Can visual outcome be improved in open globe ocular trauma?

Background: Visual prognosis of injured eyes estimated by the Ocular Trauma Score (OTS) can be used to evaluate the efficacy of open globe treatment. The aim of this study was to identify the OTS features over which interventions could be performed to improve visual outcome in patients with open globe trauma. Methods: We carried out an observational, longitudinal, retrospective-prospective, analytical study. Patients with open globe trauma from a general hospital were evaluated. The initial proportions of visual deficiency (best corrected visual acuity <20/40) and ambulatory vision (best corrected visual acuity >20/200) were identified, and the corresponding expected proportions and 95% confidence intervals (CI) after treatment were estimated using the OTS; both proportions were compared with those obtained in the sample (chi(2)). OTS features associated with a higher proportion of visual improvement were identified. Results: Fifty eyes were studied (mean age 28.6 +/- 19 years, 58.4% males). The initial proportion of visual deficiency changed from 92% to 72% (p = 0.009) and that of ambulatory vision changed from 24% to 52% (p = 0.004); the expected proportion of visual deficiency was 58% (95% C. I. 44-72) and that of ambulatory vision was 64% (95% CI 52-77). In eyes with OTS category 3 where neither ruptures nor surgical retinal diseases were initially found, visual improvement was more common but less than expected. Conclusions: Treatment significantly changed the proportions of visual deficiency and ambulatory vision, but its efficacy was the minimal expected. Standardization of anterior segment surgical procedures may improve visual outcome in eyes with open globe trauma with OTS categories 3 to 5.