Visual and ocular morbidity in severe open-globe injuries presenting to a regional eye centre in New Zealand

Abstract

Importance: Open-globe injuries (OGI) are a leading cause of monocular blindness world-wide with considerable cost to the individual and society.

Background: To characterize the epidemiology, severity and outcomes of OGI treated at a major ophthalmology centre in New Zealand.

Design: Retrospective study.

Participants: A total of 385 eyes of 381 patients over a 10-year period.

Methods: Eligible patients were identified using diagnosis and surgery codes on hospital discharge summaries. Clinical notes were reviewed to determine patient demographics, injury details, treatments and outcomes.

Main outcome measures: Complications of injury, visual acuity at 3 months and final follow-up, and final status of the eye.

Results: The estimated annual incidence of OGI was 2.8 per 100 000. Working-age males predominated but age at injury ranged from 9 months to 90 years. Maori and Pacific peoples were over-represented. Injuries were severe with 58.7% presenting with vision of hand movements or worse. Penetrating injuries (56.4%) were most common, followed by globe ruptures (35.6%). Major complications included retinal detachment (15.8%), enucleation/evisceration (9.1%), phthisis bulbi (9.9%), endophthalmitis (2.6%) and sympathetic ophthalmia (0.26%). Despite the injury severity, 46% of eyes achieved final BCVA of ≥6/12. The Ocular Trauma Score (OTS) was a useful prognostic tool for stratifying severity of injury and predicting visual outcome (Fisher's exact test P < 0.001).

Conclusions and relevance: The incidence and severity of OGI in NZ are comparable to global statistics. Surgical repair can effectively recover vision, predicted well by the OTS. We identified at-risk groups to target with education and prevention strategies.

Keywords: blunt trauma; enucleation; globe perforation; ocular trauma; post-traumatic endophthalmitis.