Skip to main content
SpringerLink
Log in

Predictive factors of enucleation after open globe injuries

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

Abstract

Background

Trauma is the leading cause of enucleations in the USA. Current information regarding open globe injuries (OGI) is based mainly on data from individual tertiary care centers across the country which might skew the findings towards the population served by these level-one trauma centers. The aim of this study is to evaluate the demographics, characteristics, and risk factors of traumatic enucleations in a large data sample.

Methods

Descriptive cross-sectional observational study using the National Inpatient Sample (NIS) Database from 2002 to 2013. Inpatients with traumatic enucleations were identified using ICD-9 codes. Chi-square and logistic regression analyses were used to identify differences between the enucleated and non-enucleated cohorts and to evaluate the predictive factors of enucleation in OGIs.

Results

Enucleations were performed in 3020 (6.2%) of 48,563 OGIs identified. The average age in the enucleated cohort for males vs. females was 44.7 vs. 62.2 years. In the USA, the highest number of traumatic enucleations occurred in the 21–40 group (41.8%) and the fewest in the 80+ age group (11.8%). The risk of enucleation decreased across the age groups significantly. Compared with the 21–40 age group, the risk of undergoing enucleation was 15% lower in patients 41 to 60 years of age, 35% in patients 61 to 80, and 40% lower in patients over 80. In total, 5.1% OGIs in women and 6.7% of OGIs in men were enucleated. The risk of enucleation was 29% higher in men than in women. The highest absolute number of enucleations was seen in Whites. Compared with Whites, Blacks had a 63% higher risk of enucleation following an OGI. OGIs with rupture-type injury, endophthalmitis, or phthisis were significantly higher odds to be enucleated.

Conclusions

The risk of enucleation following traumatic OGI significantly increased for patients who were in the 21–40 age group, of Black race, or of male gender; the risk also increased if the injury was a rupture-type or associated with endophthalmitis or phthisis. The risk of depression was 75% higher in enucleated patients versus non-enucleated patients.

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

Access this article

Log in via an institution

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

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Erie JC, Nevitt MP, Hodge D, Ballard DJ (1992) Incidence of enucleation in a defined population. Am J Ophthalmol 113(2):138–144

    Article  CAS  PubMed  Google Scholar 

  2. Setlur VJ, Parikh JG, Rao NA (2010) Changing causes of enucleation over the past 60 years. Graefes Arch Clin Exp Ophthalmol 248(4):593–597

    Article  PubMed  Google Scholar 

  3. Chan S, Wah S (2017) A decade of surgical eye removals in Ontario: a clinical-pathological study. Can J Ophthalmol 52(5):486–493

    Article  PubMed  Google Scholar 

  4. Farokhfar A, Ahmadzadeh-Amiri A, Sheikhrezaee MR, Gorji MAH, Agaei N (2017) Common causes of eye Enucleation among patients. J Nat Sci Biol Med 8(2):150–153

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Savar A, Andreoli MT, Kloek CE, Andreoli CM (2009) Enucleation for open globe injury. Am J Ophthalmol 147(4):595–600

    Article  PubMed  Google Scholar 

  6. Dunn ES, Jaeger EA, Jeffers JB, Freitag SK (1992) The epidemiology of ruptured globes. Ann Ophthalmol 24(11):405–410

    CAS  PubMed  Google Scholar 

  7. Klopfer J, Tielsch JM, Vitale S, See L, Canner JK (1992) Ocular trauma in the United States: eye injuries resulting in hospitalization, 1984 through 1987. Arch Ophthalmol 110(6):838–842

    Article  CAS  PubMed  Google Scholar 

  8. May DR, Kuhn FP, Morris RE, Witherspoon CD, Danis RP, Matthews GP (2000) The epidemiology of serious eye injuries from the United States eye injury registry. Graefes Arch Clin Exp Ophthalmol 238(2):153–157

    Article  CAS  PubMed  Google Scholar 

  9. Framme C, Roider J (1999) Epidemiology of open globe injuries. Klin Monatsbl Augenheilkd 215(5):287–293

    Article  CAS  PubMed  Google Scholar 

  10. Lundin AM, Azari AA, Kanavi MR, Potter HD, Lucarelli MJ, Burkat CN, Albert DM (2014) Ocular trauma resulting in Enucleation: a 12-year experience from a large regional institution. WMJ. 113(3):99–101

