MS Ophthalmology, FICO (UK), Consultant- Department of Glaucoma, CL Gupta Eye Institute, Ram Ganga Vihar Phase II, Moradabad-244001 (India).

Ocular open globe injuries frequently leave the person and society disabled because the majority of these eyes may never be saved. Numerous early factors have been found to be helpful in predicting the eventual visual result with these eyes. Additionally, numerous prognostic methods have been supported by earlier research. This essay seeks to examine each of these elements.

Key words:open globe injury, ocular trauma, and ocular trauma score

Visual impairment is frequently brought on by ocular damage, which is frequently avoidable. Even though it accounts for only 2% of all ocular injuries, it causes over 500,000 cases of monocular blindness globally. [1-5] According to World Health Organization estimates from 1998, there are 3.5 open globe injuries (OGIs) for every 100,000 people worldwide each year. [5] The main goal of treating these eyes is to do primary repair as soon as possible in order to restore the globe's structural integrity. A primary enucleation can be an option for eyes that can no longer be repaired. Despite the better microsurgical facilities that are now accessible, the outlook for the majority of these eyes is still bleak.

Injury that penetrates: no exit wound and a full-thickness corneoscleral wound a perforating wound an exit wound and a full-thickness corneoscleral wound Foreign object kept inside the eye is known as an intra-ocular foreign body (IOFB).

Previous writers have found a variety of damage pathways. The most frequent source of injuries, according to the majority of the articles, is a sharp object (such as a glass projectile), followed by injuries from wooden or metal sticks, fists, pellets, falls, etc.
[3,6,17,18]
Males have a considerably greater rate of OGIs than females, which may be due to either more aggressive behaviour or participation in higher risk indoor and outdoor activities. [2,3,6-9] Additionally, a connection has been shown between gender and the location of the injury. Males are more likely to sustain injuries at the workplace and on the streets, whereas females are more likely to get injuries at home. In the paediatric age range, schools are where injuries occur the most frequently. [6,12-14,17,18]

The existence or absence of RAPD, the presenting VA, and the extent of the wound are the most important preoperative characteristics linked with the visual outcome of surgical repair in OGIs, according to previous studies.[10-\s19,23-25] Age, the location of the incision, lens damage, vitreous haemorrhage (VH), retinal detachment (RD), [13,15,17,19], and the presence of an intraocular foreign substance are additional factors (IOFB) [3,12,13,17,19] If the RAPD is present during the initial evaluation, the prognosis is noticeably poorer. According to earlier research, patients who present with a VA of less than 6/60 will experience a significantly worse outcome than those who present with a VA of more than 6/60. [17-19, 23-25] In their study, Agarwal et al. [25]
claimed that hyphema and adnexal injuries were linked to a poor visual outcome; however, Rahman et al. [18] and Agarwal et al. [23] reports disproved this. Studies by Groessl et al., Pieramici et al., Rahman et al., [18] and Williams et al. [27] have demonstrated that the visual outcome is much better in cases where just one first procedure was necessary than in those requiring many procedures.

The most significant consequence of OGIs related with worse ultimate vision is post-traumatic endophthalmitis. 4.9% to 54.2% of people have it. [28-31] Another significant OGI complication that is linked to a poorer visual result is RD.

On the basis of previously recognised presenting characteristics, a variety of systems have been reported to anticipate final visual outcomes. Ocular trauma score (OTS) was created in 2002 by Kuhn et al [32] using data from the eye injury registry. They cited factors that adversely affected the ultimate VA, including the initial low VA, rupture, endophthalmitis, perforations, RD, and APD. OTS scores range from 1 (worst prognosis and most severe injury at six months) to 5 (least poor prognosis and least severe injury at six months). A variety of projected post-injury visual acuities are connected to each score. With a predicted accuracy of about 80%, the OTS will be accurate four out of five times.To prospectively confirm the VA prognosis in OGIs, Schmidt et al [20] created the classification and regression tree (CART) model in 2008. This helped Gupta et al. [6] estimate the eventual visual result based on some initial characteristics. According to Scott R, Shah et al, Unver et al, and Scott R, OTS can be helpful in predicting the final visual result of certain ocular injuries. OTS has a high predictive accuracy to predict the final visual outcome, according to Wai Man et al [24]. The OTS and CART models, according to Knippers et al. [36], are reliable predictors of visual acuity outcomes following open globe injury.

An ophthalmologist has management challenges when treating open globe injuries. Assessing the visual prognosis of such eyes is frequently challenging. They may benefit from the OTS in this aspect. Non-ophthalmologists may find it helpful to anticipate the final visual prognosis in OGIs based on the initial visual acuity.

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Richa Gupta. Open Globe Ocular Injury: Causes and Prognosis. Insights of Clinical and Medical Images 2022.