Factors Affecting Visual Outcome in Patients with Penetrating Corneal Injury

Abstract

Objective: To assess the visual acuity in patients with penetrating corneal injury with or without iris prolapse. Methods & Materials: This prospective observational study was conducted over 60 eyes with penetrating corneal injury with or without iris prolapse in National Institute of Ophthalmology & Hospital from October 2022 to September 2023. Detailed ophthalmic and systemic examinations of the patients was done with special attention to assessment of presenting visual acuity. All repairs were done under general anaesthesia with all aseptic precaution by multiple surgeons. Follow up was done on first post operative day, after 7 days, after 1 month and after three months. Results: This study shows the mean age for subjects with iris prolapse is 36.23± 11.64 years and without iris prolapse were 35.30±11.48 years. There were 19 male subjects (63.3%) with iris prolapse while there were 24 male subjects (80.0%) in the group without iris prolapse. For the female subjects, there were 11 (36.7%) with iris prolapse and 6 (20.0%) without irish prolapse. In the group with irish prolapse, 36.7% of injuries were caused by sharp objects, while 40% of injuries were in without irish prolapse group. The Best Corrected Visual Acuity (BCVA) of the study subjects after 3 months surgery, majority 88.9% were 6/6-6/36 in without irish prolapse group but 10.7% were 6/6- 6/36 in with iris prolapse group in 3 months follow up. Analysis revealed that statistically significant (P<0.001) better outcome of visual acuity (Log MAR) without irish prolapse than with irish prolapse at 3 month follow up. Lower level of Log MAR chart in without irish prolapse group than with irish prolapse group which was 0.57±0.20 versus 1.57±0.90 respectively. The difference was statistically significant between with and without irish prolapse group (P<0.001). During follow up of 3months, 35.8% patients had complication in iris prolapse group and 11.1% patients had complication in without iris prolapse group included traumatic cataract (25%), retinal detachment (17.9%), Endopthalmitis (3.6%) and some other (7.1%) in iris prolapse group, on the other hand traumatic cataract (11.1%), retinal detachment (3.7%) in without iris prolapse group. Conclusion: This study shows best corrected visual acuity (BCVA) revealed that iris prolapse had a higher proportion of poor visual outcomes, with a higher percentage reporting a BCVA of hand movement or 6/60. These findings have implications for clinical practice, highlighting the importance of prompt intervention and comprehensive follow-up care in patients with penetrating corneal injuries.