JOURNAL READING

Pathophysiology and management of glaucoma and ocular

hypertension related to trauma

Pembimbing :

dr. Hadi Soesilo, Sp.M

Penyusun :

Cahya Yudha Laksmana Putra (2021.04.2.0032)

BAGIAN ILMU KESEHATAN MATA

FAKULTAS KEDOKTERAN UNIVERSITAS HANG TUAH

RSPAL DR.RAMELAN

SURABAYA

2023
LEMBAR PENGESAHAN
 JOURNAL READING
ILMU KESEHATAN MATA

Journal reading yang berjudul “Open Globe Injuries from Projectile Impact:
Initial Presentation and Outcomes” ini telah diperiksa dan disetujui sebagai salah
satu tugas untuk menyelesaikan kepaniteraan klinik di bagian Ilmu Kesehatan
Mata RSPAL Dr. Ramelan Surabaya.

Surabaya, 1 Februari 2023

Pembimbing, dr. Hadi Soesilo, Sp.M

 KATA PENGANTAR

Alhamdulillahi Robbil `Alamin atas kehadirat Allah Subhanahu Wa Ta’ala

karena berkat dan rahmat-Nya penyusun dapat menyelesaikan journal reading
yang berjudul “Open Globe Injuries from Projectile Impact: Initial Presentation
and Outcomes”. Penyusunan journal reading ini dibuat untuk memenuhi salah
satu tugas kepaniteraan di bagian Ilmu Penyakit Mata RSPAL Dr. Ramelan
Surabaya.

Penyusun mengucapkan banyak terima kasih kepada dr. Hadi Soesilo,

Sp.M, atas bimbingan serta waktu yang telah diberikan sehingga penyusun dapat
menyelesaikan journal reading ini. Penyusun menyadari segala kesalahan dan
kekurangan dalam pembuatan journal reading ini. Oleh karena itu, saran dan
kritik sangat diharapkan dan diterima oleh penyusun dalam penyempurnaan
journal reading ini.

Demikian journal reading ini dibuat dengan harapan semoga journal

reading ini dapat bermanfaat bagi kita semua.

Surabaya, 1 Februari 2023

Penyusun

Kharizmatika
Open Globe Injuries from Projectile Impact: Initial Presentation and

Outcomes Angelica C Scanzera, Yannek I Leidman, Maria S Cortina, Ellen S

Shorter

Department of Ophthalmology and Visual Science, Illinois Eye and Ear

Infirmary, University of Illinois at Chicago, Chicago, IL, United States
Corresponding to: Dr. Angelica C Scanzera, Illinois Eye and Ear Infirmary, UIC
Department of Ophthalmology and Visual Sciences, 1855 W, Taylor Street,
Chicago, IL – 60612, United States.

