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Visual Outcome and Profile of Patients with Ocular Trauma in a ...

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TRAUMA SESSION571TRAUMA SESSIONChairman: Dr. B. Shukla, Co-Chairman: Dr. D.K. MehtaConvenor: Dr. Reyaz Hussan, Moderator: Dr. Yogesh ShahAUTHORS’S PROFILE:DR. SUDESH KUMAR ARYA: M.B.B.S. (1988), PGIMS, M.D. University, Rohtak; M.S. (1991),R.P. Centre, AIIMS, New Delhi; Fellowship, FIACLE, IACLE, Sydney, Australia. Formerly,Lecturer, PGIMS, Rohtak. Presently, Reader (Dept. <strong>of</strong> Ophthalmology), Govt. Medical CollegeHospital, Sector-32, Ch<strong>and</strong>igarh.Address: HN, 1155A, Sector-32B, Ch<strong>and</strong>igarh; Contact: (0172)2607707;E-mail: aryasudesh@yahoo.com<strong>Visual</strong> <strong>Outcome</strong> <strong>and</strong> <strong>Pr<strong>of</strong>ile</strong> <strong>of</strong> <strong>Patients</strong> <strong>with</strong> <strong>Ocular</strong> <strong>Trauma</strong> <strong>in</strong> aTertiary Care Centre <strong>of</strong> Eastern NepalDr. Sudesh Kumar Arya, Dr. Badri Prasad Badhu, Dr. Poonam Lavaju,Dr. Archna Sharma, Dr. Sushila Patel(Present<strong>in</strong>g Author: Dr. Sudesh Kumar Arya)<strong>Ocular</strong> trauma is a major cause <strong>of</strong> monocularbl<strong>in</strong>dness worldwide 1,2 <strong>in</strong>volv<strong>in</strong>g half amillion people. Accord<strong>in</strong>g to the study done <strong>in</strong>Nepal (2000), the crude <strong>in</strong>cidence <strong>of</strong> oculartrauma was 0.51 per 1000 population at risk peryear. 3Materials <strong>and</strong> MethodsThis study <strong>in</strong>cluded retrospective data <strong>of</strong> 68patients present<strong>in</strong>g <strong>with</strong> ocular trauma fromApril 2007 to March 2008. Information collected<strong>in</strong>clude the type, cause, <strong>and</strong> location <strong>of</strong> <strong>in</strong>jury,time between <strong>in</strong>jury <strong>and</strong> presentation, <strong>and</strong>demographic data. The ocular exam<strong>in</strong>ationconsisted <strong>of</strong> visual acuity test<strong>in</strong>g <strong>with</strong> detailedslitlamp evaluation. Posterior segmentevaluation was done <strong>with</strong> dilated pupilswherever possible.In patients <strong>with</strong> hazy media,ultrasonography B scan was done. Cl<strong>in</strong>icalfeatures <strong>of</strong> the <strong>in</strong>jury were recorded <strong>and</strong>classified accord<strong>in</strong>g to <strong>in</strong>ternational oculartrauma classification as open globe <strong>and</strong> closedglobe <strong>in</strong>jury.Rupture, penetrat<strong>in</strong>g <strong>in</strong>jury,<strong>in</strong>traocular foreign body, perforat<strong>in</strong>g <strong>in</strong>jurieswere kept under open globe while, contusion,lamellar laceration <strong>and</strong> superficial foreign bodywere kept <strong>in</strong> the closed globe type.In the openglobe <strong>in</strong>jury, <strong>in</strong>jury upto to the corneosclerallimbus was taken as zone I, <strong>in</strong>juries extend<strong>in</strong>gfrom limbus to 5mm was taken as zone II <strong>and</strong>beyond 5mm was taken as zone III <strong>in</strong>juries. Thepatients’ corrected visual acuities werecategorized as hav<strong>in</strong>g corrected vision worsethan 20/400 (WHO def<strong>in</strong>ition <strong>of</strong> bl<strong>in</strong>dness) orvision worse than 20/60 (WHO def<strong>in</strong>ition <strong>of</strong>visual impairment) <strong>in</strong> the <strong>in</strong>jured eye.ResultsOut <strong>of</strong> 68 patients, 53 (78%) were males <strong>and</strong>15(22%) were females. Age ranged from 9months to 76 years <strong>with</strong> a mean <strong>of</strong> 19 years .42(63%) patients were less than 14 years <strong>of</strong> age. Out<strong>of</strong> 68 patients, 31 (45.4%) patients were students,17 (25 %) were preschool, 8(12.1%) were workers,7(10.6%) were farmers <strong>and</strong> 5 (7.6%) were housewives. 38 (56 %) patients had <strong>in</strong>jury whileplay<strong>in</strong>g while15 (22 %) had work related <strong>in</strong>juries,11(16%) had <strong>in</strong>jury by physical assault <strong>and</strong> 4(6%)had <strong>in</strong>jury due to fall from height.Agents <strong>of</strong> <strong>in</strong>jury: Injury <strong>with</strong> wooden stick wasthe commonest <strong>in</strong>volv<strong>in</strong>g 28 (41%) patientsfollowed by stone 11(16%) patients <strong>and</strong> sickle 5patients (7%). Other modes <strong>of</strong> <strong>in</strong>jury were needle,glass piece, goat horn, cricket bat, pen, slipper<strong>and</strong> others. Out <strong>of</strong> 68 cases, 30 (44%) had<strong>in</strong>volvement <strong>of</strong> right eye while 37 (54%) had<strong>in</strong>volvement <strong>of</strong> left eye <strong>and</strong> one (1.5%) hadbilateral <strong>in</strong>juries. 28 (41%) patients presented<strong>with</strong><strong>in</strong> 24 hours <strong>of</strong> <strong>in</strong>jury, 24(36%) patients <strong>with</strong><strong>in</strong>2 to 5 days while, 16 (23% )presented after 5 days<strong>of</strong> <strong>in</strong>jury.Diagnosis at presentation: 56 (83%) patients hadopen globe <strong>in</strong>jury while rest <strong>of</strong> them had closed


