Observation of patient clinical outcomes based on the new subclassification of zone Ⅲ open-globe injury_Chinese Journal of Ocular Fundus Diseases

Authors：

Gu Peng ¹ , Li Sha ¹ , Jiang Dianjun ¹ , Liu Yong ¹ ,  Wu Nan ²

1. Department of Ophthalmology, The First Affiliated Hospital of Army Medical University, Chongqing 400038, China;
2. Department of Ophthalmology, The Second Affiliated Hospital of Army Medical University, Chongqing 400037, China;

Corresponding author：

Wu Nan, Email: nanwu1122@163.com

Keywords：

Open globe injuries; Subtypes of injury in open-globe trauma; Influencing factors analysis

DOI：

10.3760/cma.j.cn511434-20250106-00003

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Objective To compare and observe the visual acuity and ocular anatomical outcome of different subtypes in open-globe injury (OGI) Ⅲ. Methods A retrospective study. A total of 187 eyes of 187 patients with OGI involving zone Ⅲ who were admitted to the Department of Ophthalmology of The First Affiliated Hospital of Army Medical University from January 2020 to December 2023 were included in the study. According to the 2022 International Globe and Adnexal Trauma Epidemiology Study groups consensus, zone Ⅲ was further divided into Ⅲa zone (5-8 mm posterior to the limbus) and Ⅲb zone (＞8 mm posterior to the limbus), with 58 eyes (31%, 58/187) in group Ⅲa and 129 eyes (69%, 129/187) in group Ⅲb. Best corrected visual acuity (BCVA) was examined using the international standard decimal visual acuity chart, converted into the logarithm of the minimum angle of resolution (logMAR) visual acuity when recorded. The injured zone, initial visual acuity, final visual acuity, retinal detachment (RD), uveal prolapse, and proliferative vitreoretinopathy (PVR) were collected. The follow-up time after surgery ≥ 6 months. The final visual acuity and anatomical prognosis of the two groups were observed. Silicone oil dependence, phthisis, and enucleation were defined as poor anatomical outcomes. Multiple linear regression analysis was performed to analyze the impact of zone Ⅲb of OGI on the final visual acuity. Results At the 6-month follow-up, the logMAR BCVA of group Ⅲa and group Ⅲb was 1.49±1.0 and 2.51±0.85; there was a statistically significant difference in the logMAR BCVA between the two groups (t=−2.736, P＜0.05). Compared with group Ⅲa, the proportion with light perception in group Ⅲb was higher, and the proportions with visual acuity of hand movement, counting fingers, and ＞0.01 were lower, and the differences were all statistically significant (P＜0.05). Compared with group Ⅲa, RD and PVR were more likely to occur in group Ⅲb, and the differences were all statistically significant (χ2= 16.696, 8.697; P＜0.05). Among the affected eyes in group Ⅲa and group Ⅲb, there were 14 eyes (24.1%, 14/58) and 95 eyes (73.6%, 95/129) with poor final anatomical outcomes respectively; the incidence of poor final anatomical outcomes in group Ⅲb was higher, and the difference was statistically significant (χ2= 40.332, P＜0.01). The results of multiple linear regression analysis showed that initial visual acuity, RD, and uveal prolapse were independent risk factors affecting the final visual acuity (odds ratio=2.407, 4.162, 3.413; P＜0.05). Conclusions Patients with OGI in zone Ⅲb have a worse visual prognosis and a higher incidence of poor anatomical outcomes. The subclassification of zone Ⅲ is helpful for better predicting the prognosis of OGI clinically.

