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Afferent pupillary defect is predictor of vision survival


All patients presenting with open-globe injuries should be treated as aggressively as possible, but a recent study shows that the presence of an afferent pupillary defect is the best indicator of permanent visual loss in these patients.

Hong Kong-The presence of an afferent pupillary defect is the best indicator of visual loss in patients with open-globe injuries, said Michael Grant, MD, PhD, at the World Ophthalmology Congress.

Dr. Grant and his colleagues developed a model by which to predict survival of vision in the presence of rupture and penetrating open-globe injuries-that is, no light perception vision versus light perception vision. The basis of this study was a retrospective cohort review of 221 patients who had open-globe injuries from Jan. 31, 2001 to Dec. 31, 2004.

Binary recursive partitioning was used to construct a classification tree to predict either vision survival (defined as light perception or better vision) or no vision (defined as no light perception, enucleation, or evisceration), explained Dr. Grant, director, cosmetic surgical services, and assistant professor, ophthalmology and plastic surgery, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore.

He and his colleagues also reported the details of the results of the statistical analysis (Schmidt GW, Broman AT, Hindman HB, Grant MP. Vision survival after open globe injury predicted by classification and regression tree analysis. Ophthalmology. 2008;115:202-209).

Most patients were men (n = 170), with a mean patient age of 37.6 years. Seventy-three percent of injuries occurred in the home. Patients were treated aggressively, and all but one case was closed within 24 hours, most cases were closed within 12 hours. The exception was a patient whose condition was too unstable to be taken to the operating room.

There were no primary enucleations. All patients underwent aggressive surgical attempts to restore their vision to the highest level possible, Dr. Grant said. Several injuries occurred among elderly patients; most were falls that resulted in blunt open-globe trauma to the eye.

"All patients received aggressive surgical treatment to achieve the best final visual acuity possible," he said. "Most patients had only one or two surgeries."

The patients were followed for a mean of 8.5 months.

Read the complete article in the Oct. 1, 2008 issue of Ophthalmology Times.

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