Date Published: January 20, 2017
Publisher: Public Library of Science
Author(s): Hiroki Kaneko, Tetsu Asami, Tadasu Sugita, Taichi Tsunekawa, Toshiyuki Matsuura, Kei Takayama, Kentaro Yamamoto, Shu Kachi, Yasuki Ito, Shinji Ueno, Norie Nonobe, Keiko Kataoka, Ayana Suzumura, Takeshi Iwase, Hiroko Terasaki, Demetrios G. Vavvas.
Ocular trauma is one of the leading causes of visual impairment worldwide. Because of the popularity of cataract surgeries, aged individuals with ocular trauma commonly have a surgical wound in their eyes. The purpose of this study was to evaluate the visual outcome of cases that were coincident with intraocular lens (IOL) ejection in the eyes with ruptured open-globe ocular injuries. Consecutive patients with open-globe ocular injuries were first reviewed. Patients’ characteristics, corrected distance visual acuities (CDVAs) over 3 years after the trauma, causes of injuries, traumatic wound patterns, and coexistence of retinal detachment were examined. The relationships between poor CDVA and the other factors, including the complications of crystalline lens and IOL ejection, were examined. A total of 105 eyes/patients [43 eyes with rupture, 33 with penetrating, 28 with intraocular foreign body (IOFB), and 1 with perforating injuries] were included. Rupture injuries were common in aged patients and were mostly caused by falls, whereas penetrating and IOFB injuries were common in young male patients. CDVAs of the eyes with rupture injuries were significantly worse than those of the eyes with penetrating or IOFB injuries. CDVA from more than 50% of the ruptured eyes resulted in no light perception or light perception to 20/500. CDVA of the ruptured eyes complicated by crystalline lens ejection was significantly worse than that of those complicated by IOL ejection. The wounds of the ruptured eyes complicated by IOL ejection were mainly located at the superior corneoscleral limbus, whereas those of the eyes complicated by crystalline lens ejection were located at the posterior sclera. There were significant correlations between poor CDVA and retinal detachment and crystalline lens ejection. These results proposed a new trend in the ocular injuries that commonly occur in aged patients; history of cataract surgery might affect the final visual outcome after open-globe ocular injuries.
Ocular trauma is one of the leading causes of visual impairment worldwide. Epidemiologic analysis has revealed that the cumulative lifetime prevalence of ocular trauma is approximately 20% . In particular, open-globe injuries commonly cause severe visual impairment and blindness, at worst, and require immediate diagnosis and ophthalmologic intervention [2–6]. Feng et al. reported that a rupture, an open globe with a full-thickness wound more than 5 mm posterior to the corneoscleral limbus, a scleral wound of >10 mm, ciliary body damage, severe intraocular hemorrhage, a closed funnel retinal detachment (RD) or retinal prolapse, and choroidal damage are risk factors for no light perception (NLP) in eyes with a traumatized open-globe injury .
In this study, we focused not only on the general characteristics in the ruptured eyes but also on the difference of the visual outcome based on the difference in the lens complications.