Journal List > J Korean Ophthalmol Soc > v.53(6) > 1009381

TOOLS
Lee, Kwag, and Lee: The Predictability of Ocular Trauma Score and Prognostic Factors of Open Globe Injury
Original Article
Journal of the Korean Ophthalmological Society

Journal of the Korean Ophthalmological Society 2012; 53(6): 825-832.

Published online: 16 June 2012

DOI: https://doi.org/10.3341/jkos.2012.53.6.825

The Predictability of Ocular Trauma Score and Prognostic Factors of Open Globe Injury

Yeon Hee Lee, MD1, 2, Joo Young Kwag, MD1, Sung Bok Lee, MD, PhD1, 2

1Department of Ophthalmology, Chungnam National University College of Medicine, Daejeon, Korea.

2Institute for Medical Sciences, Chungnam National University Research, Daejeon, Korea.

Address reprint requests to Sung Bok Lee, MD, PhD. Department of Ophthalmology, Chungnam National University Hospital, #282 Munhwa-ro, Jung-gu, Daejeon 301-721, Korea. Tel: 82-42-280-7604, Fax: 82-42-255-3745, sblee@cnu.ac.kr

Received 22 August 2011       Accepted 18 April 2012

Copyright © 2012 The Korean Ophthalmological Society

Abstract

Purpose

To determine the prognostic factors of visual outcome in open globe injury and to assess the possibility of an ocular trauma score (OTS) model of predictive value in open globe injuries in Koreans.

Methods

The medical records of 242 patients with open globe injury from 2000 to 2010 were retrospectively reviewed. Prognostic factors of visual outcome, positive predictive rate, and negative predictive rate were surveyed.

Results

In the multivariate analysis, old age, relative afferent pupillary defect, impaired initial visual acuity and retinal detachment were the worst predictive factors of vision survival. In OTS categories 1 and 2, worse final visual acuity was acquired, and positive predictive rate and negative predictive rate for assessment of final visual acuity less than 0.02 were 70.1% and 89.8%, respectively.

Conclusions

The prognostic factors of open globe injury associated with impaired final visual acuity were old age, relative afferent pupillary defect, worse initial visual acuity, retinal detachment and OTS categories 1 and 2. The OTS may have prognostic value in open globe injuries in Korean patients. However, identified prognostic factors of the present study did not entirely coincide with those of other Koreans or previous studies. Therefore, additional studies on the modified open globe injury as a prognostic model in Korean patients are needed.

Keywords: Globe rupture, Ocular Trauma Score, Prognostic factors

Figures and Tables

Table 1
Ocular trauma score*
jkos-53-825-i001

To the score of the initial best-corrected visual acuity the score for the following characteristics were subtracted in order to obtain a final score. With the final score, each eye evaluated was placed within an OTS category: category 1: 0-44 points, category 2: 45-65 points, category 3: 66-80 points, category 4: 81-91 points, category 5: 92-100 points.

NLP = no light perception; LP = light perception; HM = hand movement.

*Adapted from Kuhn et al., Ophthalmol Clin North Am 2002; 15:163-5.

Table 2
Characteristics of the study population
jkos-53-825-i002

Values are presented as n or mean ± SD.

F/U = follow-up.

*Unknown history of injury.

Table 3
Univariate analysis for clinical variables to the final visual outcome
jkos-53-825-i003

Values are presented as number.

VA = visual acuity; LP = light perception; FB = foreign body; RAPD = relative afferent pupillary defect; RD = retinal detachment; VH = vitreous hemorrhage.

*p-value by chi-square test.

Table 4
Multivariate analysis for clinical variables to the final visual outcome
jkos-53-825-i004

RAPD = relative afferent pupillary defect; VA = visual acuity; FB = foreign body; RD = retinal detachment; VH = vitreous hemorrhage.

*p-value by multiple linear regression analysis.

Table 5
Comparison of final acuities assessed with the Ocular Trauma Score (OTS) category with that of Kuhn et al's OTS study
jkos-53-825-i005

Percentage in each column may not equal 100% due to rounding.

NLP = no light perception; LP = light perception; HM = hand movement; CF = counting finger.

*p-value by chi-square test.

Table 6
Relationship between Ocular Trauma Score (OTS) category and final visual acuity
jkos-53-825-i006

LP = light perception.

*p-value by chi-square test.

Table 7
Positive predictive value and negative predictive value for assessment of OTS (Ocular Trauma Score) category
jkos-53-825-i007

LP = light perception.

*p-value by chi-square test.

