Characteristics of Open-globe Eye Injuries with Respect to Zone of Injury

Abstract

Aims: To describe the demographics, characteristics and outcomes of open-globe injuries (OGI) with respect to zone of injury. Methods: Medical records of all patients presenting with OGIs to University Hospital, Newark, NJ between January 2001 and December 2008 with a follow-up of at least 3 months were reviewed. Demographics, characteristics of the trauma and outcomes were compared with respect to the zone of injury; location of injury is confined to the cornea and limbus in zone 1 (Z1), <5 mm posterior to the limbus in zone 2 (Z2)and >5mm posterior to the limbus in zone 3 (Z3). Results: Of the 309 patients (310 eyes) identified, 228 (74%) were male. The mean ageat presentation was 35.3years (1-96). Mean follow-up was 22.8 months (3-108 months). Most of the eyes presented with Z1 injury: 141 eyes (46%) Z1 injury, 83 (27%) Z2 and 86 (28%) Z3. Rupture was the most common type of injury in Z2 and Z3 injuries. Nineteen (86%) of 22 eyes with an intraocular foreign body (IOFB) had a Z1 injury. 32 (42%) of 77 eyes with Z3 injury had no light perception (NLP) at presentation, compared with 9 (8%) of 119 Z1 and 13 (17%) of 78 Z2-injured eyes. Four percent of Z1, 11% of Z2 and 18% of Z3-injured eyes had a final vision (VA) of NLP. Primary enucleation was undertaken in 10 eyes (9 were Z2 injured eyes). Secondary enucleation was performed in 12 (9%) of 141 Z1, 7 of 82 (9%) of Z2 and 22 (26%) of 78 Z3 eyes. Thirty (36%) of 86 Z3 injuries resulted in primary or secondary enucleation. The final Snellen VA was 1.05, 1.41, and 2.19 respectively in Z1, Z2 and Z3-injured eyes. Posterior segment surgery was performed in 30% Z1, 39% Z2 and 49% Z3-injured eyes. Retinal detachment (RD) was diagnosed in 11% Z1, 27% Z2 and 40% Z3 injuries. Conclusion: Z1 injury may be associated with a better visual prognosis than Z2 andZ3injuries. The visual prognosis of Z3 injured eyes is poor with one-third of these eyes being enucleated.