VISUAL OUTCOME AND OCULAR SURVIVAL AFTER PENETRATING TRAUMA - A CLINICOPATHOLOGICAL STUDY

Purpose: Ocular trauma is a leading cause of blindness in the United S tates. This study was undertaken to identify clinical and histopatholo gic factors that predict ocular survival and final visual acuity after penetrating ocular trauma. Methods: One hundred seventy-six cases of ruptured globe were reviewed. Factors analyzed included (1) initial vi sual acuity, (2) wound location, (3) wound length, (4) mechanism of in jury (sharp, blunt, or missile), (5) presence of intraocular foreign b ody, (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 regress ion analysis. Results: Predictors of excellent final visual acuity (20 /60 or better) were initial visual acuity of 20/200 or better, wound l ocation anterior to the plane of insertion of the four rectus muscles, wound length 10 mm or less, and sharp mechanism of injury. In contras t, predictors of poor vision were initial visual acuity of light perce ption or no light perception, wounds extending posterior to rectus mus cle insertion plane, wound length greater than 10 mm, and blunt or mis sile injury. Vitrectomy did not improve final vision. Factors predicti ng enucleation were similar to those predicting poor vision; however, vitrectomy decreased the likelihood of enucleation. Histopathologic re view showed fibrous ingrowth in 93% of eyes enucleated more than 14 da ys after injury, and none of those enucleated within 2 weeks. Conclusi on: Significant predictive factors of final visual acuity after penetr ating trauma include visual acuity, wound location and length, and mec hanism of injury. Establishment of predictors of ocular survival and v isual function may assist clinicians in selecting salvageable eyes for surgical repair.