Citation： Gu Peng, Li Sha, Jiang Dianjun, Liu Yong, Wu Nan. Observation of patient clinical outcomes based on the new subclassification of zone Ⅲ open-globe injury. Chinese Journal of Ocular Fundus Diseases, 2025, 41(4): 271-276. doi: 10.3760/cma.j.cn511434-20250106-00003 Copy

1.	Fujikawa A, Mohamed YH, Kinoshita H, et al. Visual outcomes and prognostic factors in open-globe injuries[J]. BMC Ophthalmol, 2018, 18(1): 138. DOI: 10.1186/s12886-018-0804-4.
2.	Meng X, Wang Q, Chen S, et al. An interpretable model predicts visual outcomes of no light perception eyes after open globe injury[J]. Br J Ophthalmol, 2024, 108(2): 285-293. DOI: 10.1136/bjo-2022-322753.
3.	Pieramici DJ, Sternberg P Jr, Aaberg TM Sr, et al. A system for classifying mechanical injuries of the eye (globe). The Ocular Trauma Classification Group[J]. Am J Ophthalmol, 1997, 123(6): 820-831. DOI: 10.1016/S00029394(14)71132-8.
4.	Dave VP, Nayak S, Kuhn F, et al. Clinical presentations, management, and factors affecting outcomes in posterior segment open globe injuries: an analysis of 2, 360 eyes[J]. Ophthalmologica, 2023, 246(2): 150-157. DOI: 10.1159/000529680.
5.	Tomaiuolo M, Justin GA, Hyman L, et al. Open globe injury repairs in the american academy of ophthalmology iris® registry 2014-2018: incidence, risk factors, and visual outcomes[J]. Ophthalmology, 2023, 130(8): 812-821. DOI: 10.1016/j.ophtha.2023.03.002.
6.	Coelho J, Kuhn F, Meireles A, et al. Globe ruptures: outcomes and prognostic analysis of severe ocular trauma[J]. Ophthalmologica, 2022, 245(4): 376-384. DOI: 10.1159/000523705.
7.	Hoskin AK, Fliotsos MJ, Agrawal R, et al. Globe and adnexal trauma terminology survey[J]. JAMA Ophthalmol, 2022, 140(8): 819-826. DOI: 10.1001/jamaophthalmol.2022.2594.
8.	Kuhn F, Morris R, Treister G, et al. A standardized classification of ocular trauma[J]. Ophthalmology, 1996, 103(2): 240-243. DOI: 10.1016/S0161395 6420(96)30710-0. DOI: 10.1016/S01613956420(96)30710-0.
9.	Santamaria A, Luis BD, Etxebarria J, et al. Clinical characteristics and prognostic factors of open globe injuries in a North Spain population: a 10-year review[J]. Eye (Lond), 2023, 37(10): 2101-2108. DOI: 10.1038/s41433-022-02297-8.
10.	He Y, Tang H, Liu Y, et al. Visual outcomes and prognostic factors of early pars plana vitrectomy for open globe injury[J]. Eye, 2024, 38(7): 1355-1361. DOI: 10.1038/s41433-023-02903-3.
11.	Perez EA, Ramirez DA, Russell JF, et al. The ocular trauma score underestimates visual recovery for the most severe open globe injuries[J]. Ophthalmol Retina., 2023, 7(7): 612-619. DOI: 10.1016/j.oret.2023.01.021.
12.	Bhagat N, Turbin R, Langer P, et al. Approach to management of eyes with no light perception after open globe injury[J]. J Ophthalmic Vis Res, 2016, 11(3): 313-318. DOI: 10.4103/2008-322X.188388.
13.	Tram JK, Yalamanchili SP, Ata A, et al. Association of open globe injury characteristics with outcome measures in the emergency department[J]. Graefe's Arch Clin Exp Ophthalmol, 2023, 261(10): 3031-3039. DOI: 10.1007/s00417-023-06087-0.
14.	Andreoli CM, Andreoli MT, Kloek CE, et al. Low rate of endophthalmitis in a large series of open globe injuries[J]. Am J Ophthalmol, 2009, 147(4): 601-608. DOI: 10.1016/j.ajo.2008.10.023.
15.	Agrawal R, Ho SW, Teoh S. Pre-operative variables affecting final vision outcome with a critical review of ocular trauma classification for posterior open globe (zone Ⅲ) injury[J]. Indian J Ophthalmol, 2013, 61(10): 541-545. DOI: 10.4103/0301-4738.121066.