Email: ascanz@uic.edu

Abstract
Purpose: To describe the characteristics and correlates of open globe injuries
secondary to projectile injury and outcomes following surgical open globe repair
at an urban tertiary referral center.
Methods: Records of all patients with a history of open globe injury secondary to
projectile injury and surgical open globe in a tertiary referral hospital between
January 1, 2010 and December 31, 2016 were reviewed. Demographics, type of
trauma, wound extent, presence of foreign body, and presenting clinical findings
are reported. Outcomes for patients with greater than 6 months of follow ‐up
included additional surgeries, final visual acuity, and clinical findings.
Results: Of 214 patients who underwent open globe repair, 73 (34.1%) were due
to projectile impact. Mean age was 37.9 years and patients were primarily male (n
= 66, P < 0.001). Most injuries resulted in globe laceration (68.5%, P < 0.001),
and wound extent was zone 1 (45.2%), zone 2 (20.5%), zone 3 (27.4%), or
unknown (6.8%). Associated findings included foreign body (35.6%) and orbital
fracture (15%). Of 41 patients with at least 6 months of follow ‐up, 70% had
additional surgeries following their initial surgical repair. Laceration injuries
tended to be more anterior (P = 0.002) with better visual outcomes (P = 0.045)
than those with globe rupture, and concomitant orbital fracture associated with
poor visual outcomes. Overall, 58.5% of patients had 20/40 or better final best‐
corrected visual acuity.
Conclusion: This is the largest report of open globe injury due to projectile
impact. Visual prognosis in this population is very good, with most patients
achieving better than 20/40 vision in our study.
Keywords: Injury, ocular trauma, open globe injury, open globe repair, projectile
Introduction
One third of eye‐related emergency department visits in the United States
are due to ocular trauma, and about a third of these injuries result in legal
blindness.[1,2] In 2008, “being struck by an object or person” in the eye was the
reason for one‐third of emergency department visits involving eye injuries.[3]
Projectile impact is the most common mechanism of open globe injury in men.
[4,5] Injury extent, presence of relative afferent pupillary defect, and visual acuity
at time of injury can help physicians predict visual survival after open globe
injury,[6‐11] and support patient education and setting realistic expectations at the
time of initial surgery. Previous reports have described the epidemiology and
clinical outcomes of open globe injury,[4,6,7] though none has specifically
focused on outcomes in open globe injury secondary to projectile impact. The
purpose of this study was to describe the epidemiology of open globe injuries
secondary to projectile impact at an urban tertiary referral center and variables
associated with favorable outcomes. Methods
We conducted a retrospective cohort study. Records of all patients with a
history of open globe injury who underwent surgical open globe repair at a tertiary
referral hospital between January 1, 2010 and December 31, 2016 were reviewed.
Charts of patients billed any of the following codes were reviewed: CPT 65273
(repair of laceration), ICD‐9: (870.1–870.9, 871.1–871.9), and ICD‐10:
(S05.2XX‐ S05.9XX). Individuals with a history of open globe injury secondary
to projectile mechanism were included. Individuals with open globe injury due to
all other mechanisms were excluded. In this study, projectile mechanism was
determined to be any open globe injury secondary to an object propelled through
force. Patient demographics, initial visual acuity, type of trauma, wound extent,
presence of a foreign body, and presenting clinical findings were reviewed for all
patients. For patients with 6 months of follow‐up available, outcomes including
best‐corrected visual acuity, clinical findings, and additional surgeries were
analyzed. Snellen
visual acuities were converted to logarithm of the minimal angle of resolution
(LogMAR) form to analyze vision at presenting visit and final visit. LogMAR
acuities were later converted back to Snellen format and categorized for further
analysis: (1) greater than or equal to 20/40, (2) 20/50 to 20/200, (3) less than
20/200 to hand motion, (4) light perception, and (5) no light perception. This
study received Institutional Review Board approval.
Injury classification
 Injuries were classified according to the Birmingham Eye Trauma
Terminology System, and the extent of injury was classified using the Ocular
Trauma Classification Group,[11,12] Zone of injury was based on the most
posterior point of injury: Zone 1 injuries involved the cornea and corneoscleral
limbus, zone 2 injuries involved the corneoscleral limbus up to 5 mm posterior,
and zone 3 included injuries posterior to the anterior 5 mm of the sclera.[12]
Data analysis
Descriptive statistics as well as t‐tests and Chi ‐square tests were used to
compare variables with a significance level of 0.05, and bivariate logistic
regression was used to obtain odds ratios. Data was analyzed using SAS Institute
Inc. 2018 (SAS 9.4M6, Cary, NC, USA).
Result
A total of 73 of 214 (34.1%) patients with open globe injury presented due
to injury from projectile impact between January 1, 2010 and December 31, 2016.
Almost all patients, 94.5%, reported injury due to accident rather than altercation
[P < 0.001; Table 1]. The majority of patients presenting were male (P < 0.001)
and had trauma resulting in globe laceration (P < 0.001). The most frequent cause
of projectile injury were related to metal work (n = 23) followed by gun‐related
injuries (n = 6), injuries related to metal tools (n = 5), and projectile wood injuries
while using a saw (n = 4).
 Clinical findings at presentation included: corneal laceration (72.6%, n =
53), hyphema (46.6%, n = 34), iris or uveal prolapse (37.0%, n = 27), foreign body
(35.6%, n = 26), lid laceration (24.6%, n = 18), shallow or collapsed anterior
chamber (23.3%, n = 17), other iris abnormalities including dyscoria, tear, or
iridodialysis(16.4%, n = 12), orbital fracture (15.0%, n = 11), and traumatic
aniridia (2.7%, n = 2). The following were noted during the initial open globe
surgical repair: excision of prolapsed iris tissue (24.7%, n = 18), primary
lensectomy (11.0%, n = 8), and laceration too posterior to close (6.8%, n = 5).
Pars plana vitrectomy was performed in two individuals (2.7%) at the time of
repair, both of which were in patients with a reported intraocular foreign body.
 Of 26 patients with foreign body on presentation, 84.6% (22/26) were of
metallic origin. Of 11 patients with orbital fracture, 18.2% (2/11) were found to
have muscle entrapment. Mean laceration length was 7.55 ±6.6 mm (range 1–27; n
= 34). When comparing vision, patients with globe laceration were 6.23 times
more likely to have better entering visual acuity, noted as hand motion or better,
than those with globe rupture (OR 6.23, CI 2.10, 18.43; P = 0.001). Most patients
underwent surgical open globe repair within 1 day of injury (94.5%; range 0–4
days). One patient had an enucleation 15 days after initial open globe repair. Table
2 provides a comparison of clinical findings at presentation by trauma type.

