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-. Ocular trauma is one of the most important subset, an ophthalmic practitioner encounters during his/her daily clinical practice. Management and proper clinical evaluation of an ocular trauma patient is therefore an important part of our practice. WHO program for the prevention of blindness suggests, approximately 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.”.

Eye injuries can result due to the involvement of the ocular surface, adnexa, extraocular muscles, optic nerve and orbital walls. Therefore, a patient presenting with what looks like a simple black- eye, might need a thorough workup, involving a detailed anterior and posterior segment examination as well as a radiological work-up is a necessity to prevent long-term complications like traumatic optic neuropathies. Ocular trauma has been a subject of controversies and debates when it comes to optimal management and classification systems, as there is nothing absolute in ocular trauma. 2 Our study provides new insights into the risk factors,prevalence , and causes of ocular trauma and morbidity across all age groups– to analyze the epidemiology, clinical features, visual outcome, and visual prognosis of ocular injuries presenting to a tertiary care centre in central India. 2 Agrawal et al., “Controversies in Ocular Trauma Classification and Management.”.

According to the most widely accepted classification system “ Birmingham Eye Trauma Terminology system (BETT)” mechanical eye injuries were classified into open and closed globe injuries, 3 most eye injuries can be classified under this system as well as the system proposed by Shukla et al, but still remains few hidden sub-types which we were not able to classify under any of the proposed classification system. So in our study we classified the patients as proposed by Shukla et al, 4 as well as we aim to determine the prognostic factors of ocular trauma and the factors affecting the final visual outcomes. 3 V. S., Abraham, and Nair, “Evaluation of the Factors Affecting Visual Prognosis in Patients with Traumatic Cataract.” 4 Natarajan, “Ocular Trauma, an Evolving Sub Specialty.”.

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. The study was conducted after approval was obtained from the institutional ethical committee. Informed written consent was obtained from all the participants and for children from their parents/guardians. 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%).

Type of Adnexal Injury Yes No Palpebral 215 (54.8%) 177 (45.2%) Conjunctival 108 (27.6%) 284 (72.4%) Lacrimal 7 (1.8%) 385 (98.2%) Orbital 74 (18.9%) 318 (81.1%).

Management Yes No Amniotic Membrane Graft 1 (0.1%) 714 (99.9%) Canalicular Repair 5 (0.7%) 710 (99.3%) Conjunctival Tear Repair 1 (0.1%) 714 (99.9%) Corneal Tear Repair 24 (3.4%) 691 (96.6%) Paracentesis 8 (1.1%) 707 (98.9%) Iris Reposition 2 (0.3%) 713 (99.7%) Uveal Tissue Abscission 5 (0.7%) 710 (99.3%) Corneo-Scleral Tear Repair 27 (3.8%) 688 (96.2%) Evisceration 8 (1.1%) 707 (98.9%) Foreign Body Removal 55 (7.7%) 660 (92.3%) Intra-Ocular Foreign Body Removal 2 (0.3%) 713 (99.7%) Keratoplasy 4 (0.6%) 711 (99.4%) Lens Extraction 6 (0.8%) 709 (99.2%) Lid Repair 173 (24.2%) 542 (75.8%) Limbal -Tear Repair 7 (1.0%) 708 (99.0%) Medical Management 364 (50.9%) 351 (49.1%) Scleral Buckling 1 (0.1%) 714 (99.9%) Scleral Tear Repair 3 (0.4%) 712 (99.6%) Primary repair 27 (3.8%) 688 (96.2%) Others 2 (0.3%) 713 (99.7%).

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 (Presentation) Chi-Squared Test LogMAR 0 to 0.8 LogMAR 0.9 to PL-ve Total χ2 P Value <1 Hour 6 (5.2%) 2 (1.9%) 8 (3.6%) 46.353 <0.001 <6 Hours 55 (47.8%) 25 (23.1%) 80 (35.9%) 6-12 Hours 14 (12.2%) 6 (5.6%) 20 (9.0%) 12-24 Hours 28 (24.3%) 24 (22.2%) 52 (23.3%) 24-48 Hours 12 (10.4%) 27 (25.0%) 39 (17.5%) 48-72 Hours 0 (0.0%) 5 (4.6%) 5 (2.2%) >5 Days 0 (0.0%) 8 (7.4%) 8 (3.6%) >7 Days 0 (0.0%) 5 (4.6%) 5 (2.2%) >1 Month 0 (0.0%) 6 (5.6%) 6 (2.7%) Total 115 (100.0%) 108 (100.0%) 223 (100.0%).

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 (Closed Globe) Visual Acuity (Presentation) Fisher's Exact Test LogMAR 0 to 0.8 LogMAR 0.9 to PL- ve Total χ2 P Value 1 57 (93.4%) 9 (28.1%) 66 (71.0%) 45.901 <0.001 2 4 (6.6%) 10 (31.2%) 14 (15.1%) 3 0 (0.0%) 13 (40.6%) 13 (14.0%) Total 61 (100.0%) 32 (100.0%) 93 (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%).

Time of Presentation Ocular Trauma Score Chi-Squared Test 1 2 3 4 5 Total χ2 P Value <1 Hour 0 (0.0%) 1 (2.7%) 1 (2.2%) 2 (7.1%) 3 (3.4%) 7 (3.2%) 97.103 <0.001 <6 Hours 1 (5.0%) 9 (24.3%) 11 (24.4%) 14 (50.0%) 44 (50.0%) 79 (36.2%) 6-12 Hours 0 (0.0%) 1 (2.7%) 4 (8.9%) 4 (14.3%) 11 (12.5%) 20 (9.2%) 12-24 Hours 2 (10.0%) 10 (27.0%) 12 (26.7%) 8 (28.6%) 17 (19.3%) 49 (22.5%) 24-48 Hours 8 (40.0%) 8 (21.6%) 10 (22.2%) 0 (0.0%) 13 (14.8%) 39 (17.9%) 48-72 Hours 1 (5.0%) 2 (5.4%) 2 (4.4%) 0 (0.0%) 0 (0.0%) 5 (2.3%) >5 Days 3 (15.0%) 4 (10.8%) 1 (2.2%) 0 (0.0%) 0 (0.0%) 8 (3.7%) >7 Days 4 (20.0%) 0 (0.0%) 1 (2.2%) 0 (0.0%) 0 (0.0%) 5 (2.3%) >1 Month 1 (5.0%) 2 (5.4%) 3 (6.7%) 0 (0.0%) 0 (0.0%) 6 (2.8%) Total 20 (100.0%) 37 (100.0%) 45 (100.0%) 28 (100.0%) 88 (100.0%) 218 (100.0%).

Association Between Ocular Trauma Score and Visual Acuity (Presentation) (n = 216).

DISCUSSION. Our study found that a large portion of the patients, were below the age of 30 . Hence, denoting the involvement of vulnerable population. This may be due larger risk faced by this age group during their line of work or their frequent social activities. This study also shows the preponderance of male gender for ocular trauma. This may be explained by the fact that male population tend have more outdoor activities and have higher tendencies to face occupational hazards.

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 vinal 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 ofsuch patients..