Characteristics of Traumatic Cataract Wound Dehiscence

Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts 02215, USA.
American Journal of Ophthalmology (Impact Factor: 4.02). 05/2011; 152(2):229-33. DOI: 10.1016/j.ajo.2011.01.044
Source: PubMed

ABSTRACT To characterize the clinical course of cataract wound dehiscence.
Retrospective, comparative case series.
Charts of open globe injuries (848 injuries in 846 patients) treated surgically at the Massachusetts Eye and Ear Infirmary between 2000 and 2009 were retrospectively reviewed. Time from original surgery to wound dehiscence, type of initial surgery, Ocular Trauma Score, age, gender, mechanism of injury, and visual acuity were analyzed.
Of 846 patients with 848 open globe injuries, 63 experienced cataract wound dehiscence. The majority of these cataract wounds (89%) were extracapsular cataract extraction (ECCE), with only 7 (11%) phacoemulsification wounds. The mean patient age in the wound rupture group was 78.2 years. Female patients comprised the majority (67%) of this subpopulation. The most common mechanisms of injury were fall (65%), blunt trauma (23%), and motor vehicle accident (7%). The median raw ocular trauma score was 47 in wound dehiscence patients. Visual acuity at presentation was light perception in the wound dehiscence group. The best postoperative visual acuity was significantly worse in the wound dehiscence group (hand motion) than in the remaining patients (20/40; P=.0002). When considering the phacoemulsification patients alone, these patients fared much better, with a median postoperative vision of 20/60.
Despite recent advances in cataract surgery, wound dehiscence remains a significant source of visual disability, mainly in the geriatric population. Rupture ECCE wound patients have a poor visual prognosis. Fortunately, patients with phacoemulsification site dehiscence appear to regain the majority of their vision after open globe repair.

  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: We aimed to identify the characteristics and prognostic indicators of poor visual and anatomic outcome in pseudophakic patients with fall-related open-globe (OG) injuries. We used a case series design, for a total of 26 patients. Charts of consecutive pseudophakic patients with fall-related OG injury at a single institution were reviewed. Demographics, ophthalmic history, circumstances of injury, initial best-corrected visual acuity (BCVA), examination findings, surgical interventions, and follow-up BCVA were tabulated for statistical analysis with unpaired t-tests and Fisher's exact tests. Nineteen patients (73%) were women. Mean (± standard deviation) age was 80.6±4.6 years (range: 61-97 years). Initial BCVA was <20/400 in 24 of 25 patients (96%). Mean ocular trauma score (OTS) was 38.54±10.95. OTS was lower (P=0.0017, P<0.0001, and P=0.0240) and wound size was larger (P=0.0440, 0.0145, and 0.0026) in patients with final BCVA <20/40, <20/400, and phthisis at final follow-up, respectively; compared to patients with BCVA ≥20/40, 20/400, and no phthisis at final follow-up, respectively. Final BCVA <20/400 was associated with 360° subconjunctival hemorrhage (SCH), retinal detachment, and proliferative vitreoretinopathy (P=0.0498, 0.0181, and 0.0310, respectively). Total hyphema, intraocular lens (IOL) damage, and IOL expulsion were associated with needing multiple surgical interventions (P=0.0345, P<0.0001, and P=0.0023, respectively). Large wound size, low OTS, 360° SCH, total hyphema, posterior injury, and IOL damage are common findings that are also prognostic of poor visual and anatomic outcome in pseudophakic patients with fall-related OG injuries. Ophthalmologists dealing primarily with geriatric populations should contribute to the discussion of fall risk.
    Clinical ophthalmology (Auckland, N.Z.) 01/2015; 9:403-8. DOI:10.2147/OPTH.S73757
  • [Show abstract] [Hide abstract]
    ABSTRACT: PURPOSE:: To describe characteristics and outcomes of fall-related open globe (OG) injuries. METHODS:: A total of 602 patients (603 eyes) presenting with OG injuries were included. Among them, 85 wounds (85 patients) were fall-related, which were compared with the nonfall-related OG injuries (control group). RESULTS:: The mean patient age in the fall group was 65.8 years, which was higher than the control population (35.8 years; P < 0.001). Most of the fall-related injuries occurred in women (58.8%). The most common zone injured in both groups was Zone I (38.8% and 46% in the fall and control group, respectively). Compared with the control group, patients with fall-related OG injuries had a worse visual acuity on admission and at final visit (P < 0.001). The authors performed regression analysis to characterize factors associated with developing no light perception and need for enucleation. Injuries involving Zone III and presenting vision of no light perception were associated with a higher rate of no light perception. Similarly, patients presenting with no light perception were more likely to undergo enucleation, eventually. CONCLUSION:: Fall-related OG injuries can lead to severe ocular morbidity especially in the elderly patients. They carry a worse visual prognosis compared with other injuries, which emphasizes on the importance of protective measures in this population.
    Retina (Philadelphia, Pa.) 04/2013; DOI:10.1097/IAE.0b013e31828abe50 · 2.93 Impact Factor


Available from
May 29, 2014