Follow-up
Over half, 56% of patients, had at least 6 months of follow‐up after open
globe repair. Of these, 70% (n = 28) had a mean of 1.9 additional surgeries.
Visual acuity
There was visual improvement in most patients with greater than 6 months
of follow‐up compared to entering visual acuity [P < 0.001; Table 3]. In patients
who completed six months of follow‐up or more, those with globe laceration were
almost 5 times more likely to have hand motion or better final visual acuity (OR
4.98 (1.03, 23.96); P = 0.045) than those with globe rupture. Final visual acuity
was not affected by history of foreign body (P = 0.44); however, those with open
globe injury and orbital fracture were 9.9 times more likely to have poorer vision
than those without fracture (OR 9.86 (2.10, 46.36); P = 0.004).
Clinical outcomes
The following clinical findings were present in patients with at least 6
months of clinical follow‐up available: corneal scarring (46.3%, n = 19),
remaining corneal sutures(19.5%, n = 8), aphakia (14.6%, n = 6), history of retinal
detachment (9.8%, n = 4), glaucoma (4.9%, n = 2), and optic nerve pallor (2.4%, n
= 1). Additional surgeries in this subset of patients included: pars plana vitrectomy
(53.6%, n = 15), lensectomy (32.1%, n = 9), pan retinal photocoagulation (17.9%,
n = 5), corneal transplantation (7.1%, n = 2; Fig. 1), peripheral iridotomy (7.1%, n
= 2), and anterior vitrectomy (3.6%, n = 1). No eyes were eviscerated, but four
additional eyes were enucleated. All patients who underwent enucleation were fit
with an ocular prosthesis.
This is the largest case series of open globe injury due to projectile impact
to date. The visual prognosis of open globe injuries secondary to projectile impact
is fairly good, with 58.5% of those completing more than 6 months of follow ‐up
achieving a final best‐corrected visual acuity of 20/40 or better in this study
population. Of 26 patients sustaining intraocular foreign body in our study, only
four sustained a zone 3 injury, two of which required pars plana vitrectomy at the
time of repair. The presence of posterior foreign bodies requiring pars plana
vitrectomy likely would affect the management and final visual outcomes
adversely. Visual outcomes in this study are better than previous reports. For
example, Han et al.[13] studied all open globe injuries presenting to their hospitals
and found that only 36% of patients had a final visual acuity of 20/40 or better 1
year after their initial injury, though 27.3% sustained zone 3 injuries. In our study
group, 27.4% of patients who underwent open globe repair secondary to projectile
injury were classified as zone 3 injuries, though almost double had a final visual
acuity of 20/40 or better. One study by Kolomeyer et al.[3] looked at nail gun
injuries, a mechanism of projectile injury, and found that only 40% of patients had
a final visual acuity of 20/40 or better, though only 16% of eyes sustained zone 3
injuries compared to 27.4% in our study group; however, 70% of the nail gun
injuries resulted in vitreous hemorrhage on presentation compared to only 2.7% of
eyes in our study. Perhaps the velocity or force of impact may be an additional
predictor of visual outcome rather than mechanism or zone of injury alone.
This study population was similar to other open globe injury studies, with
a mean age of 37.9 years and the majority of patients being male (90.4%; P <
0.001).[4,5,14] Males tend to have greater risk of exposure to ocular trauma due to
occupation and responsibilities performed at home. Poor prognostic factors in the
current study included globe rupture, more posterior injury, and presence of
orbital fracture, which is consistent with other studies.[10,15,16] There was no
association between the presence of intraocular foreign body and visual outcomes
in this study. Though size of foreign body was not documented in this study, a
study by Liu et al.[17] describes that small foreign body size is associated with
better visual
outcomes, suggesting that documentation of foreign body size could also assist in
estimating visual prognosis.

