Study of Clinico-epidemiological profile of ocular trauma patients in a tertiary eye care center, with factors affecting visual prognosis.

Study of Clinico -epidemiological profile of ocular trauma patients in a tertiary eye care center, with factors affecting visual prognosis..

INTRODUCTION-. WHO program for the prevention of blindness suggests, around 1.6 million blind due to ocular injuries and 55 million eye injuries restricting activities more than one day. 1 This data reflects the amount of socio-economical burden ocular trauma imposes on the health of the nation. Hence, the need for epidemiological studies based on the patterns of ocular trauma to determine the factors that affect the visual outcome, and the hot-spots which need our attention, improving the overall quality of life of a patient of eye injury. 1 Négrel and Thylefors , “The Global Impact of Eye Injuries.”.

METHODS-. This was a prospective study, which involved 716 ocular trauma patients presenting to our tertiary eye care centre based in central India, by far this has been the largest available data on ocular trauma from central India. The study duration was from January 2021 to May 2022. Demographical characteristics were recorded for age, sex, time duration lapsed before presenting to the hospital, laterality, circumstances of injury, objects causing injury, History of intoxication..

All the patients of ocular trauma were classified as local, associated and based on cause. Local were sub-divided into mechanical and non-mechanical. Mechanical injuries were further classified into globe, adnexal and posterior segment involving.

OPEN GLOBE CLOSED GLOBE Contusion (28.7 %) POSTERIOR SEGMENT INVOLVING Lens involving (0.6%) ADENEXAL Orbital (11.3%) Destructive globe injuries (10.1 %) IOFB (0.3%) Lamellar laceration (0.6%) Corneal abrasions (4.6 %) Superficial foreign bodies (7.5%) Lacrimal(1.8%) Palpebral (28.1%) Conjuctival (14.1%) uveal tissue involving (4.2%) Vitreous involving (0.1%) Retina involving (0.3%) Optic nerve involving (0.1%).

RESULTS. Basic Details Age (Years) 31.30 ± 14.70 Gender (M/F) 574 (80.2%)/ 142 (19.8%) Eye Affected (R / L / Both) 300 (41.9%)/ 288 (40.2%) / 128 (17.9%) Multisystem involvement Head Injury 230 (32.1%) Facial Injury 204 (28.5%) Isolated Ocular Trauma 114 (15.9%) Polytrauma 168 (23.5%) Type of Trauma Mechanical 691 (96.5%) Non-Mechanical 25 (3.5%).

Basic Details Precise Cause Blunt Trauma 496 (71.0%) Penetrating Trauma 178 (25.5%) Perforating Trauma 4 (0.6%) Chemical Injury 14 (2.0%) Thermal Injury 7 (1%).

Injury Yes Destructive globe injury 74 (10.1%) Intra Ocular Foreign Body 2 (0.3%) Contusion 204 (28.7%) Lamellar Laceration 4 (0.6%) Corneal Abrasion 33 (4.6%) Superficial Foreign Body 53 (7.5%) Lens Involvement 4 (0.6%) Choroid Involving 30 (4.2%) Vitreous Involving 1 (0.1%) Retina Involving 2 (0.3%) Optic Nerve Involving 1 (0.1%) Endophthalmitis 4 (0.6%) Conjunctival 102 (14.3%) Orbital 80 (11.3%) Lacrimal 13 (1.8%) Palpebral 200 (28.1%) Extra Ocular Muscle Involvement 4 (0.6%).

70 60 50 40 30 20 10 71.1% LogMAR O to 0.8 LogMAR 0.9 to PL-ve Visual Acuity.

Zone (Open Globe) Frequency Percentage 95% CI 1 24 32.4% 22.3% - 44.4% 2 36 48.6% 37.0% - 60.5% 3 14 18.9% 11.1% - 30.0%.

Time of Presentation Visual Acuity (Final) Chi-Squared Test LogMAR 0 to 0.8 LogMAR 0.9 to PL-ve Total χ2 P Value <1 Hour 6 (3.9%) 0 (0.0%) 6 (2.8%) 60.194 <0.001 <6 Hours 68 (43.9%) 11 (17.5%) 79 (36.2%) 6-12 Hours 18 (11.6%) 2 (3.2%) 20 (9.2%) 12-24 Hours 39 (25.2%) 11 (17.5%) 50 (22.9%) 24-48 Hours 20 (12.9%) 19 (30.2%) 39 (17.9%) 48-72 Hours 2 (1.3%) 3 (4.8%) 5 (2.3%) >5 Days 0 (0.0%) 8 (12.7%) 8 (3.7%) >7 Days 1 (0.6%) 4 (6.3%) 5 (2.3%) >1 Month 1 (0.6%) 5 (7.9%) 6 (2.8%) Total 155 (100.0%) 63 (100.0%) 218 (100.0%).

Visual Acuity (Final) Visual Acuity (Presentation) Chi-Squared Test LogMAR 0 to 0.8 LogMAR 0.9 to PL-ve Total χ2 P Value LogMAR 0 to 0.8 112 (100.0%) 43 (40.6%) 155 (71.1%) 93.622 <0.001 LogMAR 0.9 to PL- ve 0 (0.0%) 63 (59.4%) 63 (28.9%) Total 112 (100.0%) 106 (100.0%) 218 (100.0%).

Ocular Trauma Score Visual Acuity (Presentation) Chi-Squared Test LogMAR 0 to 0.8 LogMAR 0.9 to PL-ve Total χ2 P Value 1 0 (0.0%) 20 (18.9%) 20 (9.3%) 162.072 <0.001 2 2 (1.8%) 35 (33.0%) 37 (17.1%) 3 3 (2.7%) 41 (38.7%) 44 (20.4%) 4 22 (20.0%) 5 (4.7%) 27 (12.5%) 5 83 (75.5%) 5 (4.7%) 88 (40.7%) Total 110 (100.0%) 106 (100.0%) 216 (100.0%).

Ocular Trauma Score Visual Acuity (Final) Chi-Squared Test LogMAR 0 to 0.8 LogMAR 0.9 to PL-ve Total χ2 P Value 1 0 (0.0%) 20 (31.7%) 20 (9.3%) 123.438 <0.001 2 10 (6.5%) 27 (42.9%) 37 (17.1%) 3 31 (20.3%) 13 (20.6%) 44 (20.4%) 4 24 (15.7%) 3 (4.8%) 27 (12.5%) 5 88 (57.5%) 0 (0.0%) 88 (40.7%) Total 153 (100.0%) 63 (100.0%) 216 (100.0%).

Zone (Open Globe) Visual Acuity (Final) Chi-Squared Test LogMAR 0 to 0.8 LogMAR 0.9 to PL-ve Total χ2 P Value 1 12 (41.4%) 12 (28.6%) 24 (33.8%) 12.054 0.002 2 17 (58.6%) 16 (38.1%) 33 (46.5%) 3 0 (0.0%) 14 (33.3%) 14 (19.7%) Total 29 (100.0%) 42 (100.0%) 71 (100.0%).

Discussion. Many of the variables analyzed showed a statistically significant correlation with final visual outcomes, including zone of involvement and time to presentation. The most common location of open globe injury in this population was a Zone I injury; however, more posterior injuries carried a worse prognosis. Time of presentation also was important as the patients who presented earlier had a better final visual outcomes. In this study, it was found that initial visual acuity, extent of injury, development of endophthalmitis, and a ruptured globe were all predictive of a poorer final visual acuity..

This is the first study in CENTRAL INDIA, comprising of a large cohort and highlights both the scope of ocular injuries and the utility of the OTS for the prediction of visual outcomes and management of such patients..