Clinical characteristics and prognostic factors of scleral rupture due to blunt ocular trauma

Purpose To describe and identify ocular and wound characteristics, and prognostic factors associated with final visual acuity (VA) in patients with scleral rupture due to blunt ocular trauma. Methods The medical records of 61 patients with globe rupture due to blunt ocular trauma who underwent primary repair were reviewed retrospectively. The data recorded included demographic characteristics, initial and final VA, ocular signs, wound characteristics, and surgeries. Initial VA, ocular signs, wound characteristics, and surgeries were analyzed to determine the association with the final VA. Results Forty three women and 18 men with a mean age of 43.6 +/- 23.5 years were included in the study. The locations of scleral wounds were mostly in the superonasal quadrant (41.0%) and zone 2 (75.4%). In eyes with hyphema (P = 0.009), vitreous hemorrhage (P = 0.001), and retinal detachment (P = 0.004), final VA was statistically worse than eyes without these signs. A moderate positive correlation was found between the initial and final VA (P < 0.001). Final VA was statistically worse in eyes with horizontal midline wounds than in eyes with vertical midline wounds (P = 0.002). A moderate negative correlation was found between scleral wound length and final VA (P < 0.001). Patients who underwent cataract surgery had statistically better final VA (P = 0.002). Conclusions Scleral rupture was detected mostly in females, superonasal quadrant and zone 2. Poor final VA was significantly associated with poor initial VA, longer wound length, horizontal midline wound, presence of hyphema, vitreous hemorrhage and retinal detachment at presentation, and cataract surgery not performed during follow-up period. Scleral ruptures have different demographic, ocular and wound characteristics than other open globe injuries.