Skip to main content

Advertisement

Log in

A 10-year review of assault-related open-globe injuries at an urban hospital

  • Trauma
  • Published:
Graefe's Archive for Clinical and Experimental Ophthalmology Aims and scope Submit manuscript

Abstract

Background

To describe the demographics and outcomes of assault-related open-globe injuries (OGI) at University Hospital (UH), Newark, New Jersey over a ten-year period.

Methods

The medical records of all subjects presenting to a single university referral center with an OGI were retrospectively analyzed to identify prognostic factors for enucleation and final visual acuity (VA) of no light perception (NLP).

Results

One hundred and forty-eight eyes of 147 patients presented to UH with assault-related OGI. Eighty-two percent of patients were male, and the mean age was 35.9 years. The anatomic site of the wound was zone 3 in the majority (54.1 %) of eyes. Most common type of injury noted was rupture (57.4 %), followed by penetrating injury (35.1 %). Mean initial presenting and final VA in LogMAR were 2.38 ± 0.12 and 2.18 ± 0.16 respectively. Initial Snellen VA was no light perception (NLP) in 57 eyes (38.5 %); four eyes had an initial VA of ≥20/40 (2.7 %). Final VA was NLP in 68 eyes (45.9 %) of which 46 were enucleated (31.1 %); 18 eyes (12.2 %) had a final VA of ≥20/40. Fifty eyes (33.8 %) underwent pars plana vitrectomy (PPV). Significant risk factors of final VA of NLP or enucleation included initial VA of NLP, perforating or rupture type of OGI, and zone 3 injury. Eyes that sustained penetrating injuries were less likely to have final VA of NLP or require enucleation.

Conclusions

Assault-related OGIs carry an extremely poor visual prognosis and a high rate of enucleations. Only eighteen eyes (12.2 %) recovered VA ≥20/40. We found initial VA of NLP and zone 3 injury to be significant predictors of final VA of NLP or undergoing enucleation. Penetrating injuries were less likely to have a final VA of NLP or an enucleation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  1. Kuhn F, Morris R, Witherspoon CD, Heimann K, Jeffers JB, Treister G (1996) A standardized classification of ocular trauma. Graefes Arch Clin Exp Ophthalmol 234:399–403

    Article  PubMed  CAS  Google Scholar 

  2. Dannenberg AL, Parver LM, Fowler CJ (1992) Penetrating eye injuries related to assault. The National Eye Trauma System Registry. Arch Ophthalmol 110:849–852

    Article  PubMed  CAS  Google Scholar 

  3. Negrel AD, Thylefors B (1998) The global impact of eye injuries. Ophthalmic Epidemiol 5:143–169

    Article  PubMed  CAS  Google Scholar 

  4. United States Eye Injury Registry. Eye Trauma: Epidemiology and Prevention. Available at http://www.useironline.org/Prevention.htm. Last accessed June 1, 2012

  5. Parver LM (1986) Eye trauma. The neglected disorder. Arch Ophthalmol 104:1452–1453

    Article  PubMed  CAS  Google Scholar 

  6. Esmaeli B, Elner SG, Schork MA, Elner VM (1995) Visual outcome and ocular survival after penetrating trauma. A clinicopathologic study. Ophthalmology 102:393–400

    PubMed  CAS  Google Scholar 

  7. Thach AB, Johnson AJ, Carroll RB, Huchun A, Ainbinder DJ, Stutzman RD, Blaydon SM, Demartelaere SL, Mader TH, Slade CS, George RK, Ritchey JP, Barnes SD, Fannin LA (2008) Severe eye injuries in the war in Iraq, 2003–2005. Ophthalmology 115:377–382

    Article  PubMed  Google Scholar 

  8. Sobaci G, Mutlu FM, Bayer A, Karagul S, Yildirim E (2000) Deadly weapon-related open-globe injuries: outcome assessment by the ocular trauma classification system. Am J Ophthalmol 129:47–53

    Article  PubMed  CAS  Google Scholar 

  9. Casson RJ, Walker JC, Newland HS (2002) Four-year review of open eye injuries at the Royal Adelaide Hospital. Clin Exp Ophthalmol 30:15–18

    Article  Google Scholar 

  10. Cruvinel Isaac DL, Ghanem VC, Nascimento MA, Torigoe M, Kara-Jose N (2003) Prognostic factors in open globe injuries. Ophthalmologica 217:431–435

    Article  PubMed  Google Scholar 

  11. May DR, Kuhn FP, Morris RE, Witherspoon CD, Danis RP, Matthews GP, Mann L (2000) The epidemiology of serious eye injuries from the United States Eye Injury Registry. Graefes Arch Clin Exp Ophthalmol 238:153–157