1. Fujikawa A, Mohamed YH, Kinoshita H, et al. Visual outcomes and prognostic factors in open-globe injuries[J]. BMC Ophthalmol, 2018, 18(1): 138. DOI: 10.1186/s12886-018-0804-4.
2. Meng X, Wang Q, Chen S, et al. An interpretable model predicts visual outcomes of no light perception eyes after open globe injury[J]. Br J Ophthalmol, 2024, 108(2): 285-293. DOI: 10.1136/bjo-2022-322753.
3. Pieramici DJ, Sternberg P Jr, Aaberg TM Sr, et al. A system for classifying mechanical injuries of the eye (globe). The Ocular Trauma Classification Group[J]. Am J Ophthalmol, 1997, 123(6): 820-831. DOI: 10.1016/S00029394(14)71132-8.
4. Dave VP, Nayak S, Kuhn F, et al. Clinical presentations, management, and factors affecting outcomes in posterior segment open globe injuries: an analysis of 2, 360 eyes[J]. Ophthalmologica, 2023, 246(2): 150-157. DOI: 10.1159/000529680.
5. Tomaiuolo M, Justin GA, Hyman L, et al. Open globe injury repairs in the american academy of ophthalmology iris® registry 2014-2018: incidence, risk factors, and visual outcomes[J]. Ophthalmology, 2023, 130(8): 812-821. DOI: 10.1016/j.ophtha.2023.03.002.
6. Coelho J, Kuhn F, Meireles A, et al. Globe ruptures: outcomes and prognostic analysis of severe ocular trauma[J]. Ophthalmologica, 2022, 245(4): 376-384. DOI: 10.1159/000523705.
7. Hoskin AK, Fliotsos MJ, Agrawal R, et al. Globe and adnexal trauma terminology survey[J]. JAMA Ophthalmol, 2022, 140(8): 819-826. DOI: 10.1001/jamaophthalmol.2022.2594.
8. Kuhn F, Morris R, Treister G, et al. A standardized classification of ocular trauma[J]. Ophthalmology, 1996, 103(2): 240-243. DOI: 10.1016/S0161395 6420(96)30710-0. DOI: 10.1016/S01613956420(96)30710-0.
9. Santamaria A, Luis BD, Etxebarria J, et al. Clinical characteristics and prognostic factors of open globe injuries in a North Spain population: a 10-year review[J]. Eye (Lond), 2023, 37(10): 2101-2108. DOI: 10.1038/s41433-022-02297-8.
10. He Y, Tang H, Liu Y, et al. Visual outcomes and prognostic factors of early pars plana vitrectomy for open globe injury[J]. Eye, 2024, 38(7): 1355-1361. DOI: 10.1038/s41433-023-02903-3.
11. Perez EA, Ramirez DA, Russell JF, et al. The ocular trauma score underestimates visual recovery for the most severe open globe injuries[J]. Ophthalmol Retina., 2023, 7(7): 612-619. DOI: 10.1016/j.oret.2023.01.021.
12. Bhagat N, Turbin R, Langer P, et al. Approach to management of eyes with no light perception after open globe injury[J]. J Ophthalmic Vis Res, 2016, 11(3): 313-318. DOI: 10.4103/2008-322X.188388.
13. Tram JK, Yalamanchili SP, Ata A, et al. Association of open globe injury characteristics with outcome measures in the emergency department[J]. Graefe's Arch Clin Exp Ophthalmol, 2023, 261(10): 3031-3039. DOI: 10.1007/s00417-023-06087-0.
14. Andreoli CM, Andreoli MT, Kloek CE, et al. Low rate of endophthalmitis in a large series of open globe injuries[J]. Am J Ophthalmol, 2009, 147(4): 601-608. DOI: 10.1016/j.ajo.2008.10.023.
15. Agrawal R, Ho SW, Teoh S. Pre-operative variables affecting final vision outcome with a critical review of ocular trauma classification for posterior open globe (zone Ⅲ) injury[J]. Indian J Ophthalmol, 2013, 61(10): 541-545. DOI: 10.4103/0301-4738.121066.

Chinese Journal of Ocular Fundus Diseases

Observation of patient clinical outcomes based on the new subclassification of zone Ⅲ open-globe injury

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