Visual outcome and ocular survival after penetrating trauma. A clinicopathologic study

Ocular trauma is a leading cause of blindness in the United States. This study was undertaken to identify clinical and histopathologic factors that predict ocular survival and final visual acuity after penetrating ocular trauma.

One hundred seventy-six cases of ruptured globe were reviewed. Factors analyzed included (1) initial visual acuity, (2) wound location, (3) wound length, (4) mechanism of injury (sharp, blunt, or missile), (5) presence of intraocular foreign body, (6) type of ocular wound (perforating versus nonperforating), (7) performance of vitrectomy, and (8) histopathologic features (n = 40). Data were analyzed using univariate and multivariate logistic regression analysis.

Predictors of excellent final visual acuity (20/60 or better) were initial visual acuity of 20/200 or better, wound location anterior to the plane of insertion of the four rectus muscles, wound length 10 mm or less, and sharp mechanism of injury. In contrast, predictors of poor vision were initial visual acuity of light perception or no light perception, wounds extending posterior to rectus muscle insertion plane, would length greater than 10 mm, and blunt or missile injury. Vitrectomy did not improve final vision. Factors predicting enucleation were similar to those predicting poor vision; however, vitrectomy decreased the likelihood of enucleation. Histopathologic review showed fibrous ingrowth in 93% of eyes enucleated more than 14 days after injury, and none of those enucleated within 2 weeks.

Significant predictive factors of final visual acuity after penetrating trauma include visual acuity, wound location and length, and mechanism of injury. Establishment of predictors of ocular survival and visual function may assist clinicians in selecting salvageable eyes for surgical repair.