572 AIOC 2009 PROCEEDINGSglobe <strong>in</strong>jury.In open globe <strong>in</strong>juries, Zone 1 wascommonest 36 (64%) followed by zone II 9 (16%)patients.26 (47%) patients had type B <strong>in</strong>juries(penetrat<strong>in</strong>g) while 12 (18 %) had type A <strong>in</strong>juries(rupture).The most common pattern <strong>of</strong>presentation was corneal perforation 38 (55%)patients followed by corneo-scleral perforation17% ,hyphema 10%, globe rupture7%, <strong>in</strong>traocularforeign body 4%, lid laceration3% <strong>and</strong> rest 4%.(52%) patients had grade 4 visual acuity (4/200to light perception) while 12% had grade 5 visualacuity (no light perception) at presentation. Only6% patients had grade 1 visual acuity. <strong>Visual</strong>acuity could not be assessed <strong>in</strong> 9 (13.23%)patients who were 5 years or younger at the time<strong>of</strong> presentation.Management: Surgery was performed <strong>in</strong> 60(88.2%) patients while 8 (11.8%) patients weremanaged conservatively. Intravitreal antibioticswere given <strong>in</strong> 18 (26%) patients <strong>and</strong> 3 (4.4%)patients underwent evisceration as these patientshad irreparable globe <strong>in</strong>jury.<strong>Visual</strong> acuity at 1 week follow up:Postoperativelyat 1week 15% had grade 1 visual acuity (≥20/40)while only 32% had grade 4 visual acuity (4/200to light perception). 40 (59%) patients were bl<strong>in</strong>d<strong>and</strong> 16 (23.5%) were visually impaired.DiscussionThe percentage <strong>of</strong> ocular trauma <strong>in</strong> men wasgreater than <strong>in</strong> women, similar to what has beenreported previously <strong>in</strong> other studies. 1,4 It ispossible that the lower percentage amongwomen may be due to less outdoor activities.Two-third patients were <strong>in</strong> pediatric age group(


TRAUMA SESSION5736. De Juan E, Sternberg P, Michels RG. Penetrat<strong>in</strong>gocular <strong>in</strong>juries; types <strong>of</strong> <strong>in</strong>juries <strong>and</strong> visual results.Ophthalmology 1983;90:1318-22.7. Esmaili B, N<strong>and</strong>a SG, Schork A, Elner VM. <strong>Visual</strong>outcome <strong>and</strong> ocular survival after penetrat<strong>in</strong>gtrauma. Ophthalmology 1995;102:393-400.8. May DR, Kuhn FP, Morris RE et al. Theepidemiology <strong>of</strong> serious eye <strong>in</strong>juries from theUnited States Eye Injury Registry. Graefes Arch Cl<strong>in</strong>Exp Ophthalmol 2000;238:153-7.9. Paul Stern berg JR; Prognosis <strong>and</strong> outcome forpenetrat<strong>in</strong>g ocular trauma. In: Sh<strong>in</strong>gleton BJ, HershPS, Kenyon KR,(eds). Eye <strong>Trauma</strong>, Mosby yearbook, 1991; pp.238-41.10. Sobaci G. Deadly weapon-related open-globe<strong>in</strong>juries: outcome assessment by the oculartrauma classification system. Am J Ophthalmol2000;129:47-53.

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