Jakobczyk-Zmija M., Spraul C. W., Stahl B., Wagner P., Lang G. K.

Department of Ophthalmology, University of Ulm, Germany

Background: To describe mechanisms and injury characteristics influencing visual outcomes in eyes with open-globe injuries admitted to a tertiary eye care center.
Method: In a retrospective observational study we identified all consecutive patients with open-globe ocular trauma admitted to the Eye-Hospital of the University of Ulm, Germany, over a four-year period from 1990 to 1994 using hospital medical records. The retrieved data contained age, sex, cause of injury, type of injury with regard to injured anatomical structures, complication, number of surgical procedures, development of visual acuity and socioeconomic impact of the injuries.
Result: A total of 283 open-globe injuries in 280 consecutive patients were available for this study. The risk for this kind of injury was greatest among 21-to-30- year-old individuals (23%, n=65) and among men (81%, n=228). The home was in 57% (n=161) the most common injury setting, followed by the work place with 43% (n=119). In 47. % of all cases only the anterior segment was involved. Injuries of the posterior segment occurred in 52.6 % of cases. In 59 % of cases there was involvement of the lens, in 38.5 % of cases damage to the retina, and in 30 % of cases an intraocular foreign body was present. Anterior segment injuries were associated with a significant better visual outcome (50 % of patients had a visual acuity of 20/40 or better) as compared to posterior segment injuries (30.9 % had a visual acuity of 20/40 or better and 42.3 % a visual acuity of worse than 0.1). Nine percent (14 eyes) were enucleated within 2 weeks of hospital admission. These cases frequently were the result of posterior segment involvement with serious anatomical damage, severe pain or risk of sympathetic ophthalmia. Development of sympathetic ophthalmia was not observed in this study.
Conclusions: Ocular perforation remains an important cause of avoidable and, predominantly, monocular visual morbidity, with over half of the injuries occurring in the home. Health education and safety strategies should targeting the home for the prevention of the serious eye injuries in addition to the traditional work, sports, and leisure environments and their related activities. Although surgical techniques have improved including the development of pars plana vitrectomy the prognosis of this kind of trauma may be still limited. We were able to observe a decrease of the frequency of the development of phthisis and enucleation following ocular trauma during the study period. Evaluation of trauma mechanism and injury characteristics according to the Ocular Trauma Classification System seems to predict visual outcomes in this series of open-globe injuries.

Copyright © Deutsche Ophthalmologische Gesellschaft, 2001. All rights reserved.

Last updated: 

Webdesign: SPALLEK.COM