Lens injury in setting of Zone I and II open globe injuries

Purpose:To characterize visual outcomes in Zone I and II open globe injuries with lens involvement.Setting:Level 1 Trauma Center Hospital, Seattle WA.Design:Retrospective case series.Methods:Zone I and II open globe injuries between May 2009 and May 2018 were reviewed for lens involvement, demographic data, injury characteristics, associated ocular comorbidities, surgical details, and visual outcomes. Eyes with nontraumatic or surgical injuries, prior penetrating keratoplasty, or a history of cataract extraction were excluded. Visual outcomes were compared using the Kruskal-Wallis and Fisher's exact tests.Results:A total of 145 Zone I and II globe injuries (63 without lens injury and 82 with lens injury) with at least 6 months of follow-up were included. Endophthalmitis was not identified in any patients without lens involvement, while 9 patients with lens injury (11%) developed endophthalmitis. Patients with lens injury demonstrated a more severe ocular trauma score (P = 0.003). Best-corrected visual acuity (BCVA) was significantly better (P = 0.03) in patients without lens injury compared to those with lens injury. The median (interquartile range) BCVA in the no-lens injury group was 20/40 (20/25 - 20/400), while in the lens injury group it was 20/80 (20/40-20/300). The location of intraocular lens (IOL) placement did not influence final visual acuity outcomes (P = 0.76). However, eyes left aphakic had worse BCVA compared to those that received a secondary IOL (P = 0.005).Conclusions:Open globe injuries with lens involvement are associated with worse visual prognosis. An increased rate of endophthalmitis may contribute to this difference. In eyes requiring secondary IOL placement, the location of the IOL did not affect final BCVA.