Ординатура / Офтальмология / Учебные материалы / Ocular Traumatology Springer

[12]Pump-Schmidt C, Behrens-Baumann W (1999) Changes in the epidemiology of ruptured globe eye injuries due to societal changes. Ophthalmologica 213: 380−386

[13]Punnonen E, Laatikainen L (1989) Prognosis of perforating eye injuries with intraocular foreign bodies. Acta Ophthalmol 66: 483−491

[14]Ramsay R, Knobloch WH (1978) Ocular perforation following retrobulbar anesthesia for retinal detachment surgery. Am J Ophthalmol 86: 61−64

[15]Ramsay RC, Cantrill HL, Knobloch WH (1985) Vitrectomy for double penetrating ocular injuries. Am J Ophthalmol 100: 586−589

[16]Rudd J, Jaeger E, Freitag S, Jeffers J (1994) Traumatically ruptured globes in children. J Pediatr Ophthalmol Strab 31: 307−311

[17]Topping T, Abrams G, Machemer R (1979) Experimental double-perforating injury of the posterior segment in rabbit eyes: the natural history of intraocular proliferation. Arch Ophthalmol 97: 735−742

1.2.1The Need for a Standardized System

to Describe Characteristics of a Serious Eye Injury

Several variables (e.g., tissue abnormalities, functional consequences) can be used to describe the injury. A system that provides meaningful yet concise information is extremely helpful for clinicians, researchers, and patients.

1.2.2The Development of the Classification System

A group of trauma specialists was gathered to develop the system based on their clinical experience, using the Delphi process and Likert questions . The fundament for the classification system was BETT (see Chap. 1.1).

The name “classification” reflects the fact that the system breaks down the findings into a few categories and has several options in each.

The initiative came from Paul Sternberg; other members of the Ocular Trauma Classification Group included: Thomas Aaberg, William Bridges, Antonio Capone, Jose Cardillo, Eugene deJuan, Ferenc Kuhn, Travis Meredith, William Mieler, Timothy Olsen, Patrick Rubsamen, and Timothy Stout.

A question is asked from the group; discussion follows and a consensus is reached. The group moves to the next question, and the procedure is repeated until all agree that the final product is the best and most useful that can be achieved.

The possible answer to the yes-or-no question ranges from “strongly agree” to “strongly disagree.”

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Table 1.2.1  Classification of open and closed globe injuries

aPresence (positive) or absence (negative) of APD in the injured eye

1.2.3The Classification System for Mechanical Eye Injuries

A separate classification system is used for open and for closed globe injuries [11]. The system evaluates four variables:

•Type (based on the mechanism of injury) [3, 6, 7, 9]

•Grade (based on the initial visual acuity) [2−4, 7, 12, 13]

•Pupil (depending on the presence or absence of an afferent pupillary defect) [3, 8]

•Zone (based on the location of the wound in open globe injuries and on what the most posterior tissue that has been damaged is in closed globe injuries) [2−4, 6, 7, 12]

Table 1.2.1 shows the details of the system.

Z Pearl

DO:

•determine the classification system’s elements during work-up and surgery

DON’T:

•forget to base your findings on the BETT system

Summary

The classification system provides a simple method of conveying important information about an eye injury, and it has been proven to carry prognostic information as well [1, 5].

16 Ferenc Kuhn and Dante Pieramici

References

[1]Bajaire B, Oudovitchenko E, Morales E (2006) Vitreoretinal surgery of the posterior segment for explosive trauma in terrorist warfare. Graefe’s Arch Clin Exp Ophthalmol 244: 991−995

[2]Brinton G, Aaberg T, Reeser F, Topping T, Abrams G (1982) Surgical results in ocular trauma involving the posterior segment. Am J Ophthalmol 93: 271−278

[3]De Juan E, Sternberg P, Michels R (1983) Penetrating ocular injuries: types of injuries and visual results. Ophthalmology 90: 1318−1322

[4]Eagling EM (1976) Perforating injuries of the eye. Br J Ophthalmol 60: 732−736

[5]Ersanli D, Unal M, Aydin A, Gulecek O, Kalemoglu M (2005) Results of pars plana vitrectomy in closed-globe injuries. Ophthal Surg Lasers Imaging 36: 182−188

[6]Gilbert CM, Soong HK, Hirst LW (1987) A two-year prospective study of penetrating ocular trauma at the Wilmer Ophthalmological Institute. Ann Ophthalmol 19: 104−106

[7]Hutton WL, Fuller DG (1984) Factors influencing final visual results in severely injured eyes. Am J Ophthalmol 97: 715−722

[8]Joseph E, Zak R, Smith S, Best W, Gamelli R, Dries D (1992) Predictors of blinding or serious eye injury in blunt trauma. J Eye Trauma 33: 19−24

[9]Martin D, Meredith T, Topping T, Sternberg PJ, Kaplan H (1991) Perforating (through-and-through) injuries of the globe. Surgical results with vitrectomy. Arch Ophthalmol 109: 951−956

[10]Park S, Marcus D, Duker J, Pesavento R, Topping P, Frederick A, D’Amico D (1995) Posterior segment complications after vitrectomy for macular hole. Ophthalmology 102: 775−781

[11]Pieramici D, Sternberg JP, Aaberg ST, Bridges JWZ, Capone JA, Cardillo JA, DeJuan JE, Kuhn F, Meredith TA, Mieler W, Olsen TW, Rubsamen P, Stout T (1997) A system for classifying mechanical injuries of the eye (globe). Am J Ophthalmol 123: 820−831

[12]Sternberg P, de Juan E, Michels RG, et al. (1984) Multivariate analysis of prognostic factors in penetrating ocular injuries. Am J Ophthalmol 98: 467−472

[13]Williams DF, Mieler WF, Abrams GW et al. (1988) Results and prognostic factors in penetrating ocular injuries with retained intraocular foreign bodies. Ophthalmology 95: 911−916

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Table 1.3.1  Contradictory prognostic information in the literature. (Modified after [4])

a These variables were determined to have prognostic significance in some studies but to not have any prognostic value in other studies.

b “Early” was defined as 3 days in one study [2] and 14 days in another [1]

c The type of drug used is important

d In posttraumatic infections tap should not be considered as an option [5] (see Chap. 2.17)

Step 2: Conversion of the raw points into the OTS, and identifying the likely visual outcome (%)

If none of the five pathologies are present, the visual acuity determines the OTS