Verification of Ocular Trauma Score for Intraocular Foreign Bodies in Lethal-Weapon-Related Ocular Injuries

The ocular trauma score (OTS) is a widely used predictive tool in determining the visual prognosis of ocular injuries. Intraocular-foreign-body (IOFB)-type injuries comprise the leading type of open-globe injuries (OGI) in ocular combat injuries. However, there are scarce reports evaluating the efficacy of OTS in IOFB-type injuries. Only one study is available that explored the validity of OTS in combat-related IOFB injuries with a limited number of eyes. The aim of this study is to confirm the predictive value of OTS in lethal-weapon (LW)-related OGI with IOFB.

The charts of 488 patients with IOFB-type-eye injuries between January 1998 and January 2018 were analyzed. Only the LW-related ocular injuries were included. Baseline details (patient demographics, surgeries, OTS categories, and visual acuity [VA]) were recorded. To test the validity of OTS, Fischer exact test was used to compare the likelihood of the final VAs for every OTS subgroups between OTS study group and this study.

The complete data of 206 eyes of 142 patients including two civilians were analyzed in the study. No subjects had ocular protection at the time of the injury. OTS study and this current study did not show an exact validation in first three OTS categories in various final VA subgroups (no light perception (NLP) subgroup (P: 0.001), light perception/hand movements subgroup (P: 0.033), 20/200 to 20/50 subgroup (P: 0.047) in OTS category 1; NLP subgroup (P: 0.000), 20/200 to 20/50 subgroup (P: 0.036), 20/40 subgroup (P: 0.018) in OTS 2; and 20/200 to 20/50 subgroup (P: 0.01), 20/40 subgroup (P: 0.003) in OTS 3, respectively). The above results indicate that in first three OTS categories, OTS study was not useful in visual prognosis prediction in the mentioned VA subgroups. The results predicted the final VA only in OTS categories 4 and 5 in which all P values were greater than 0.05.

Visual outcome of this type of ocular injury may be unpredictable due to more frequent discouraging results. OTS failed to predict visual outcome in first three OTS categories in this study. Therefore, OTS appears to be verified only in better (OTS categories 4 and 5) categories.