Hutton and Fuller identified factors affecting the final visual outcome after severe ocular injury involving the posterior segment. Information on these factors is available at the time of ophthalmologic management. The authors are from Texas Retinal Associates in Dallas.
|
Factor |
Better |
Intermediate |
Worse |
|
preoperative visual acuity |
good preoperative |
|
|
|
size of entrance wound or laceration |
< 6 mm |
6 to 9 mm |
> 12 mm (> 9 mm in discussion) |
|
type of injury |
foreign body |
blunt not requiring vitrectomy |
penetration or perforation; blunt injury requiring vitrectomy |
|
depth of injury |
penetrating |
blunt |
perforation through and through |
|
type of foreign body |
nonmagnetic |
magnetic |
BB |
|
scleral buckling |
significantly reduces delayed retinal detachment |
|
|
|
bright flash electroretinogram |
|
|
absent response |
|
flash visual-evoked potential |
normal response |
reduced response |
absent response |
|
ultrasonography |
|
|
extensive retinal detachments and hemorrhagic retinal detachments worse |
where:
• Flash visual-evoked potentials gives information about central visual function. Damage to either the macula or optic nerve causes reduction in the potentials (page 721). This test was the most accurate for predicting the postoperative vision in the injured eye.
• Bright flash electroretinography might not be practical for many patients with severely injured eyes since it requires a corneal contact lens. It also does not measure optic nerve function.
• Timing of surgery was not an independent variable for predicting outcome.
Specialty: Ophthalmology, Emergency Medicine, Surgery, general
