Surgical outcome of open globe injury and associated prognostic factors at jimma university medical center, south west Ethiopia

Abstract

Background:-Ocular trauma is one of the most common preventable causes of eye morbidity worldwide. Among types of globe injury, open-globe injury is a significant cause of permanent vision loss globally. In Ethiopia, ocular injury is a public health problem that lacks health care service at a community level. Studies done in Ethiopia showed that open globe injury is common cause of monocular blindness mainly in the young productive age group. Objective:-The aim of this study was to assess the surgical outcome of open globe injury at Jimma University medical center. Methods:-The study employed a retrospective study design on illegible patients treated surgically for open globe injury at Jimma University medical center during the period of August 1, 2019 to June 1, 2021G.C. All collected data was entered into EpiData4.6.0.2 and exported to SPSS version 26 for further analysis. The descriptive finding of the study was reported as frequency, mean and standard deviation. Binary logistic regression analysis was used to identify predictors of the outcome and variables with p-value <0.05 were considered statistically significant. Result: A total of 79 patients were included in the study. The mean age of patients was 24.08 ± 17.157, M: F was 5.58:1 and 72.15% of the total cases were young patients (age range of 3 to 30years). Accident (playing, fall down, sport activities etc.) was found to be the main risk factor for OGI accounting for 51.9% (n=41) of cases followed by work related risks. Sharp objects were found to be the most common cause of OGI at all age group followed by blunt objects. Wood was found to be the most common object causing OGI followed by metal (all were sharp). About 87.4% of patients were presented with visual acuity in blindness range out of which 12.7% (n=10) were totally blind. Penetrating globe injury was found to be the most commonly occurred OGI. Patients with ruptured globe were presented with poorer presenting visual acuity (visual acuity of hand motion or worse). The cornea was found to be the most frequently injured structure. At the time of presentation, crystalline lens was either opaque or not visible in most of the cases. Most of the patients (about 80%) presented to the hospital after 24 hours of injury and about 82.3% of patients were managed within the first 24hours of arrival to the hospital. II Repeated surgery was done only for 11(13.9%) patients. Cataract extraction, stich correction, secondary IOL insertion and pupiloplasty were done during the second surgery. During the follow up period, there were 4 keratitis and 1 endophthalmatis cases. Refraction was not done for 96.2% of patients during follow up period. After 3 months of post-surgical management, 60.8% (n=48) of patients remained blind while 12.7% (n=10) of patients gained normal to near normal visual acuity and 26.6% (n=21) of patients got low visual acuity. Gross anatomy of the globe was maintained in 79.7% (63) of the cases while 16 patients developed phthisic bulbi. Multivariate logistic regression analysis showed that presenting poor visual acuity is an independent poor prognostic factor for final visual outcome while globe rupture was the independent poor prognostic factor for final globe anatomic outcome. Conclusion and recommendations:- Open globe injury is a type of ocular trauma that causes devastating ocular morbidity resulting in significant socio-economic burden in the community. Most of patients with open globe injury developed blindness despite surgical management. Poor presenting visual acuity and globe rupture were found to be poor prognostic factors of final visual and globe anatomical outcome respectively. In order to prevent the burden of OGI, it is important to provide adequate health education for the community, more health professionals should be trained in the field of ophthalmology and the existing ophthalmic center should be strengthened and monitored for providing quality service.