    PubMed  Google Scholar 

  11. Emami-Naeini P, Bauza AM, Langer PD, Zarbin MA, Bhagat N (2013) Gender disparities in open globe injuries: ten-year review of an urban population. Br J Med Res 3(4):1380–1387

    Article  Google Scholar 

  12. Burstein ES, Lazarro DR (2013) Traumatic ruptured globe eye injuries in a large urban center. Clin Ophthalmol 7:485–488

    Article  PubMed  PubMed Central  Google Scholar 

  13. Loy KC, Obrieze A (2015) Disparities in the treatment of open globe injuries. Invest Ophthalmol Vis Sci 56(7):6035

    Google Scholar 

  14. Bauza AM, Emami P, Son JH, Langer P, Zarbin MA, Bhagat N (2013)Work-related open-globe injuries: demographics and clinical characteristics. Eur J Ophthalmol 23(2):242–248

    Article  PubMed  Google Scholar 

  15. Bauza AM, Emami P, Soni N et al (2013) A 10-year review of assault-related open-globe injuries at an urban hospital. Graefes Arch Clin Exp Ophthalmol 251:653–659

    Article  PubMed  Google Scholar 

  16. Andreoli TM, Andreoli MC (2011) Geriatric and traumatic open globe injuries. Ophthalmology. 118(1):156–159

    Article  PubMed  Google Scholar 

  17. Kavoussi SC (2015) Characteristics and outcomes of fall-related open-globe injuries in pseudophakic patients. Clin Ophthalmol 9:403–408

    Article  PubMed  PubMed Central  Google Scholar 

  18. Sheng I, Bauza A, Langer P et al (2015) A 10-year review of open-globe trauma in elderly patients at an urban hospital. Retina. 35(1):105–110

    Article  PubMed  Google Scholar 

  19. Kolomeyer AM, Shah A, Bauza AM, Langer PD, Zarbin MA, Bhagat N (2014) Nail gun-induced open-globe injuries: a 10-year retrospective review. Retina. 34:254–261

    Article  PubMed  Google Scholar 

  20. Landen D (1990) Perforating eye injury in Allegheny County, Pennsylvania. Am J Public Health 80(9):1120–1122

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Bhagat N, Li X, Bauza A, Lesniak SP (2017) Characteristics and outcomes of delayed open globe repair. Mathews J Ophthalmol 2(1):013

    Article  Google Scholar 

  22. Katz J, Tielsch JM (1993) Lifetime prevalence of ocular injuries from the Baltimore eye survey. Arch Ophthalmol 111(11):1564–1568

    Article  CAS  PubMed  Google Scholar 

  23. Bhagat N, Turbin R, Langer P et al (2016) Approach to Management of Eyes with no light perception after open globe injury. J Ophthalmic Vis Res 11(3):313–318

    Article  PubMed  PubMed Central  Google Scholar 

  24. Soni NG, Bauza AM, Son JH et al (2013) Open globe ocular trauma: functional outcome of eyes with no light perception at initial presentation. Retina. 33:380–386

    Article  PubMed  Google Scholar 

  25. Shah AS, Andreoli MT, Andreoli CM, Kloek C (2007) Visual recovery in patients suffering open-globe injuries caused by intraocular foreign bodies. Invest Ophthalmol Vis Sci 48(13):718

    Google Scholar 

  26. Feng K, Shen L, Pang X et al (2011)Case-control study of risk factors for no light perception after open-globe injury: eye injury vitrectomy study. Retina 31:1988–1996

    Article  PubMed  Google Scholar 

  27. Thompson JT, Parver LM, Enger CL, Mieler WF, Liggett PE (1993) Infectious endophthalmitis after penetrating injuries with retained intraocular foreign bodies. Ophthalmology. 100(10):1468–1474

    Article  CAS  PubMed  Google Scholar 

  28. Ehlers JP, Kunimoto DY, Ittoop S et al (2008) Metallic intraocular foreign bodies: characteristics, interventions, and prognostic factors for visual outcome and globe survival. Am J Ophthalmol 146(3):427–433