    Article  PubMed  CAS  Google Scholar 

  12. Liggett PE, Pince KJ, Barlow W, Ragen M, Ryan SJ (1990) Ocular trauma in an urban population. Review of 1132 cases. Ophthalmology 97:581–584

    PubMed  CAS  Google Scholar 

  13. Vinger PF (1992) Eye injury resulting from violence. Research and prevention. Arch Ophthalmol 110:765–766

    Article  PubMed  CAS  Google Scholar 

  14. Mader TH, Carroll RD, Slade CS, George RK, Ritchey JP, Neville SP (2006) Ocular war injuries of the Iraqi Insurgency, January–September 2004. Ophthalmology 113:97–104

    Article  PubMed  Google Scholar 

  15. Weichel ED, Colyer MH (2008) Combat ocular trauma and systemic injury. Curr Opin Ophthalmol 19:519–525

    Article  PubMed  Google Scholar 

  16. Eagling EM (1976) Perforating injuries of the eye. Br J Ophthalmol 60:732–736

    Article  PubMed  CAS  Google Scholar 

  17. Gordon YJ, Mokete M (1981) Adult ocular injuries in Lesotho. Doc Ophthalmol 51:187–192

    Article  PubMed  CAS  Google Scholar 

  18. Groessl S, Nanda SK, Mieler WF (1993) Assault-related penetrating ocular injury. Am J Ophthalmol 116:26–33

    PubMed  CAS  Google Scholar 

  19. Johnston S (1971) Perforating eye injuries: a five year survey. Trans Ophthalmol Soc U K 91:895–921

    PubMed  CAS  Google Scholar 

  20. Lambah P (1969) Adult eye injuries at Wolverhampton. Trans Ophthalmol Soc U K 88:661–673

    PubMed  CAS  Google Scholar 

  21. Landen D, Baker D, LaPorte R, Thoft RA (1990) Perforating eye injury in Allegheny County, Pennsylvania. Am J Public Health 80:1120–1122

    Article  PubMed  CAS  Google Scholar 

  22. Niiranen M (1981) Perforating eye injuries treated at Helsinki University Eye Hospital 1970 to 1977. Ann Ophthalmol 13:957–961

    PubMed  CAS  Google Scholar 

  23. Punnonen E (1989) Epidemiological and social aspects of perforating eye injuries. Acta Ophthalmol (Copenh) 67(5):492–498

    Article  CAS  Google Scholar 

  24. Roper-Hall MJ (1959) The treatment of ocular injuries. Trans Ophthalmol Soc U K 79:57–69

    PubMed  CAS  Google Scholar 

  25. Rufer F, Peters A, Klettner A, Treumer F, Roider J (2010) Influence of alcohol consumption on incidence and severity of open-globe eye injuries in adults. Graefes Arch Clin Exp Ophthalmol 249:1765–1770

    Article  PubMed  Google Scholar 

  26. Scherf J, Zonis S (1976) Perforating injuries of the eye. Eye Ear Nose Throat Mon 55:32–40

    PubMed  CAS  Google Scholar 

  27. Tielsch JM, Parver L, Shankar B (1989) Time trends in the incidence of hospitalized ocular trauma. Arch Ophthalmol 107:519–523

    Article  PubMed  CAS  Google Scholar 

  28. Kim JH, Yang SJ, Kim DS, Kim JG, Yoon YH (2007) Fourteen-year review of open globe injuries in an urban Korean population. J Trauma 62:746–749

    Article  PubMed  Google Scholar 

  29. Hyun Lee S, Ahn JK (2010) Emergent risk factors associated with eyeball loss and ambulatory vision loss after globe injuries. J Trauma 69:195–198

    Article  PubMed  Google Scholar 

  30. Rahman I, Maino A, Devadason D, Leatherbarrow B (2006) Open globe injuries: factors predictive of poor outcome. Eye 20:1336–1341

    Article  PubMed  CAS  Google Scholar 

  31. Colyer MH, Chun DW, Bower KS, Dick JS, Weichel ED (2008) Perforating globe injuries during operation Iraqi Freedom. Ophthalmology 115:2087–2093

    Article  PubMed  Google Scholar 

  32. Barak A, Elhalel A, Pikkel J, Krauss E, Miller B (2011) Incidence and severity of ocular and adnexal injuries during the Second Lebanon War among Israeli soldiers and civilians. Graefes Arch Clin Exp Ophthalmol 249(12):1771–1774