Discussion
In this study, patients with 6 months of follow‐up required a mean of 1.9
additional surgeries, which is slightly higher than Kolomeyer et al.[3] which
reported 1.5 surgeries. No eyes were treated for suspected endophthalmitis which
is consistent with Fujikawa et al.[15], though several studies have noted higher
estimates of infection from 2.0 to 13.3%.[14,18,19] This is likely due to early
intervention and antibiotic treatment. In addition, only 5 eyes (6.8%) were
enucleated in this study, which is also lower than previously reported rates of 12–
26%.[10,18,20‐22] As patients presenting with open globe injury due to projectile
had more anterior injuries, the severity of injury was likely less than that of other
studies. Without direct comparison to other mechanisms of injury, this
suggeststhat visualsurvival in eyes presenting with injury from projectile impact is
likely greater than that of other mechanisms of injury.
According to Prevent Blindness America, 90% of all eye injuries are
preventable.[23] Although U.S. trends have shown a decrease in the incidence of
open globe injury,[4] these injuries continue to occur and cause devastating
consequences due to visual impairment. Prevention is important and strict safety
with ocular protection measures should be adhered to whenever possible. The
issue of eye protection has been highlighted previously[24]; yet, these devastating
injuries continue to occur both in the workplace and at home.
The retrospective design of this study was a limitation as documentation
was not standardized and data collection was dependent on existing medical
records. Good clinical documentation is critical to improve our knowledge of the
epidemiology and clinical outcomes of individuals with such injuries. For
example, limited documentation restricted the use of ocular trauma score
calculations to predict visual outcomes. In addition, incomplete history including
type of object, location where the injury occurred, and reported use of eye
protection reduced our knowledge of the epidemiology of such injuries. In
addition, surgical repair was completed by different surgeons based on the
hospital on call system. There was also a large proportion of patients (44%) lost to
follow‐up after initial surgical repair. Though patient care likely continued for
patients by outside eye care providers, records were only available for those who
continued follow‐up at our institution. This may have led to an overestimation of
complications and subsequent surgeries or best‐corrected visual acuity. Future
prospective studies are needed to further define predictors of visual outcomes after
projectile eye injury.
Conclusion
Though the visual prognosis after open globe injury due to projectile
impact is mostly guarded, a number of patients achieved a best ‐corrected visual
acuity better than 20/40 in this study. Further education and prevention efforts are
needed to help inform the public and employers to prevent severe ocular injuries.
Open Globe Injuries from Projectile Impact: Initial Presentation and

Outcomes Angelica C Scanzera, Yannek I Leidman, Maria S Cortina, Ellen S

Shorter

Department of Ophthalmology and Visual Science, Illinois Eye and Ear

Infirmary, University of Illinois at Chicago, Chicago, IL, United States

Corresponding to: Dr. Angelica C Scanzera, Illinois Eye and Ear Infirmary, UIC
Department of Ophthalmology and Visual Sciences, 1855 W, Taylor Street,
Chicago, IL – 60612, United States.

Email: ascanz@uic.edu
Abstrak: Trauma okular adalah penyebab kebutaan yang sangat signifikan di seluruh
dunia, terutama jika dikaitkan dengan glaukoma, yang diakibatkan oleh trauma tumpul
atau penetrasi, perdarahan, peradangan,lensa, patologi sistem vaskular orbita dan otak
karena trauma, dan cedera kimia dapat meningkatkan tekanan intraokular dan
menyebabkan glaukoma traumatik. Penanganan nya dapat dengan menghilangkan
penyebab yang mendasari namun dalam beberapa kondisi penangnaan glaukoma
traumatik dapat menjadi tantangan, tergantung pada mekanisme kerusakannya. Jika
penanganan yang tepat tidak dilakukan, fungsi penglihatan bisa menjadi buruk. Disini
kami membahas secara luas mekanisme peningkatan tekanan intraokular akibat trauma,
serta penanganan nya