References

1. May DR, Kuhn FP, Morris RE, et al. The epidemiology of serious eye injuries from the United States Eye Injury Registry. Graefes Arch Clin Exp Ophthalmol. 2000. 238:153–157.
2. Pieramici DJ, Au Eong KG, Sternberg P Jr, Marsh MJ. The prognostic significance of a system for classifying mechanical injuries of the eye (globe) in open-globe injuries. J Trauma. 2003. 54:750–754.
3. Wong TY, Tielsch JM. A population-based study on the incidence of severe ocular trauma in Singapore. Am J Ophthalmol. 1999. 128:345–351.
4. Landen D, Baker D, LaPorte R, Thoft RA. Perforating eye injury in Allegheny County, Pennsylvania. Am J Public Health. 1990. 80:1120–1122.
5. Négrel AD, Thylefors B. The global impact of eye injuries. Ophthalmic Epidemiol. 1998. 5:143–169.
6. Esmaeli B, Elner SG, Schork MA, Elner VM. Visual outcome and ocular survival after penetrating trauma. A clinicopathologic study. Ophthalmology. 1995. 102:393–400.
7. Sternberg P Jr, de Juan E Jr, Michels RG, Auer C. Multivariate analysis of prognostic factors in penetrating ocular injuries. Am J Ophthalmol. 1984. 98:467–472.
8. de Juan E Jr, Sternberg P Jr, Michels RG. Penetrating ocular injuries. Types of injuries and visual results. Ophthalmology. 1983. 90:1318–1322.
9. Rahman I, Maino A, Devadason D, Leatherbarrow B. Open globe injuries: factors predictive of poor outcome. Eye (Lond). 2006. 20:1336–1341.
10. Dalma-Weiszhausz J, Quiroz-Mercado H, Morales-Canton V, et al. Vitrectomy for ocular trauma: a question of timing? Eur J Ophthalmol. 1996. 6:460–463.
11. Miyake Y, Ando F. Surgical results of vitrectomy in ocular trauma. Retina. 1983. 3:265–268.
12. Pieramici DJ, MacCumber MW, Humayun MU, et al. Open-globe injury. Update on types of injuries and visual results. Ophthalmology. 1996. 103:1798–1803.
13. Hutton WL, Fuller DG. Factors influencing final visual results in severely injured eyes. Am J Ophthalmol. 1984. 97:715–722.
14. Punnonen E, Laatikainen L. Prognosis of perforating eye injuries with intraocular foreign bodies. Acta Ophthalmol (Copenh). 1989. 67:483–491.
15. Matthews GP, Das A, Brown S. Visual outcome and ocular survival in patients with retinal detachments secondary to open- or closed-globe injuries. Ophthalmic Surg Lasers. 1998. 29:48–54.
16. Brinton GS, Aaberg TM, Reeser FH, et al. Surgical results in ocular trauma involving the posterior segment. Am J Ophthalmol. 1982. 93:271–278.
17. Martin DF, Meredith TA, Topping TM, et al. Perforating (through-and-through) injuries of the globe. surgical results with vitrectomy. Arch Ophthalmol. 1991. 109:951–956.
18. Sternberg P Jr, de Juan E Jr, Michels RG. Penetrating ocular injuries in young patients. initial injuries and visual results. Retina. 1984. 4:5–8.
19. Barr CC. Prognostic factors in corneoscleral lacerations. Arch Ophthalmol. 1983. 101:919–924.
20. Groessl S, Nanda SK, Mieler WF. Assault-related penetrating ocular injury. Am J Ophthalmol. 1993. 116:26–33.
21. Kim JH, Yang SJ, Kim DS, et al. Fourteen-year review of open globe injuries in an urban Korean population. J Trauma. 2007. 62:746–749.
22. Kuhn F, Maisiak R, Mann L, et al. The Ocular Trauma Score (OTS). Ophthalmol Clin North Am. 2002. 15:163–165.
23. Unal MH, Aydin A, Sonmez M, et al. Validation of the ocular trauma score for intraocular foreign bodies in deadly weaponrelated open-globe injuries. Ophthalmic Surg Lasers Imaging. 2008. 39:121–124.
24. Sobaci G, Akin T, Erdem U, et al. Ocular trauma score in deadly weapon-related open-globe injuries. Am J Ophthalmol. 2006. 141:760–761.
25. Dosková H. Evaluation of results of the penetrating injuries with intraocular foreign body with the Ocular Trauma Score (OTS). Cesk Slov Oftalmol. 2006. 62:48–52.
26. Unver YB, Kapran Z, Acar N, Altan T. Ocular trauma score in open-globe injuries. J Trauma. 2009. 66:1030–1032.
27. Uysal Y, Mutlu FM, Sobaci G. Ocular Trauma Score in childhood open-globe injuries. J Trauma. 2008. 65:1284–1286.
28. Han SB, Yu HG. Visual outcome after open globe injury and its predictive factors in Korea. J Trauma. 2010. 69:E66–E72.
29. Kuhn F, Morris R, Witherspoon CD. Birmingham Eye Trauma Terminology (BETT): terminology and classification of mechanical eye injuries. Ophthalmol Clin North Am. 2002. 15:139–143.
30. Shock JP, Adams D. Long-term visual acuity result after penetrating and perforating ocular injuries. Am J Ophthalmol. 1985. 100:714–718.
31. Rofail M, Lee GA, O'Rourke P. Prognostic indicators for open globe injury. Clin Experiment Ophthalmol. 2006. 34:783–786.
32. Schmidt GW, Broman AT, Hindman HB, Grant MP. Vision survival after open globe injury predicted by classification and regression tree analysis. Ophthalmology. 2008. 115:202–209.
33. Cruvinel Isaac DL, Ghanem VC, Nascimento MA, et al. Prognostic factors in open globe injuries. Ophthalmologica. 2003. 217:431–435.
TOOLS
Similar articles