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

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. of Ophthalmology), Govt. Medical CollegeHospital, Sector-32, Chandigarh.Address: HN, 1155A, Sector-32B, Chandigarh; Contact: (0172)2607707;E-mail: aryasudesh@yahoo.comVisual Outcome and Profile of Patients with Ocular Trauma in aTertiary Care Centre of Eastern NepalDr. Sudesh Kumar Arya, Dr. Badri Prasad Badhu, Dr. Poonam Lavaju,Dr. Archna Sharma, Dr. Sushila Patel(Presenting Author: Dr. Sudesh Kumar Arya)Ocular trauma is a major cause of monocularblindness worldwide 1,2 involving half amillion people. According to the study done inNepal (2000), the crude incidence of oculartrauma was 0.51 per 1000 population at risk peryear. 3Materials and MethodsThis study included retrospective data of 68patients presenting with ocular trauma fromApril 2007 to March 2008. Information collectedinclude the type, cause, and location of injury,time between injury and presentation, anddemographic data. The ocular examinationconsisted of visual acuity testing with detailedslitlamp evaluation. Posterior segmentevaluation was done with dilated pupilswherever possible.In patients with hazy media,ultrasonography B scan was done. Clinicalfeatures of the injury were recorded andclassified according to international oculartrauma classification as open globe and closedglobe injury.Rupture, penetrating injury,intraocular foreign body, perforating injurieswere kept under open globe while, contusion,lamellar laceration and superficial foreign bodywere kept in the closed globe type.In the openglobe injury, injury upto to the corneosclerallimbus was taken as zone I, injuries extendingfrom limbus to 5mm was taken as zone II andbeyond 5mm was taken as zone III injuries. Thepatients’ corrected visual acuities werecategorized as having corrected vision worsethan 20/400 (WHO definition of blindness) orvision worse than 20/60 (WHO definition ofvisual impairment) in the injured eye.ResultsOut of 68 patients, 53 (78%) were males and15(22%) were females. Age ranged from 9months to 76 years with a mean of 19 years .42(63%) patients were less than 14 years of age. Outof 68 patients, 31 (45.4%) patients were students,17 (25 %) were preschool, 8(12.1%) were workers,7(10.6%) were farmers and 5 (7.6%) were housewives. 38 (56 %) patients had injury whileplaying while15 (22 %) had work related injuries,11(16%) had injury by physical assault and 4(6%)had injury due to fall from height.Agents of injury: Injury with wooden stick wasthe commonest involving 28 (41%) patientsfollowed by stone 11(16%) patients and sickle 5patients (7%). Other modes of injury were needle,glass piece, goat horn, cricket bat, pen, slipperand others. Out of 68 cases, 30 (44%) hadinvolvement of right eye while 37 (54%) hadinvolvement of left eye and one (1.5%) hadbilateral injuries. 28 (41%) patients presentedwithin 24 hours of injury, 24(36%) patients within2 to 5 days while, 16 (23% )presented after 5 daysof injury.Diagnosis at presentation: 56 (83%) patients hadopen globe injury while rest of them had closed

572 AIOC 2009 PROCEEDINGSglobe injury.In open globe injuries, Zone 1 wascommonest 36 (64%) followed by zone II 9 (16%)patients.26 (47%) patients had type B injuries(penetrating) while 12 (18 %) had type A injuries(rupture).The most common pattern ofpresentation was corneal perforation 38 (55%)patients followed by corneo-scleral perforation17% ,hyphema 10%, globe rupture7%, intraocularforeign body 4%, lid laceration3% and 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. Visualacuity could not be assessed in 9 (13.23%)patients who were 5 years or younger at the timeof presentation.Management: Surgery was performed in 60(88.2%) patients while 8 (11.8%) patients weremanaged conservatively. Intravitreal antibioticswere given in 18 (26%) patients and 3 (4.4%)patients underwent evisceration as these patientshad irreparable globe injury.Visual 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 blindand 16 (23.5%) were visually impaired.DiscussionThe percentage of ocular trauma in men wasgreater than in women, similar to what has beenreported previously in other studies. 1,4 It ispossible that the lower percentage amongwomen may be due to less outdoor activities.Two-third patients were in pediatric age group(

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