Kata kunci: angle recession carotid-cavernous fistula iritis hyphema hemolytic

glaucoma hemosiderotic glaucoma vitreous hemorrhage orbital hemorrhage
suprachoroidal hemorrhage steroid-induced glaucoma traumatic glaucoma
Latar Belakang
Sepertiga dari kunjungan gawat darurat terkait mata di Amerika Serikat
disebabkan oleh trauma okular, dan sekitar sepertiga dari cedera ini
mengakibatkan kebutaan. Pada tahun 2008, "dipukul oleh benda atau orang" di
mata adalah alasan sepertiga dari kunjungan gawat darurat yang melibatkan
cedera mata. Dampak proyektil adalah mekanisme yang paling umum dari cedera
bola mata terbuka pada pria. Tingkat cedera, adanya relative afferent papillary
defect, dan ketajaman visual pada saat cedera dapat membantu dokter
memprediksi kelangsungan hidup visual setelah cedera bola mata terbuka, dan
mendukung edukasi pasien dan menetapkan harapan yang realistis pada saat
operasi awal. Laporan sebelumnya telah menggambarkan epidemiologi dan hasil
klinis cedera bola mata terbuka, meskipun tidak ada yang secara khusus berfokus
pada hasil cedera bola mata terbuka sekunder akibat dampak proyektil. Tujuan
dari penelitian ini adalah untuk menggambarkan epidemiologi cedera bola mata
terbuka sekunder akibat dampak proyektil di pusat rujukan tersier perkotaan dan
variabel yang terkait dengan hasil yang menguntungkan.
Metode
Kami melakukan studi kohort retrospektif. Catatan dari semua pasien
dengan riwayat cedera bola mata terbuka yang menjalani bedah perbaikan bola
mata terbuka di rumah sakit rujukan tersier antara 1 Januari 2010 dan 31
Desember 2016 yang telah ditinjau. Bagan pasien yang ditagih salah satu kode
berikut ditinjau: CPT 65273 (perbaikan laserasi), ICD‐9: (870.1–870.9, 871.1–
871.9), dan ICD‐10: (S05.2XX‐S05.9XX). Individu dengan riwayat cedera bola
mata terbuka akibat mekanisme proyektil dimasukkan. Individu dengan cedera
bola mata terbuka karena semua mekanisme lain dikeluarkan. Dalam penelitian
ini, mekanisme proyektil ditentukan sebagai cedera bola mata terbuka sekunder
akibat benda yang didorong melalui gaya. Demografi pasien, ketajaman visual
awal, jenistrauma, luas luka, adanya benda asing, dan temuan klinis yang
disajikan ditinjau untuk semua pasien. Untuk pasien dengan 6 bulan masa tindak
lanjut yang tersedia, hasil termasuk ketajaman penglihatan terbaik yang dikoreksi,
temuan klinis, dan operasi tambahan dianalisis. Ketajaman visual Snellen diubah
menjadi logaritma dari bentuk sudut resolusi minimal (LogMAR) untuk
menganalisis penglihatan pada kunjungan presentasi dan kunjungan terakhir.
Ketajaman LogMAR kemudian dikonversi kembali ke format Snellen dan
dikategorikan untuk analisis lebih lanjut: (1) lebih besar dari atau sama dengan
20/40, (2) 20/50 hingga 20/200, (3) kurang dari 20/200 untuk gerakan tangan, (4)
persepsi cahaya, dan (5) tidak ada persepsi cahaya. Studi ini mendapat persetujuan
Institutional Review Board.
Klasifikasi cedera
Cedera diklasifikasikan menurut Sistem Terminologi Trauma Mata
Birmingham, dan tingkat cedera diklasifikasikan menggunakan Kelompok
Klasifikasi Trauma Okuler, Zona cedera didasarkan pada titik cedera paling
posterior: Cedera zona 1 melibatkan kornea dan limbus korneosklera, cedera zona
2 melibatkan limbus korneoskleral hingga 5 mm posterior, dan zona 3 termasuk
cedera posterior hingga 5 mm anterior sklera.
Analisis data
Statistik deskriptif serta uji-t dan uji Chi-kuadrat digunakan untuk
membandingkan variabel dengan tingkat signifikansi 0,05, dan regresi logistik
bivariat digunakan untuk mendapatkan rasio odds. Data dianalisis menggunakan
SAS Institute Inc. 2018 (SAS 9.4M6, Cary, NC, USA).
Hasil
Sebanyak 73 dari 214 (34,1%) pasien dengan cedera bola mata terbuka
karena cedera akibat benturan proyektil antara 1 Januari 2010 dan 31 Desember
2016. Hampir semua pasien, 94,5%, melaporkan cedera karena kecelakaan
daripada pertengkaran [P <0,001; Tabel 1]. Mayoritas pasien yang datang adalah
laki-laki (P <0,001) dan mengalami trauma yang mengakibatkan laserasi bola
mata (P <0,001). Penyebab cedera proyektil yang paling sering terkait dengan
pekerjaan logam (n = 23) diikuti oleh cedera terkait senjata (n = 6), cedera terkait
alat logam (n = 5), dan cedera kayu proyektil saat menggunakan gergaji (n = 4).

