A Study of Factors Affecting Visual Acuity after Penetrating Ocular Injury

Dear Editor, Ocular trauma is a significant cause of low vision and blindness worldwide and is also one of the most preventable public health issues. According to the World Health Organization (WHO), approximately 55 million individuals suffer from ocular traumas each year, out of which 1.6 million lose their vision completely. Additionally, a total of 19 million individuals have blindness or low vision in one eye due to trauma. Hence, conducting a comprehensive study of the clinical condition of penetrating ocular trauma and the factors that affect visual acuity after the injury is crucial. This forms the foundation of our research work. Between 2021 and 2022, a retrospective study was conducted using the data of 123 patients who were admitted to the Department of Ophthalmology of the First State Central Hospital with a diagnosis of penetrating ocular trauma and underwent surgery. Statistical processing was performed with STATA 15 using Chi-square, ANOVA, and a 2-sample T-test for relevant data. A P value <0.05 was considered statistically significant. The majority of the respondents were male, and the gender ratio was 7.7:1. According to subordination, 80 (71.3%) patients were from rural areas, and 79 (64.2%) had primary or basic education (P = 0.0001). 91 (73.4%) of the patients were injured accidentally, and 40 (34%) were injured due to household injuries. By type of wound, there were 62 (50.4%) penetrating ocular wounds, 42 (34.1%) wounds involving the 1st zone or corneal limbus, and 64 (52%) wounds less than 10 mm in length. There were 30 (24.8%) patients with visual acuity ≤6/60 at the first examination, and 52 (42.3%) patients with visual acuity more excellent than 6/60 at the sixth-month post-treatment examination doubled. In addition, 93.3% of 30 (24.4%) patients with visual acuity more excellent than 6/60 at the first examination had good final visual acuity (6/60≤). In comparison, 52 (15 (28.8%) of 42.3%) patients improved their visual acuity to ≤6/60, and 26 (50%) patients got have blindness. At the initial visit, 30 (24.4%) patients had no light perception (NPL), of which 26 (86.7%) patients underwent evisceration or enucleation surgery, and the remaining 4 (13.3%) patients had no light perception (NPL) (P = 0.0001). After six months of treatment, patients who improved to more than 6/60 visual acuity were evaluated according to the location of the wound, 36 (85.7%) of 42 (34.15%) patients with wounds involving the corneal limbus (Zone I) and sclera up to 5 mm posterior to the limbus (II region) 10 (52.6%) out of 19 (15.45%) patients, and 6 (17.7%) out of 34 (27.64%) patients with combined region (I) and (II) were improved, respectively. On the other hand, 28 (22.76%) patients with wounds involving the sclera more than 5 mm from the limbus (Zone III) did not improve their visual acuity to more than 6/60, and 23 (82.1%) of these patients underwent cataract surgery. lost (P = 0.00001). Furthermore, when examining the relationship between the length of the wound after 6 months of treatment in patients with visual acuity more excellent than 6/60, 64 (52.03%) of the patients had a wound length of less than 10 mm, 49 (76.5%) of the patients, and only 52 (42.28%) of the patients with a 10 mm–20 mm long wound. 3 (5.7%) had a good visual acuity of more than 6/60, while 7 (5.69%) patients with wounds more significant than 20 mm underwent cataract surgery in all cases (P = 0.00001). Of the total 31 (25%) patients who underwent evisceration/enucleation surgery, 25 (83.8%) had NPL at the first examination, 22 (74%) patients had zone III involvement, and 20 (67.7%) patients had wound length. 10 mm–20 mm, 7 (22%) patients had an eyeball wound more than 20 mm. Moreover, according to the International Ocular Trauma Score (OTS) of ophthalmology, which predicts the outcome of visual power after penetrating eyeball injury, calculations were made into 5-point groups, and the result of visual acuity six months after treatment was directly related to the initial injury score. For example, according to this assessment, 73% of patients with OTS-1 (0–44 points) have a probability of NPL or light sensitivity after six months, while in our study, 96.2% of patients and OTS-2 (45–65 points) have 28%. Moreover, 46.7% were patients in our study, which was strongly correlated (P < 0.001). However, the improvement of visual acuity began to dominate among the patients who were evaluated from the OTS-3 score (66–80), and the patients who improved from 6/60 to 6/15 had 28% according to this score, compared to 33.3% in our study (P < 0.001). 75% of patients with an OTS-4 score (rated 81–91) improved to < 6/12 compared to 74% in our study, a similar effect (P < 0.05). In our country, most of the patients who have penetrating ocular injuries are men from rural areas with primary and basic education. Visual acuity after six months of treatment of penetrating ocular injury, visual acuity at the first examination were hand movement (HM), light perception (PL), NPL, and wound location involving zone III and wound length greater than 20 mm is the leading cause of severe visual impairment and blindness. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.