Deadly weapon–related open-globe injuries: outcome assessment by the Ocular Trauma Classification System

● PURPOSE: To describe mechanisms and injury characteristics influencing visual outcomes in eyes with openglobe injuries caused by deadly weapons and to apply the classification system introduced by the Ocular Trauma Classification Group. ● METHODS: Two-hundred-twenty-eight eyes of 212 consecutive patients, who were mostly injured in military confrontation, were analyzed. Mechanism and injury characteristics were evaluated for predicting visual outcome according to the recently studied classification system as well as other variables pertinent to this specific clinical setting of severe eye trauma. Final visual acuities were defined as favorable (5/200 or better) or unfavorable (less than 5/200, including enucleation). ● RESULTS: The mean age of patients was 23 years, and the mean follow-up was 5.7 months. The predictors for favorable visual outcome were type B, grade 1, zone I, and relative afferent pupillary defect-negative injuries. The predictors for unfavorable outcome were type A, grade 5, zone III, and relative afferent pupillary defectpositive injuries. Land mine and hand grenade injuries had the worst outcome among causative agents. Proliferative vitreoretinopathy, comprising 30.4% of postoperative failures, was the most common complication. ● CONCLUSION: Deadly weapon–related open-globe injuries, especially those associated with land mines and hand grenades, have devastating visual results. Evaluation of trauma mechanism and injury characteristics according to the Ocular Trauma Classification System seems to predict visual outcomes in this series of severe open-globe injuries. (Am J Ophthalmol 2000;129: 47–53. © 2000 by Elsevier Science Inc. All rights reserved.) O CULAR TRAUMA CONSTITUTES ONE OF THE MOST common causes of unilateral morbidity and blindness in the world today. Despite huge advances in vitreoretinal surgery in recent years, a dismal prognosis still persists in certain injuries. Eye injuries resulting from violence are increasing in both civilian and wartime settings in recent years.1–3 The heterogeneity of the injuries in ocular trauma has made it difficult to interpret results of clinical studies with respect to intervention and prevention of blindness. Recently, a classification system for standardized assessment of ocular trauma was introduced.4 If validated, this system, or a similar classification system, would allow objective assessment for both clinical prognosis and interventional studies. We aimed to identify patient and injury characteristics in deadly weapon-related eye injuries according to the Ocular Trauma Classification System, as well as other variables pertinent to this unusual type of severe eye trauma, at a principal center for military medicine in Turkey.