    Article  PubMed  Google Scholar 

  33. Rofail M, Lee GA, O’Rourke P (2006) Prognostic indicators for open globe injury. Clin Exp Ophthalmol 34:783–786

    Article  Google Scholar 

  34. Hatton MP, Thakker MM, Ray S (2002) Orbital and adnexal trauma associated with open-globe injuries. Ophthal Plast Reconstr Surg 18:458–461

    Article  PubMed  Google Scholar 

  35. Babar TF, Khan MT, Marwat MZ, Shah SA, Murad Y, Khan MD (2007) Patterns of ocular trauma. J Coll Phys Surg Pak 17:148–153

    Google Scholar 

  36. Salehi-Had H, Andreoli CM, Andreoli MT, Kloek CE, Mukai S (2009) Visual outcomes of vitreoretinal surgery in eyes with severe open-globe injury presenting with no-light-perception vision. Graefes Arch Clin Exp Ophthalmol 247:477–483

    Article  PubMed  Google Scholar 

  37. Savar A, Andreoli MT, Kloek CE, Andreoli CM (2009) Enucleation for open globe injury. Am J Ophthalmol 147:595–600

    Article  PubMed  Google Scholar 

  38. Heidari E, Taheri N (2010) Surgical treatment of severely traumatized eyes with no light perception. Retina 30:294–299

    Article  PubMed  Google Scholar 

  39. Feng K, Hu YT, Ma Z (2011) Prognostic indicators for no light perception after open-globe injury: Eye Injury Vitrectomy Study. Am J Ophthalmol 152:654–662

    Article  PubMed  Google Scholar 

  40. Arroyo JG, Postel EA, Stone T, McCuen BW, Egan KM (2003) A matched study of primary scleral buckle placement during repair of posterior segment open globe injuries. Br J Ophthalmol 87:75–78

    Article  PubMed  CAS  Google Scholar 

  41. Kuhn F, Morris R, Witherspoon CD (2002) Birmingham Eye Trauma Terminology (BETT): terminology and classification of mechanical eye injuries. Ophthalmol Clin North Am 15:139–143

    Article  PubMed  Google Scholar 

  42. Pieramici DJ, Sternberg P Jr, Aaberg TM Sr, Bridges WZ Jr, Capone A Jr, Cardillo JA, De Juan E Jr, Kuhn F, Meredith TA, Mieler WF, Olsen TW, Rubsamen P, Stout T (1997) A system for classifying mechanical injuries of the eye (globe). The Ocular Trauma Classification Group. Am J Ophthalmol 123:820–831

    PubMed  CAS  Google Scholar 

  43. Kuhn F, Maisiak R, Mann L, Mester V, Morris R, Witherspoon CD (2002) The Ocular Trauma Score (OTS). Ophthalmol Clin North Am 15:163–165

    Article  PubMed  Google Scholar 

  44. Koo L, Kapadia MK, Singh RP, Sheridan R, Hatton MP (2005) Gender differences in etiology and outcome of open globe injuries. J Trauma 59:175–178

    Article  PubMed  Google Scholar 

  45. Entezari M, Rabei HM, Badalabadi MM, Mohebbi M (2006) Visual outcome and ocular survival in open-globe injuries. Injury 37:633–637

    Article  PubMed  Google Scholar 

  46. Rao LG, Ninan A, Rao KA (2010) Descriptive study on ocular survival, visual outcome and prognostic factors in open globe injuries. Indian J Ophthalmol 58:321–323

    Article  PubMed  Google Scholar 

  47. Knyazer B, Levy J, Rosen S, Belfair N, Klemperer I, Lifshitz T (2008) Prognostic factors in posterior open globe injuries (zone-III injuries). Clin Exp Ophthalmol 36:836–841

    Article  Google Scholar 

  48. Schmidt GW, Broman AT, Hindman HB, Grant MP (2008) Vision survival after open globe injury predicted by classification and regression tree analysis. Ophthalmology 115:202–209

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

The research in this project was supported by Research to Prevent Blindness, Inc., The New Jersey Lions Eye Research Foundation, and the Eye Institute of New Jersey.

The authors of this manuscript have no financial relationship with the organization that funded this research.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Neelakshi Bhagat.

Additional information

The authors have full control of all primary data of this research, and agree to allow Graefe’s Clinical and Experimental Ophthalmology to review upon their request.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Bauza, A.M., Emami, P., Soni, N. et al. A 10-year review of assault-related open-globe injuries at an urban hospital. Graefes Arch Clin Exp Ophthalmol 251, 653–659 (2013). https://doi.org/10.1007/s00417-012-2136-z

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00417-012-2136-z

Keywords

Navigation