuity (BCVA) recorded, 149 (23.0%) patients had BCVA of NLP or PL/PR inaccurate, 151 (23.3%) had BCVA of HM or PL/PR accurate, 136 (21.0%) had BCVA between 19/200 and CF, 106 (16.4%) had BCVA between 20/50 and 20/200 while 105 (16.2%) had BCVA more than or equals to 20/40. In visits between 4 to 11 weeks post-surgery, 65 (58.0%) out of 112 patients had VA poorer than 6/60. In visits between 12 to 24 weeks post-surgery, 110 (65.0%) out of 169 had VA poorer than 6/60. In visits > 24 weeks post-surgery, 10 (30.3%) out of 33 had VA poorer than 6/60. Sub-group analysis was performed on 53 eyes (n=53) fulfilling the study criteria. Poorer initial BCVA, visual axis involvement, presence of RAPD, blunt trauma, presence of conjunctival injury and specific iris injury types (iris prolapse, uveal prolapse and blood clot over the iris) were determined to be poor prognostic factors for zone III OGIs. Notably, there was a statistically significant difference between the different durations from onset of injury to presentation and initial BCVA, but no linear association was established.
Conclusions :
Initial BCVA, visual axis involvement, presence of RAPD and blunt trauma were poor prognostic factors for zone III OGIs. These findings can be used to developed a revised Ocular Trauma Score (OTS-2) in future.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.