I read with interest the article on, ‘Descriptive study on ocular survival, visual outcome and prognostic factors in open globe injuries,’ by Rao et al. There are few points which I would like to clarify, based on the data provided in the manuscript.
Initial visual acuity: In the study by Rao et al., the main conclusion is, preoperative or initial visual acuity is the most important indicator of prognostic significance. What was the vision at one month in patients with an initial visual acuity of <5/200? What were the other associated factors present in contributing to the poor final visual acuity? Was there a presence of traumatic cataract, vitreous hemorrhage, anterior chamber hyphema, or retinal detachment? As most of these factors are treatable factors, I believe that concluding initial visual acuity as a poor prognostic indicator and that too at one month of follow up, is not appropriate. Traumatic cataract, vitreous hemorrhage, and retinal detachment can all be taken care by second and if required a third surgery.
Ocular survival: The authors have stated that two eyes were eviscerated, but as per the results, one eye with no perception of light was eviscerated and two eyes, which progressed to panophthalmitis were eviscerated. There is also a mention of one eye with intraocular foreign body (IOFB) being eviscerated; eventually from the data, three or maybe four eyes were eviscerated, but as per conclusion only two eyes were eviscerated. As six eyes developed phthisis, there should be total of nine eyes out of sixty-nine that could not be restored anatomically or functionally, hence, the ocular survival should be 86.95 and not 97%.
Evisceration of the no-light perception eye with an afferent pupillary defect: As per the current state of art management of trauma patients, we do not enucleate or eviscerate any ocular trauma patient with no perception of light, even if there is presence of afferent pupillary defect. I wonder how we can eviscerate the eye based on no light perception vision.
Time since injury: Time since injury is stated to be not significantly associated with the final outcome. There is no mention about the analysis of time since injury in the whole article. It is quite surprising that without even analyzing the time since injury, authors can conclude that it is not an important prognostic factor.
IOFB: As one of the eyes with IOFB was to be eviscerated, concluding that IOFB is not the important prognostic factor for the final visual outcome is not the correct message to send out to the readers.
Extent of wound: How many of the patients in the series had a wound extending posterior to the recti insertion and how many of them regained useful vision, will be interesting data to look for from the study, as stating the length of the wound and zone III of the injury as prognostic indicators of the outcome in patients with open globe injury is very vague. The extent of the wound in terms of rectus insertion will be very important for the final prognostic outcome.
1. Rao LG, Ninan A, Rao KA. Descriptive study on ocular survival, visual outcome and prognostic factors in open globe injuries Indian J Ophthalmol. 2010;58:321–3
2. Heidari E, Taheri N. Surgical treatment of severely traumatized eyes with no light perception Retina. 2010;30:294–9
3. Esmaeli B, Elner SG, Schork MA, Elner VM. Visual outcome and ocular survival after penetrating trauma.A clinicopathologic study Ophthalmology. 1995;102:393–400