University of Sydney School of Medicine, Sydney, Australia.
Faculty of Medicine, University of New South Wales, Sydney, Australia.
Clin Exp Ophthalmol. 2021 May;49(4):336-346. doi: 10.1111/ceo.13944. Epub 2021 May 26.
Open globe injuries (OGI) represent a visually and economically devastating cause of vision loss. We examined the epidemiology, predictive variables, prognostic models, and economic cost of surgically managed OGI.
A retrospective tertiary centre study from 2008 to 2018 of 155 consecutive OGI in individuals aged 16 and older was performed. Medical records review, application of Ocular Trauma Score (OTS) and Classification and Regression Tree Analysis (CART) and cost analysis were undertaken. Key outcomes measured were visual acuity, number of operating theatre visits, prognostication using OTS and CART and estimated costs.
Younger males at work with inadequate protective eyewear (89.1%) and falls in the elderly were overrepresented. Inferior visual outcomes were associated with a more severe OTS score, a larger injury zone, increasing age, the presence of retinal detachment, extraocular muscle involvement, intraocular foreign body, and globe rupture (R = 0.723, p < 0.001). Multiple operating theatre visits were required in the presence of retinal detachment, lens or orbit involvement, work-related injury, globe rupture, and a history of previous intraocular surgery (R = 0.0423, p < 0.001). Both OTS and CART prognosticated outcomes (p < 0.001). The OTS predicted for no vision (no light perception/enucleation/evisceration) and profound visual loss (worse than 6/120; specificity: both 100%, sensitivity: 88.2% and 88%) whereas the CART predicted for visual survival (light perception or better) and minimal-to-severe visual loss (6/120 or better; specificity: 88.5% and 81.7% , sensitivity: 97.7% and 100%). Estimated annual OGI cost for Australia was AUD48.1-60.5 million (USD37.3-47.0 million).
The total cost of OGI is immense with young males and the elderly being disproportionately affected. Implementation of targeted government legislation and public health preventative measures may be cost-effective in ameliorating the significant burden.
开放性眼球损伤（OGI）是导致视力丧失的一种极具视觉和经济破坏性的原因。我们研究了接受手术治疗的 OGI 的流行病学、预测变量、预后模型和经济成本。
这是一项回顾性的三级中心研究，纳入了 2008 年至 2018 年期间 155 例年龄在 16 岁及以上的 OGI 患者。进行了病历回顾、应用眼外伤评分（OTS）和分类回归树分析（CART）以及成本分析。主要观察指标为视力、手术次数、OTS 和 CART 预测结果以及估计成本。
工作中未佩戴适当防护眼镜的年轻男性（89.1%）和老年人跌倒的占比过高。较差的视力预后与更严重的 OTS 评分、更大的损伤范围、年龄增长、视网膜脱离、眼外肌受累、眼内异物和眼球破裂（R = 0.723，p < 0.001）相关。存在视网膜脱离、晶状体或眼眶受累、工作相关损伤、眼球破裂和既往眼内手术史时，需要多次手术（R = 0.0423，p < 0.001）。OTS 和 CART 均可预测预后（p < 0.001）。OTS 预测无光感（无光感/眼球摘除/眼内容剜除）和严重视力丧失（视力差于 6/120；特异性均为 100%，敏感性为 88.2%和 88%），而 CART 预测视力存活（光感或更好）和轻度至重度视力丧失（6/120 或更好；特异性分别为 88.5%和 81.7%，敏感性为 97.7%和 100%）。澳大利亚 OGI 的年估计费用为 4810 万至 6050 万澳元（3730 万至 4700 万美元）。
OGI 的总成本巨大，年轻男性和老年人的受影响程度不成比例。实施有针对性的政府立法和公共卫生预防措施可能具有成本效益，可以减轻这一重大负担。
