【摘要】 With regard to the high incidence of ocular trauma and consequent severe visual loss, parents attention, eye safety protection and early treatment should be considered as final preserving globe in most accidents.
【关键词】 eye injuries inpatients outcome metallic objects traumatic visual loss
INTRODUCTION
Ocular injuries have been identified as a major cause of visual impairment and blindness. In spite of the new microsurgical techniques, the prognosis of eye injuries in many cases is still quite poor and dependent mostly on the severity of the primary injury. Ocular trauma is a common, but preventable accident. Approximately one in five adults reports a history of ocular trauma in the lifetime, although in less than 2% the trauma is severe enough to warrant hospitalization[1]. There are approximately 1.6 million blind persons and additional 2.3 million bilateral low visions from ocular injuries in the world, and also 19 million have unilateral blindness or low vision[2]. Most ocular traumas occur in young people and could be prevented by safety eyewear.
Implementing known strategies for eye injury prevention would substantially reduce their incidence. The prevention approaches include certified eye protectors at workplaces and sports activities whenever possible, rather than making their use voluntary[3].
Standardized international classification of ocular trauma (Birmingham Eye Trauma Terminology, BETT) allows the surgeon to establish an early, objective, and accurate prognosis of the injury[4]. The injuries are classified as blunt or sharp forces, penetrating and perforating[4].
Optimizing outcome in ocular injury requires prompt diagnosis and treatment. The final outcome may be ambiguous because severe ocular trauma is often associated with a variety of devastating complications[5].
Based on high frequency of trauma and accidents, our study aimed to survey the inpatients with eye injury in Yazd, Iran. The final outcomes and consequences were evaluated.
MATERIALS AND METHODS
In this descriptive case series study we reviewed 70 patients with eye injuries hospitalized at department of ophthalmology of Shahid Sadoughi Hospital between August 2005 and August 2006. Variables like age, sex, date of injury, cause, type of injury, initial visual acuity, therapeutic procedures, and visual outcome at the final discharge time were recorded for each patient.
Cases with extraocular injuries including hematoma, eyelids, canalicular, orbital injuries and patients with incomplete data were excluded from the study.
To classify mechanical eye injuries, we used a system recommended by the Ocular Trauma Classification Group (OTCG). This classification is based on anatomic and physiologic variables that have prognostic value for visual outcome in ocular injuries[6]. The type of injury was classified according to BETT as closed globe injury (contusion and lamellar laceration)or open globe injury(rupture and penetrating, intraocular foreign body or perforating laceration)[4].
Visual outcome was defined in terms of the bestcorrected Snellen chart visual acuity (VA) in the injured eye at the final discharge time. Counting finger (CF), hand movement (HM), light perception (LP) and no light perception (NLP) are legal blindness that is defined as visual acuity≤20/200.
Data were analyzed by using SPSS 11.5 software (SPSS Inc., Chicago, IL, USA) and presented in the form of descriptive statistics like mean ± standard deviation (SD), median and range. Appropriate statistical tests such as chisquare test, MannWhitney Utest, and Pearsons correlation coefficient test were applied to evaluate the possible associations and differences. A significance level of P<0.05 was considered statistically significant.
RESULTS
A total of 70 patients with ocular injuries were hospitalized at department of ophthalmology of Shahid Sadoughi Hospital. The male to female ratio was 2.8 to 1.
The most frequent objects causing injuries were metallic objects (34.3%) especially in age group of≤10 and ≥ 30 years old. Accidents (22.8%) and assaults (17.2%) were next frequent causes (Table 1, 2). Waiting time to initial treatment was 624 hours in most cases (51.4%) (Table 3). Trauma was blunt in 38.6% and penetrating in 61.4%. The most and the least final visual acuity were LP (51.8%) and HM (7.5%) in blunt trauma and LP (41.8%) and HM (4.7%) in penetrating trauma respectively (Table 4). As for surgery results, globe saving with acceptable visual acuity was achieved in 72.9% and enucleation occurred in 24.2% (Table 5).
DISCUSSION
Ocular trauma is a considerable cause of visual impairment[7]. In our study, male patients predominated over female (male/female ratio was 2.8/1). Male predominance and also peak incidence of eye injuries (mostly with metal objects) in male population were reported in other studies[812]. It is probably the result of the nature of mens job and other activities. High prevalence of eye injuries in average age of 21.7 years old in our study is similar to some studies, for instance, the studies by Khatry et al[13] and Smith et al[14] with an average age of 28 and 29 years old respectively. It was supposed in our society because of crowd and activity of young population. High prevalence of penetrating trauma (61.4%) rather than blunt trauma (38.6%) in our study has been reported by the survey of Entezari et al[15] in a prospective study on 116 injured eyes during 20012004. Penetrating trauma caused by metal and sharp objects was the most common type of eye injuries in age group of<10 years old in our study. In the study of Cariello et al[16], the most frequent cause for ocular injuries in children was external agents such as stone, iron and wood objects. This study shows that among children the mechanisms of injury are quite variable, and that inappropriate attention of parents can lead to visual loss threatening injuries in pediatric group.
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