Table 1 Karakteristik Cedera Bola Mata Terbuka Sekunder Akibat Cedera

Proyektil Karakteristik n(%)

Jenis Kelamin

Laki-laki 66 (90.4)

Wanita 7 (9.6)

Rata-rata usia (tahun)

37.9±17.8 (antara 3-89)

Ras

Hitam/Afrika Amerika 13 (17.8)

Putih 27 (37.0)

Hispanik 14 (19.2)

Lainnya 19 (26)

Asuransi

Komersial 19 (26.0)

Medicaid 12 (16.4)
Medicare 4 (5.5)

Lainnya 38 (52.0)

Rujukan dari luar RS 61 (83.6)

Jarak dari klinik (mil)

31.2±32.4 (antara 1-175)

Menyebabkan cedera

Kecelakaan 69 (94.5)

Pertengkaran 4 (5.5))
 Lokasi cedera terjadi

Bekerja 21 (28.8)

Rumah 11 (15.1)

Lainnya 41 (56.2)

Zona cedera

1 33 (45.2)

2 15 (20.5)

3 20 (27.4)

Lainnya 5 (6.8)
Sebanyak 73 dari 214 (34,1%) pasien dengan cedera bola mata terbuka
karena cedera akibat benturan proyektil antara 1 Januari 2010 dan 31 Desember
2016. Hampir semua pasien, 94,5%, melaporkan cedera karena kecelakaan
daripada
pertengkaran [P <0,001; Tabel 1]. Mayoritas pasien yang datang adalah laki-laki
(P <0,001) dan mengalami trauma yang mengakibatkan laserasi bola mata (P
<0,001). Penyebab cedera proyektil yang paling sering terkait dengan pekerjaan
logam (n = 23) diikuti oleh cedera terkait senjata (n = 6), cedera terkait alat logam
(n = 5), dan cedera kayu proyektil saat menggunakan gergaji (n = 4).
Temuan klinis pada presentasi meliputi: laserasi kornea (72,6%, n = 53),
hifema (46,6%, n = 34), prolapsiris atau uveal (37,0%, n = 27), benda asing
(35,6%, n = 26) , laserasi kelopak mata (24,6%, n = 18), bilik mata depan dangkal
atau kolaps (23,3%, n = 17), kelainan iris lainnya termasuk diskoria, robekan, atau
iridodialisis (16,4%, n = 12), fraktur orbita (15,0% , n = 11), dan aniridia
traumatis (2,7%, n = 2). Berikut ini dicatat selama perbaikan bedah bola mata
terbuka awal: eksisi jaringan iris prolaps (24,7%, n = 18), lensektomi primer
(11,0%, n = 8), dan laserasi terlalu posterior untuk menutup (6,8%, n = 5 ).
Vitrektomi pars plana dilakukan pada dua orang (2,7%) pada saat perbaikan,
keduanya pada pasien dengan laporan benda asing intraokular.
Dari 26 pasien dengan benda asing pada presentasi, 84,6% (22/26) berasal
dari logam. Dari 11 pasien dengan fraktur orbita, 18,2% (2/11) ditemukan
memiliki otot yang terjepit. Rata-rata panjang laserasi adalah 7,55 ±6,6 mm
(kisaran 1–27; n = 34). Saat membandingkan penglihatan, pasien dengan laserasi
bola mata 6,23 kali lebih mungkin memiliki ketajaman penglihatan masuk yang
lebih baik, dicatat sebagai gerakan tangan atau lebih baik, dibandingkan mereka
yang bola mata pecah (OR 6.23, CI 2.10, 18.43; P = 0.001). Sebagian besar pasien
menjalani bedah perbaikan bola mata terbuka dalam 1 hari setelah cedera (94,5%;
kisaran 0-4 hari). Satu pasien menjalani enukleasi 15 hari setelah perbaikan bola
mata terbuka awal. Tabel 2 memberikan perbandingan temuan klinis pada
presentasi berdasarkan jenis trauma.
Table 2 Perbandingan Temuan Klinis Berdasarkan Tipe Trauma

