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Yusuf Uysal, Fatih M Mutlu, Güngör Sobaci
Ocular Trauma Score in childhood open-globe injuries.
J Trauma. 2008 Dec;65(6):1284-6. doi: 10.1097/TA.0b013e31817de3cc.
Abstract/Text
BACKGROUND: To assess prognostic value of the Ocular Trauma Score (OTS) in childhood open-globe injuries.
METHODS: This retrospective, interventional case series included 61 children with open-globe injuries. Certain numerical values rendered to the OTS variables (visual acuity, rupture, endophthalmitis, perforating injury, retinal detachment, afferent pupillary defect) at presentation were summated and converted into OTS categories; the likelihood of the final visual acuities in the OTS categories were calculated, and compared with those in the OTS Study.
RESULTS: Age ranged from 3 years to 14 years (mean, 8.0 years). Forty-two boys and 19 girls were included. Follow-up ranged from 6 months to 56 months (mean, 18 months). The likelihood of the final visual acuities (no light perception, light perception/hand motion, 1/200-19/200, 20/200-20/50, and > or = 20/40) in the OTS categories (1 through 5) in this group were similar to those in the OTS Study group.
CONCLUSIONS: OTS calculated at initial examination may provide prognostic information in children with open-globe injuries.
Ferenc Kuhn, Richard Maisiak, LoRetta Mann, Viktória Mester, Robert Morris, C Douglas Witherspoon
The Ocular Trauma Score (OTS).
Ophthalmol Clin North Am. 2002 Jun;15(2):163-5, vi.
Abstract/Text
Only based on a standardized terminology of ocular trauma terms, and using a very large number of injuries treated by a wide variety of ophthalmologists, could a reliable method be developed so that the functional outcome of a serious eye injury can be predicted with reasonable certainty. The authors used the databases of the United States and Hungarian Eye Injury Registries and, with a grant from the National Center for Injury Prevention at the Centers for Disease Control and Prevention, designed such a system.
Yaprak Banu Unver, Ziya Kapran, Nur Acar, Tuğrul Altan
Ocular trauma score in open-globe injuries.
J Trauma. 2009 Apr;66(4):1030-2. doi: 10.1097/TA.0b013e3181883d83.
Abstract/Text
BACKGROUND: To determine the value of calculating an ocular trauma score (OTS) for patients with open-globe injuries. OTS evaluating system can provide valuable prognostic information, and its use may be an asset in counseling patients with open-globe injuries.
METHODS: This study was conducted as a retrospective review of 114 eyes of 114 patients who presented with open-globe injuries between January 2001 and July 2006. OTS variables (visual acuity, rupture, endophthalmitis, perforating injury, retinal detachment, and afferent pupillary defect) were determined and OTS was calculated in 114 eyes of 114 patients at the time of initial examination. In this study, presenting and final visual acuity were grouped (1 through 5) as > or = 20/40, 20/200 to 20/50, 1/200 to 19/200, light perception (LP)/hand motion (HM), and no light perception (NLP), similar to the OTS study group. Numerical values to the OTS variables were converted into OTS categories. Similarity of final visual acuities by groups was compared with those in the OTS study. Patients under the age of two and the ones with incomplete data for OTS variables were excluded.
RESULTS: When comparing the distribution of final visual acuity in all OTS categories, no statistically significant difference was found (p = 0.35) between the results of our study and the OTS study group. NLP ratio in category 1 and > or = 20/40 ratio in category 5 were statistically higher than in our study (p = 0.01). However, in our study, category 2 of LP/HM ratio (p < 0.0001) was statistically higher than in the OTS study. The likelihood of the final visual acuities (NLP, LP/HM, 1/200 to 19/200, 20/200 to 20/50, and > or = 20/40) in the other OTS categories in this group was similar to those in the OTS study group. The OTS showed positive correlation with final visual acuity (p < 0.001).
CONCLUSION: In open-globe injuries, a commonly accepted system for calculating ocular trauma score (OTS) can provide reliable prognostic information.
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L A Levin, R W Beck, M P Joseph, S Seiff, R Kraker
The treatment of traumatic optic neuropathy: the International Optic Nerve Trauma Study.
Ophthalmology. 1999 Jul;106(7):1268-77.
Abstract/Text
OBJECTIVE: To compare the visual outcome of traumatic optic neuropathy treated with corticosteroids, treated with optic canal decompression surgery, or observed without treatment.
DESIGN: Comparative nonrandomized interventional study with concurrent treatment groups.
PARTICIPANTS: A total of 133 patients with traumatic optic neuropathy (127 unilateral and 6 bilateral) who had an initial visual assessment within 3 days of injury. At least 1 month of follow-up was required for inclusion in the primary analysis.
INTERVENTIONS: On the basis of treatment received within 7 days of injury, patients with unilateral injuries were categorized as being in one of three treatment groups: untreated (n = 9), corticosteroid (n = 85), or optic canal decompression surgery (n = 33).
MAIN OUTCOME MEASURE: Visual acuity.
RESULTS: Visual acuity increased by > or = 3 lines in 32% of the surgery group, 57% of the untreated group, and 52% of the steroid group (P = 0.22). The surgery group had more patients whose initial vision was no light perception. After adjustment for the baseline visual acuity, there were no significant differences between any of the treatment groups. There was no indication that the dosage or timing of corticosteroid treatment or the timing of surgery was associated with an increased probability of visual improvement.
CONCLUSIONS: No clear benefit was found for either corticosteroid therapy or optic canal decompression surgery. The number of patients studied was sufficient to rule out major effects in the treatment groups, although clinically relevant effects in specific subgroups could have been missed. These results and the existing literature provide sufficient evidence to conclude that neither corticosteroids nor optic canal surgery should be considered the standard of care for patients with traumatic optic neuropathy. It is therefore clinically reasonable to decide to treat or not treat on an individual patient basis.
Cassandra B Onofrey, David T Tse, Thomas E Johnson, Ann G Neff, Sander Dubovy, Billy E Buck, Roy Casiano
Optic canal decompression: a cadaveric study of the effects of surgery.
Ophthal Plast Reconstr Surg. 2007 Jul-Aug;23(4):261-6. doi: 10.1097/IOP.0b013e3180cac220.
Abstract/Text
PURPOSE: To simulate a transphenoidal medial optic canal decompression and determine the anatomic effect on the optic nerve.
METHODS: A medial optic canal decompression was performed on 5 cadaveric optic canals within 12 hours of death. Two canals were decompressed under direct visualization and 3 were decompressed by a transphenoidal endoscopic approach. The optic canal was subsequently removed en bloc, beginning at the annulus of Zinn and extending to the optic chiasm. Each specimen was processed and examined grossly. Serial coronal step sections of the entire length of the intracanalicular optic nerve were assessed histologically.
RESULTS: Microscopic examination of the intracanalicular portion of optic nerve revealed incision in an extraocular muscle at the annulus, incomplete bone removal, fraying of the dural sheath, incomplete dural/arachnoid release, and incision in the pia and optic nerve.
CONCLUSIONS: Transphenoidal medial wall decompression of the optic nerve canal with dural sheath opening may induce physical damage to the nerve. Any hypothetical value in dural-arachnoid sheath opening must be weighed against the potential for harm to the optic nerve caused by the surgical intervention.
