A Retrospective Analysis of Epidemiological Factors and Surgical Outcomes of Patients With Ocular Trauma at Hospital Kuala Lumpur, Malaysia

Background The objective of this review is to study the demographics, aetiology, clinical findings, and surgical outcomes of patients who presented with ocular trauma and underwent emergency operations at Hospital Kuala Lumpur, Malaysia. Methods Patients who presented from 2016 to 2023 with ocular trauma and underwent emergency ocular surgery were identified and their medical records were reviewed with respect to demographics, mechanism of injury, type of injury, initial presenting visual acuity and final visual acuity after surgery. Components of the ocular trauma score (OTS) were also recorded. Results A total of 218 eyes from 214 patients were analysed. The majority of patients are male (185, 86.4%) and are young adults from the age of 21-40 (105, 49.1%). Industrial or workplace injuries are the most common cause of ocular injury (77, 36.5%) followed by domestic household accidents (43, 20.4%) and motor vehicular accidents (40, 19.0%). A total of 123 (56.4%) had open-globe injuries, 63 (28.9%) had injuries to their adnexa and 32 (14.7%) had a closed-globe injury. The majority of patients (61, 96.8%) who sustained adnexal injuries presented with mild visual impairment and had a high OTS. An overwhelming majority (96.4%) had a final visual acuity of at least 20/40 or better. For patients with closed-globe injuries, slightly more than half of them (18, 56.2%) had an OTS of 5, eight (25%) had an OTS of 4 and six (18.8%) had an OTS of 3. After surgical intervention for closed-globe injuries, the majority of patients with OTS 5 (15, 83.3%) and OTS 4 (6, 75%) had a final visual acuity of 20/40 or better. Four (66.7%) of patients with OTS 3 had a final visual acuity of 1/200 to 19/200. Most patients with open-globe injury presented with severe visual impairment and had a low OTS, which carries a poorer prognosis. Forty-one (33.3%) had OTS 1, 19 (15.4%) had OTS 2, 31 (25.2.%) had OTS 3, 31 (25.2%) had OTS 4 and only six (5.4%) had OTS 5. Even after surgical intervention to repair these open-globe injuries, 56.1% (23) of patients with OTS 1 had a vision of no perception to light (NPL) and 26.8% (11) had severe visual impairment of perception to light (PL) or hand movements (HM) after surgery. Thirty-three per cent (five) of patients with open-globe injuries and OTS 4 had final visual acuity of only PL or HM. The percentage of a better final visual outcome gradually increased for patients with higher OTS scores. Conclusion We have identified that young male adults are most at risk for sustaining ocular trauma while at the workplace and are more likely to sustain open-globe injury with lasting visual impairment. Our study also found that the OTS is a helpful tool to help healthcare practitioners predict the final visual acuity based on initial findings. Targeted approaches should be taken to reduce visual morbidity.