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An experimental evaluation of traumatic globe rupture
R H Haug1, D B Haghighi, J E Barber
1Division of Oral and Maxillofacial Surgery, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH 44109, USA.
Summary
Surgeons accurately identified severe globe injuries but struggled with less severe ones. Clinical retraction forces exceeded the force needed to rupture globes, posing a risk of further injury.
Area of Science:
- Ophthalmology
- Trauma Surgery
- Biomechanics
Background:
- Ocular globe injuries require precise surgical assessment.
- Understanding the forces involved in globe rupture and surgical manipulation is crucial for patient outcomes.
Purpose of the Study:
- To assess surgeons' accuracy in identifying different types of ocular globe injuries.
- To determine the rupture force for various globe injury types.
- To measure clinical orbital retraction forces.
Main Methods:
- Enucleated bovine globes underwent simulated injuries (laceration, perforation).
- Oral and maxillofacial surgeons assessed injury types and simulated globe retraction.
- Mechanical testing determined globe rupture forces using an Instron unit.
Main Results:
- Surgeons achieved 100% accuracy for through-and-through lacerations, but only 15% for perforations.
- Globe rupture forces varied significantly, with through-and-through lacerations rupturing at the lowest force (4.94 kg).
- Mean clinical retraction force (0.35 kg) was significantly lower than rupture forces, but still exceeded rupture forces for severe injuries.
Conclusions:
- Surgical accuracy in assessing globe injuries decreases with injury severity.
- Globes with perforations and subtotal lacerations rupture at forces comparable to uninjured globes, but significantly less than severe lacerations.
- Clinical retraction forces, while seemingly low, can exceed the force required to rupture globes, indicating a potential risk.