    Article  PubMed  Google Scholar 

  29. Loporchio D, Mukkamala L, Gorukanti K et al (2016) Intraocular foreign bodies: a review. Surv Ophthalmol 61(5):582–596

    Article  PubMed  Google Scholar 

  30. Serdarevic R (2015) The ocular trauma score as a method for the prognostic assessment of visual acuity in patients with close eye injuries. Cta informatica medica. Acta Inform Med 23(2):81–85

    Article  PubMed  PubMed Central  Google Scholar 

  31. Shah MA, Shah SM, Gosai SR et al (2011) Comparative study of final visual outcome between open-and closed-globe injuries following surgical treatment of traumatic cataract. Greafes Arch Clin Exp Ophthalmol 249(12):1775–1781

    Article  Google Scholar 

  32. Yu M, Yan H (2015) Prognostic factors for open globe injuries and correlation of ocular trauma score in Tianjin, China. J Ophthalmol 2015(2):345764

    Google Scholar 

  33. Ahmed Y, Schimel AM, Pathengay A et al (2012) Endophthalmitis following open-globe injuries. Eye (Lond) 26(2):212–217

    Article  CAS  Google Scholar 

  34. Bhagat N, Li X, Zarbin MA (2016)Post-traumatic Endophthalmitis. In: Durand M, Miller J, Young L (eds) Endophthalmitis. Springer, Cham

    Google Scholar 

  35. Bhagat N, Nagori S, Zarbin MA (2011)Post-traumatic infections endophthalmitis. Surv Ophthalmol 56(3):214–251

    Article  PubMed  Google Scholar 

  36. Li X, Zarbin MA, Langer PD, Bhagat N (2018) Posttraumatic endophthalmitis: an 18-year case series. Retina. 38(1):60–71

    Article  PubMed  Google Scholar 

  37. Schrader WF (2004) Open globe injuries: epidemiological study of two eye clinics in Germany, 1981-1999. Croat Med J 45(3):268–267

    PubMed  Google Scholar 

  38. Boldt HC, Pulido JS, Blodi CF, Folk JC, Weingeist TA (1989) Rural endophthalmitis. Ophthalmology. 96(12):1722–1726

    Article  CAS  PubMed  Google Scholar 

  39. Essex RW, Yi Q, Charles PG, Allen PJ (2004)Post-traumatic Endophthalmitis. Ophthalmology. 111(11):2015–2022

    Article  PubMed  Google Scholar 

  40. Jonas JB, Knorr HL, Budde WM (2000) Prognostic factors in ocular injuries caused by intraocular or retrobulbar foreign bodies. Ophthalmology. 107(5):823–828

    Article  CAS  PubMed  Google Scholar 

  41. Ferrari TM, Cardascia N, Di Gesu I, Catella N, Recchimurzo N, Boscia F (2001) Early versus late removal of retained intraocular foreign bodies. Retina. 21(1):92–93

    Article  CAS  PubMed  Google Scholar 

  42. Lu X, Ng DS, Zheng K et al (2016) Risk factors for endophthalmitis requiring evisceration or enucleation. Sci Rep 6:28100

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  43. Ye J, Lou L, Jin K et al. (2015)Vision-related quality of life and appearance concerns are associated with anxiety and depression after eye Enucleation: a cross-sectional study. Huang J, ed. PLoS One. 10(8)

Download references

Author information

Authors and Affiliations

  1. Rutgers New Jersey Medical School, Institute of Ophthalmology and Visual Science, Rutgers University, 90 Bergen Street, Newark, NJ, 07103, USA

    Effy Ojuok, Aditya Uppuluri, Paul D. Langer, Marco A. Zarbin, Loka Thangamathesvaran & Neelakshi Bhagat

Authors
  1. Effy Ojuok
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Aditya Uppuluri
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Paul D. Langer
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Marco A. Zarbin
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Loka Thangamathesvaran
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Neelakshi Bhagat
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Neelakshi Bhagat.

Ethics declarations

Conflicts of interest

All authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ojuok, E., Uppuluri, A., Langer, P.D. et al. Predictive factors of enucleation after open globe injuries. Graefes Arch Clin Exp Ophthalmol 259, 247–255 (2021). https://doi.org/10.1007/s00417-020-04794-6

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00417-020-04794-6

Keywords

Search

Navigation