This study describes the profile of open globe injuries presenting to a tertiary hospital in Nepal and evaluates the use of the OTS in predicting visual outcomes. The patterns of ocular trauma and demographic profile of patients found in this study closely matched to studies of ocular trauma worldwide (20). Our study found that a large portion of the patients, about one fourth, were below the age of 10. Hence, denoting the involvement of vulnerable population. However, it must also be noted that second largest age group were between 2nd to 3rd decade of life, this may be due larger risk faced by this age group during their line of work or their frequent social activities. This correlates with the occupational distribution of patients, with more than one third being students. This study also shows the preponderance of male gender for ocular trauma. This may be explained by the fact that male population tend have more outdoor activities and have higher tendencies to face occupational hazards. Most patients were from the hilly region of Nepal, with the majority being from the urban city of Kathmandu, showing the influence of location and awareness to seek ophthalmic care.
Causative agent and mode of trauma often depend on location of a study. Similar to other studies in the region, the most common agent of injury was vegetative material such as sticks and branches, followed by metal; however, this is in contrast to many western studies that reported blunt objects as the most common causative agent (8, 21, 22). Accidental trauma was most common, followed by inadvertent trauma. Comparatively, studies conducted in larger urban areas of developed countries have shown assault (41%) as the most common cause of ocular trauma (23).
Many of the variables analyzed showed a statistically significant correlation with final visual outcomes, including zone of involvement and time to presentation. The most common location of open globe injury in this population was a Zone I injury; however, more posterior injuries carried a worse prognosis (24–26). In general, final VA decreased as the time to presentation after trauma increased. Among the patients who presented less than 6 hours after the injury, 50% had a final VA of 6/12 or better compared to 15.8% of patients presenting after two days. Previous studies have also shown evidence that final visual outcome is affected by time to presentation or repair (27). In this study, it was found that initial visual acuity, extent of injury, need for intravitreal injection, development of endophthalmitis, and a ruptured globe were all predictive of a poorer final visual acuity.
When the OTS-predicted visual acuity was compared to the actual final visual acuity for each group, it was found that there was no statistically significant difference for 15 of the 25 groups, resulting in a 60% predictive accuracy of the OTS for patients at 3 months. This is comparable to a 77% predictive value for the OTS at 6 months in the study by Kuhn et al (17). The variations in Groups 1–4 captured worse outcomes than predicted, while Group 5 showed better outcomes. This may be due to the shorter follow up time that fails to reliably capture the final visual outcomes of the injured eye.
The use of the OTS in general, pediatric, weapon-related eye injuries to predict visual outcomes has been evaluated in numerous studies in North America, Europe, and Asia (4, 17, 28–31). This is the first study in a Nepalese population and highlights both the scope of open globe injury in the Nepal and the utility of the OTS for the prediction of visual outcomes and management of patients with open globe injury.
One limitation of this study is its scope at a single hospital, which may not capture the trends of the entire population with diverse geographical settings. Further multicenter studies need to be done to better evaluate the scope of ocular injury in Nepal and utilization of the OTS in open globe injury.