The prospective study of visual outcome in patients with isolated open-globe injuries

Abstract

Objectives: The objective of this study was to study and predict factors affecting visual acuity in patients with open-globe injuries and determine the final visual acuity after intervention. Materials and Methods: This prospective observational study was carried out on 30 patients of isolated open-globe injury involving cornea, sclera, lens, and iris, presenting to our hospital from January 2021 to October 2021. We recorded demographic data including age, sex, occupation, and a thorough history of the mode of injury including the type of object responsible for trauma. A detailed ophthalmic examination by recording pre-operative visual acuity, torch-light, and slit-lamp examination along with dilated fundoscopy (wherever possible) was performed. Injuries were classified into zones I, II, and III. X-ray orbit was done for all patients to rule out associated intraocular foreign body and orbital fractures. All patients were given medical treatment in the form of local and systemic antibiotics and steroids. All patients underwent surgical intervention in the form of primary suturing repair of corneoscleral lacerations. Postoperatively, we monitored visual acuity daily and on follow-up visits after discharge. Results: A total of 30 patients were enrolled based on the inclusion and exclusion criteria with the male-to-female ratio being 4:1. About 60% of injuries were attributed to agricultural and industrial professions, 16.67% to domestic mode, 13.33% to accidental and 10% to other modes like firecracker. The object responsible in the majority was wood (26.67%) followed by iron material (20%). Other objects responsible were metal, glass, firecrackers, etc. The right eye was more commonly involved than the left with the majority being a penetrating mode of trauma resulting in zone I injuries. Visual acuity was markedly reduced (<6/60) in 83.3% of patients preoperatively. About 60% of patients showed improvement in visual acuity after intervention with 40% having best-corrected visual acuity >6/60, 6 weeks after surgery, most of them belonging to the zone I category. We dichotomized the outcomes into two groups, improvement versus no improvement or deterioration, and carried out logistic regression taking the above factors into account. We assessed independent variables against the probability of obtaining improved visual acuity after 6 weeks and discovered that the type of open-globe injury was the only independent variable found to be significantly associated. Participants with ruptured open-globe injury had an adjusted odds ratio (aOR) of −0.91 (P = 0.023). Conclusion: It was hence concluded that the type of injury and the time of presentation significantly affect the visual outcome after surgery. Patients with a penetrating type of open-globe injuries showed improvement in visual acuity postoperatively. However, ruptured open-globe injuries were significantly predictive of non-improvement or deterioration of visual acuity after 6 weeks. This study provides comprehensive insights into the management and outcomes of open-globe injuries, highlighting the importance of prompt evaluation, appropriate treatment, and diligent follow-up care in optimising patient outcomes.