Semua Ruptur n Laserasi n Signifikansi

(P<0.05)

Tipe Trauma 73 23 50 P<0.0001* laserasi (mm)7.55±6.6 (1-27;

Panjang n=34) 12.55±8.5 (3-27; n=11) n=23)

5.14±4.6 (1-15, P=0.017*

Benda asing 26 7 19 P=0.017* Odds rupture berdasarkan zona cedera

Zona Cedera n OR (95% CI) Signifikansi (P<0.05)
1 33 Ref Ref 2 15 2.036 (0460, 9.020) P=0.529 3 20 OR 8.4 (2.275, 31.001) P=0.016
Lainnya 5 3 - Odds tambahan bedah berdasarkan tipe trauma

n OR (95% CI) Signifikansi

(P<0.05)
Laserasi 25 Ref
Ruptur 15 11.0 (1.247, 97.014) P=0.031 Odds pergerakan tangan atau visus lebih baik

n OR (95% CI) Signifikansi

(P<0.05)
Laserasi 49 6.23 (2.103, 18.434) P =0.001* Ruptur 22 Ref
Table 3 Hasil Visus Pasien dalam 6 Bulan (%)
Follow Up Hasil Terbaik Koreksi Ketajamn Visual n
(%)
Memasuki Ketajaman Visual n

≥20/40 5 (12.2) 24 (58.5) 20/50-20/200 5 (12.2) 3 (7.3)

<20/200-pergerakan tangan 16 (39.0) 5 (12.2)
 Presepsi cahaya 12 (29.3) 3 (7.3)
Tidak ada presepsi cahaya n OR (95% CI) Signifikansi (P<0.05)
3 (7.3) 6 (14.6) Laserasi 26 4.98 (1.034, 23.960)
Ruptur 15 Ref
Odds pergerakan tangan atau visus akhir lebih P=0.045*
baik berdasarkan tipe trauma

Odds pergerakan tangan atau visus akhir lebih baik berdasarkan

riwayat benda asing
n OR (95% CI) Signifikansi (P<0.05)
Benda asing (tidak) 29 Ref P=0.444 Benda asing (ya) 10 1.83 (0.391, 8.532)

Odds tidak ada presepsi cahaya berdasarkan riwayat fraktur orbita

n OR (95% CI) Signifikansi (P<0.05)

Fraktur orbita (tidak) 32 Ref P =0.004*
Fraktur orbita (ya) 7 9.86 (2.099,
46.355)

Follow up
Lebih dari setengah, 56% pasien, memiliki setidaknya 6 bulan masa tindak
lanjut setelah perbaikan bola mata terbuka. Dari jumlah tersebut, 70% (n = 28)
memiliki rata-rata 1,9 operasi tambahan.
Ketajaman penglihatan
Ada perbaikan visual pada sebagian besar pasien dengan lebih dari 6 bulan
masa tindak lanjut dibandingkan dengan memasuki ketajaman visual [P <0,001;
Tabel 3]. Pada pasien yang menyelesaikan enam bulan masa tindak lanjut atau
lebih, mereka dengan laserasi bola mata hampir 5 kali lebih mungkin untuk
memiliki gerakan tangan atau ketajaman visual akhir yang lebih baik (OR 4,98
(1,03, 23,96); P = 0,045) dibandingkan mereka dengan ruptur bola mata. .
Ketajaman visual akhir tidak dipengaruhi oleh riwayat benda asing (P = 0,44);
namun, mereka yang mengalami cedera bola mata terbuka dan fraktur orbita 9,9
kali lebih mungkin memiliki penglihatan yang lebih buruk daripada mereka yang
tidak mengalami fraktur (OR 9,86 (2,10, 46,36); P = 0,004).
Hasil klinis
Temuan klinis berikut ditemukan pada pasien dengan setidaknya 6 bulan
masa tindak lanjut klinis: jaringan parut kornea (46,3%, n = 19), sisa jahitan
kornea (19,5%, n = 8), aphakia (14,6%, n = 6), riwayat ablasi retina (9,8%, n = 4),
glaukoma (4,9%, n = 2), dan pucat saraf optik (2,4%, n = 1). Operasi tambahan
pada subset pasien ini meliputi: pars plana vitrectomy (53,6%, n = 15),
lensectomy (32,1%, n = 9), fotokoagulasi pan retina (17,9%, n = 5), transplantasi
kornea (7,1%, n = 2; Gbr. 1), iridotomi perifer (7,1%, n = 2), dan vitrektomi
anterior (3,6%, n = 1). Tidak ada mata yang dikeluarkan isi perutnya, tetapi empat
mata tambahan diberi inti. Semua pasien yang menjalani enukleasi cocok dengan
prostesis okular.

