Validation of the ocular trauma score and identification of additional prognostic factors in open-globe injuries

Abstract

Objective

This study's aim was to validate the Ocular Trauma Score (OTS) for open globe injuries and to identify additional pre-operative factors that may affect the final visual acuity outcomes of patients with open globe injuries.

Design

This was a retrospective cross-sectional study done via chart review.

Methods

This was a single center study of patients who presented to VCU Medical Center from 2013 to 2020. A total of 140 patients with open globe injuries were included in the study. OTS was calculated for each patient based on the initial study by Kuhn et al. OTS predicted visual acuities were compared with the actual final visual acuities using Mann Whitney U test. The distribution of visual acuities in each OTS category was also compared with the original study by Kuhn et al. using Chi square analysis. The effects of lens involvement, presence of an intraocular foreign body, zone of injury, and time of surgery on the final visual acuity outcomes were also analyzed using Mann Whitney U test. The main outcome measure was the final visual acuity in Snellen and LogMAR equivalents.

Results

LP/HM was the most common presenting visual acuity category (59%) and OTS 1 was the most common OTS (45%). OTS reliably predicted final visual acuity in most cases, except for OTS 1 and 4, where there were significant differences between our study and the Kuhn et al. study. Of the four pre-operative factors analyzed, lens status and foreign body had significant effects on final visual acuity outcomes – injuries with an atraumatic lens or without an IOFB had better final VAs than predicted by OTS. Zone of injury and time of surgery had no significant effects.

Conclusion

Our study finds that OTS is overall a reliable predictor of final visual acuity and further validates it as a tool for open globe injury prognostication. However, our investigation showed that certain factors were not adequately accounted for by OTS, demonstrating the importance of considering other pre-operative factors when using OTS.