Article
Changing demographics in ocular trauma: Review of the past 30 years at the Wilmer Eye Institute
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Authors
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Michael Grant
- Baltimore/USA
| Published: | June 18, 2008 |
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Outline
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Purpose: To evaluate a recent series of patients who presented to the Wilmer Eye Institute with open-globe injuries and to compare this series with previous series collected at the Wilmer Eye Institute and to identify recent epidemiologic trends and types of injuries at risk for poorer outcomes.
Methods: A retrospective analysis of 225 eyes of consecutive patients presenting to the Wilmer Eye Institute with open-globe injuries between January of 2001 and December of 2004 was performed. Demographic information, setting and mechanism of injury, location and extent of injury, and initial exam findings were recorded. Imaging techniques utilized were also documented. Medical and primary surgical interventions were collected as well as information regarding complications and secondary surgical interventions. Data on follow-up length, final visual acuity, and ocular status (enucleation, evisceration, pthsis) were also collected. Findings were compared to prior series [1970-1981 (Group A), 1985-1993 (Group B)] conducted on open-globe injuries at the Wilmer Eye Institute.
Results: Two hundred twenty-five traumatic open-globe injuries were identified. There was a slight decrease in overall enucleation rates as compared to prior studies, however, 49% of patients had no or very limited vision (VA < 5/200) at last follow-up. Fifty-two percent of the open-globe injuries were secondary to a rupture mechanism, and this percentage has grown over the last 75 years. Ruptures had poor visual acuity outcomes with 42% of ruptures ending with no light perception vision, enucleation, or evisceration. Major causes of ruptured globes included assaults, accidents, falls, and motor vehicle accidents.
Conclusions: The percentage of rupture-induced injuries has increased at the Wilmer Eye Institute over the past 75 years, with the majority of current open-globe injuries secondary to this mechanism of injury. Ruptured globes have very poor visual acuity outcomes. Assaults, falls, and motor vehicle accidents have been identified as major causes of ruptured globes and may present an opportunity for intervention and injury prevention.
