Clinical presentation, management, and outcomes in posterior segment open globe injuries
Reviewed by Sofia Rokerya

This is a retrospective, non-comparative, interventional case study of patients presenting with scleral and corneoscleral wounds covering a five-year period. It reports the clinical presentation, management, and factors affecting the outcomes of posterior segment open globe injuries (OGI) in 2360 consecutive eyes. The cases were defined according to the Birmingham Eye Trauma Terminology system (BETTs) classification. The Ocular Trauma Score (OTS) was applied to the dataset. Mean age of presentation was 36.63 ± 19.92 years (median 35 years). Males accounted for 1913 (81.1%) of cases. Eighteen injuries were bilateral. Penetrating trauma accounted for 70.92%, rupture for 18.6%, perforation for 4.6%, and intraocular foreigh body (IOFB) in 5.88% eyes. In 76.6%, the location of injury involved zone 1 extending to zone 2, while in 23.4% it involved zone 2 and / or zone 3. The wound of the eye wall was visible clinically in 69.1% of the cases and occult (suspected clinically and confirmed during surgery) in 30.9%. Associated clinical features noted were lens rupture or cataract in 17.3%, vitreous haemorrhage in 21.3%, and retinal detachment (RD) in 8%. Vision at presentation was logMAR 3.03 ± 0.99 and at the last visit was logMAR 2.47 ± 1.42 (p=0.0001). Time interval between presentation to the clinic and globe repair was 13.93 ± 19.56 h (median 7.60 h). The mean follow-up was 10.59 ± 15.26 months (median four months). Favourable functional outcomes were seen in 29.20% eyes and favourable anatomic outcomes in 66.9%. Among the unfavourable anatomic outcomes, 20.3% had intractable hypotony, 11.1% developed phthisis bulbi, and 1.7% had an inoperable RD noted at the final follow-up (range 4.50–42.50 months). The cases with rupture of the globe had an overall poorer outcome due to either hypotony related to injury to the ciliary body or due to inoperable RD developing because of severe vitreous loss and severe retinal prolapse. These injuries stabilised early (5.65 ± 2.37 months) following primary repair. Conversely, penetrating injuries stabilised later during follow-up (10.72 ± 7.72 months). This discrepancy was attributed to the fact that penetrating injuries were found to be “more viable” and hence underwent more repeat procedures to salvage vision. Decreasing age at presentation, penetrating injury instead of rupture or perforating injury, a higher OTS, absence of corneal involvement, absence of retinal detachment at presentation, and absence of concurrent orbital fracture were associated with a favourable functional outcome. Usually, a younger age group is likely to have a poorer prognosis in view of a greater propensity to develop proliferative vitreoretinopathy. In the current study, a relatively younger age showed greater odds of a favourable visual outcome. Though statistically significant, this difference is not clinically significant, as the odds in favour of a younger age group were only 1.02. This further validated the application of the OTS for prognosticating OGI at presentation. Strength: large number of cases. Weakness: retrospective nature.

Clinical presentations, management, and factors affecting outcomes in posterior segment open globe injuries: an analysis of 2,360 eyes.
Dave VP, Das AV, Nayak S, et al.
OPHTHALMOLOGICA
2023;246:150–7.