Gambar 1 (a) Pasien cedera mata terbuka dengan laserasi palpebra

Diskusi inferior (b) 1 hari setelah perbaikan

Ini adalah rangkaian kasus cedera dunia terbuka terbesar akibat dampak
proyektil hingga saat ini. Prognosis visual cedera bola mata terbuka sekunder
akibat dampak proyektil cukup baik, dengan 58,5% dari mereka yang
menyelesaikan lebih dari 6 bulan masa tindak lanjut mencapai ketajaman visual
terkoreksi terbaik akhir 20/40 atau lebih baik dalam populasi penelitian ini. Dari
26 pasien yang
mempertahankan benda asing intraokular dalam penelitian kami, hanya empat
yang menderita cedera zona 3, dua di antaranya memerlukan vitrektomi pars plana
pada saat perbaikan. Kehadiran benda asing posterior yang membutuhkan
vitrektomi pars plana kemungkinan akan mempengaruhi penatalaksanaan dan
hasil visual akhir secara negatif. Hasil visual dalam penelitian ini lebih baik dari
laporan sebelumnya. Misalnya, Han et al. mempelajari semua cedera bola mata
terbuka yang datang ke rumah sakit mereka dan menemukan bahwa hanya 36%
pasien memiliki ketajaman visual akhir 20/40 atau lebih baik 1 tahun setelah
cedera awal mereka, meskipun 27,3% menderita cedera zona 3. Dalam kelompok
penelitian kami, 27,4% pasien yang menjalani perbaikan bola mata terbuka akibat
cedera proyektil diklasifikasikan sebagai cedera zona 3, meskipun hampir dua kali
lipat memiliki ketajaman visual akhir 20/40 atau lebih baik. Satu studi oleh
Kolomeyer et al. melihat cedera senjata paku, mekanisme cedera proyektil, dan
menemukan bahwa hanya 40% pasien memiliki ketajaman visual akhir 20/40 atau
lebih baik, meskipun hanya 16% mata yang mengalami cedera zona 3
dibandingkan dengan 27,4% pada kelompok studi kami. Namun, 70% dari luka
tembak paku mengakibatkan perdarahan vitreous pada presentasi dibandingkan
dengan hanya 2,7% dari mata dalam penelitian kami. Mungkin kecepatan atau
kekuatan tumbukan dapat menjadi prediktor tambahan dari hasil visual daripada
mekanisme atau zona cedera saja.
Populasi penelitian ini mirip dengan studi cedera bola mata terbuka
lainnya, dengan usia rata-rata 37,9 tahun dan mayoritas pasien adalah laki-laki
(90,4%; P <0,001). Laki-laki cenderung memiliki risiko paparan yang lebih besar
trauma okular karena pekerjaan dan tanggung jawab yang dilakukan di rumah.
Faktor prognostik yang buruk dalam penelitian ini termasuk ruptur bola mata,
lebih banyak cedera posterior, dan adanya fraktur orbita, yang konsisten dengan
penelitian lain. Tidak ada hubungan antara keberadaan benda asing intraokular
dan hasil visual pada pelajaran ini. Meskipun ukuran benda asing tidak
didokumentasikan dalam penelitian ini, sebuah penelitian oleh Liu et al.
menjelaskan bahwa ukuran benda asing yang kecil dikaitkan dengan hasil visual
yang lebih baik, menunjukkan bahwa dokumentasi ukuran benda asing juga dapat
membantu memperkirakan prognosis visual.
Kesimpulan
Meskipun prognosis visual setelah cedera bola mata terbuka karena
dampak proyektil sebagian besar dijaga, sejumlah pasien mencapai ketajaman
visual terkoreksi terbaik lebih baik dari 20/40 dalam penelitian ini. Upaya
pendidikan dan pencegahan lebih lanjut diperlukan untuk membantu memberi
tahu masyarakat dan pengusaha untuk mencegah cedera mata yang parah.
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