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Characteristics and outcomes of fall-related open-globe injuries in pseudophakic patients

Authors Kavoussi S, Slade M, Meskin S, Adelman R

Received 4 September 2014

Accepted for publication 7 October 2014

Published 27 February 2015 Volume 2015:9 Pages 403—408


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 3

Editor who approved publication: Dr Scott Fraser

Shaheen C Kavoussi,1 Martin D Slade,2 Seth W Meskin,1 Ron A Adelman1

1Department of Ophthalmology and Visual Science, 2Department of Occupational and Environmental Medicine, Yale University School of Medicine, New Haven, CT, USA

Aim: We aimed to identify the characteristics and prognostic indicators of poor visual and anatomic outcome in pseudophakic patients with fall-related open-globe (OG) injuries. We used a case series design, for a total of 26 patients.
Methods: Charts of consecutive pseudophakic patients with fall-related OG injury at a single institution were reviewed. Demographics, ophthalmic history, circumstances of injury, initial best-corrected visual acuity (BCVA), examination findings, surgical interventions, and follow-up BCVA were tabulated for statistical analysis with unpaired t-tests and Fisher’s exact tests.
Results: Nineteen patients (73%) were women. Mean (± standard deviation) age was 80.6±4.6 years (range: 61–97 years). Initial BCVA was <20/400 in 24 of 25 patients (96%). Mean ocular trauma score (OTS) was 38.54±10.95. OTS was lower (P=0.0017, P<0.0001, and P=0.0240) and wound size was larger (P=0.0440, 0.0145, and 0.0026) in patients with final BCVA <20/40, <20/400, and phthisis at final follow-up, respectively; compared to patients with BCVA ≥20/40, 20/400, and no phthisis at final follow-up, respectively. Final BCVA <20/400 was associated with 360° subconjunctival hemorrhage (SCH), retinal detachment, and proliferative vitreoretinopathy (P=0.0498, 0.0181, and 0.0310, respectively). Total hyphema, intraocular lens (IOL) damage, and IOL expulsion were associated with needing multiple surgical interventions (P=0.0345, P<0.0001, and P=0.0023, respectively).
Conclusion: Large wound size, low OTS, 360° SCH, total hyphema, posterior injury, and IOL damage are common findings that are also prognostic of poor visual and anatomic outcome in pseudophakic patients with fall-related OG injuries. Ophthalmologists dealing primarily with geriatric populations should contribute to the discussion of fall risk.

Keywords: fall, injury, open globe, pseudophakia, trauma

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