Global Current Practice Patterns for the Management of Open Globe Injuries - 02/02/22

Doi : 10.1016/j.ajo.2021.08.003

Sarah C. Miller ^a, Michael J. Fliotsos ^a, Grant A. Justin ^b, Yoshihiro Yonekawa ^c, Ariel Chen ^a, Annette K. Hoskin ^d,^e, Richard J. Blanch ^f,^g,^h, Kara Cavuoto ⁱ, Prajna Meeralakshmi ^j, Rebecca Low ^k, Matthew Gardiner ^l, Tin Yan Alvin Liu ^a, Rupesh Agrawal ^k,^m,^n,^o,^⁎ , Fasika A. Woreta ^a,^⁎
on behalf of The
International Globe and Adnexal Trauma Epidemiology Study (IGATES)^¹
Study group authors are listed in Acknowledgements.
^a Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
^b Department of Ophthalmology, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
^c Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University School of Medicine, Philadelphia, Pennsylvania, USA
^d Save Sight Institute, University of Sydney, Sydney, New South Wales, Australia
^e Lions Eye Institute, University of Western Australia, Perth, Western Australia, Australia
^f Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, UK
^g University Hospitals Birmingham, Birmingham, UK
^h Neuroscience and Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
ⁱ Bascom Palmer Eye Institute, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida, USA
^j Aravind Eye Hospital, Madurai, Tamil Nadu, India
^k Department of Ophthalmology, Tan Tock Seng Hospital, Singapore
^l Massachusetts Eye and Ear, Boston, Massachusetts, USA
^m Singapore Eye Research Institute, Singapore
ⁿ Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
^o Duke National University of Singapore (NUS) Medical School, Singapore

^⁎⁎Co-corresponding author: Rupesh Agrawal, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore 308433National Healthcare Group Eye InstituteTan Tock Seng Hospital308433Singapore^⁎Corresponding author: Fasika A Woreta, The Wilmer Eye Institute, Johns Hopkins Hospital, 600 N Wolfe St, Baltimore, MD 21205, USAThe Wilmer Eye InstituteJohns Hopkins Hospital600 N Wolfe StBaltimoreMD21205USA

Résumé

PURPOSE

To determine global current practice patterns for the management of open globe injuries and identify areas of variation.

DESIGN

Cross-sectional survey.

METHODS

An online survey assessed global management paradigms for open globe injuries from August 2020 to January 2021. Responses were collected from experts at eye trauma centers and emergency departments worldwide who manage ≥1 open globe injury per month. The survey assessed the use/selection of antibiotics and steroids, procedural and imaging decisions, and admission practices for open globe injuries.

RESULTS

Responses were received from representatives of 36 of 42 institutions (85.7%), of which 33 (78.6%) had sufficient trauma volume to be included. Included responses were distributed across North America (n=12, 36.4%), Asia (n=12, 36.4%), South America (n=4, 12.1%), Africa (n=3, 9.1%), Europe (n=1, 3.0%), and Australia (n=1, 3.0%). Preoperative systemic antibiotics for open globe injuries were administered by 75.8% (n = 25/33) of institutions, while 30.3% (n = 10/33) administered preoperative topical antibiotics. Intraoperative ophthalmic antibiotics for open globe injuries were used by 54.5% (n = 18/33) of experts. Most institutions also administered postoperative systemic antibiotics (n = 23 [69.7%]) and topical steroids (n = 29 [87.9%]), although specific medication choices diverged. At 19 responding centers (61.3% of the 31 that had trainees), residents participated in surgical repairs. Many institutions discharged patients after repair, but 54.5% (n = 18/33) of locations routinely admitted them for observation.

CONCLUSIONS

Preferred management practices for open globe injuries vary widely. To ensure the highest standard of care for all patients, evidence-based international guidelines for the treatment of these injuries are needed.

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Keywords : globe injuries, ocular trauma, practice patterns, antibiotics, surgical preferences

Plan

SUMMARY OF RESPONDENTS

ANTIBIOTIC AND STEROID MANAGEMENT PARADIGMS FOR OGI

SURGICAL PROTOCOLS FOR OGI REPAIRS

OGI MANAGEMENT IN USA VS. NON-USA CENTERS

DISCUSSION

Supplemental Material available at AJO.com.
Dr. Fliotsos is currently training at the Department of Ophthalmology, Yale New Haven Hospital, New Haven, Connecticut, USA, and Dr. Justin is currently training at the Department of Vitreoretinal Surgery, Duke Eye Center, Durham, North Carolina, USA.
Additional study group authors are listed in the Acknowledgments.

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Vol 234

P. 259-273 - février 2022 Retour au numéro

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Global Current Practice Patterns for the Management of Open Globe Injuries - 02/02/22

Résumé

PURPOSE

DESIGN

METHODS

RESULTS

CONCLUSIONS

Plan

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