Clinical Characteristics and Treatment Outcome of Surgically Treated Open Globe Injuries in a Tertiary Eye Hospital

Author(s): Bini Sukumaran Thulasi1 , Reena Abdul Rasheed2

BACKGROUND Open globe injuries are ocular emergencies which require appropriate surgical treatment. We analyzed the presenting clinical characteristics, factors affecting the final visual outcome of open globe injuries over a 12 months period in a tertiary eye care center. METHODS This is a prospective observational non comparative interventional study, analysing 112 eyes of 111 patients admitted with open globe injuries at Regional Institute of Ophthalmology, South Kerala, India, from March 2018 to February 2019. Detailed history of trauma, eye examination, and visual assessment were done at the time of admission. Major outcome measure was final best corrected visual acuity (BCVA) at the end of follow up period of 6 months and important factors affecting final visual outcome. Role of additional clinical signs like presence of hyphaema, traumatic cataract, vitreous haemorrhage, retinal detachment, and prolapse of intraocular contents at the time of presentation were noted and these factors were separately analysed with final BCVA. RESULTS Mean age of presentation was 39.8 ± 20.5 years. 79.5 % patients (89 eyes) were males and 20.5 % (23 eyes) were females. 38.4 % patients (43 eyes) had injuries at work place, and 61.6 % (69 eyes) were non-work related but happened outdoor. Remaining 38.4 % of the injuries (43 eyes) occurred at home. Most common agent causing injury was metal piece in 34.8 % (39 eyes). 57.1 % of the patients (64 eyes) had BCVA of more than 6 / 18 Snellen’s vision, 12.5 % had (14 eyes) BCVA ranging 6 / 18 - 6 / 60, 19 patients (17 %) had final vision between 6 / 60 - 3 / 60. Fifteen eyes (13.4 %) had vision less than 3 / 60 which is equivalent to legal blindness as per WHO (World Health Organization) classification. Among them, 10 eyes lost vision completely and ended up with no perception of light (NO PL). CONCLUSIONS Majority of the patients with open globe injuries were young males in productive age group and open globe injuries are a major cause for morbidity in these groups. As per our observations in this study injuries happen equally at home and work place. Major poor prognostic factors deciding final visual outcome were presence of additional clinical features including hyphaema, vitreous haemorrhage, retinal detachment and prolapse of intraocular contents at the time of presentation. Based on our observations in this study, we recommend better implementation of health education and awareness campaigns, appropriate preventive and prophylactic measures with regular monitoring of adequate use of protective goggles and shields at work place for high risk group.