An analysis of the visual acuity outcomes following surgical repair of penetrating corneal injuries among patients seen at Sekuru Kaguvi Hospital (SKH), eye unit at Parirenyatwa Central Hospital in Harare, Zimbabwe

Abstract

Trauma is an important cause of morbidity and mortality in most disciplines in the practice of medicine and constitutes a great proportion of patients seen in emergency departments. Ocular trauma causes significant visual morbidity and fortunately mortality from purely ocular injuries is rare unless the patient develops complications that spread into the cranium. Although, studies have been done to find out causes of ocular trauma that result in hospital admission, including one at SKH, the prevalence of good visual outcomes has not been evaluated. This study was therefore conducted to evaluate the prevalence of good visual outcomes following penetrating corneal injury and surgical repair at SKH. Objectives The principal objective was to analyze the visual outcomes of patients in the study population who underwent surgical repair for penetrating corneal injuries at SKH. The specific objectives were to describe the demographics of the study population, to elicit the causes of penetrating corneal injuries and to evaluate the best corrected monocular visual acuities of the patients’ eyes under study. Design of Study A hospital based prospective study. Study Setting Study was conducted at Sekuru Kaguvi Hospital, Parirenyatwa Group of Hospitals. Study Population Patients who had surgical repair of penetrating corneal injuries at SKH between August 2012 and April 2013, meeting enrolment criteria were recruited. Methods Authorization to carry out the study at SKH was granted by the Joint Research and Ethics Committee. Patients with penetrating corneal injuries referred to SKH were managed as per standard operating procedure. Day 1 post operatively the researcher interviewed and examined patients for eligibility to enroll into study. Data about the patients' demography, history about the injury and examination findings were captured onto data sheet. Patients were followed up a total of 7 weeks post surgical repair and were seen Day 1, 2 weeks, 6 weeks and 7 weeks post operatively. At six weeks post op, corneal sutures were removed on the slit lamp. Best corrected monocular visual acuities of the injured eyes were evaluated at week 7 objectively and subjectively. Examination findings of state of anterior and posterior segments were recorded. Results Seventy (70) patients were recruited into study. Median age of the patients was 39 years, range 6 to 72 years. The male: female ratio was 2.7:1. The proportion of patients that achieved best corrected monocular visual acuities (BCVA) of 6/60 or better was 59% (n=41). There was an association between the BCVA and location of the corneal scar (p=0.001). The association between the BCVA and the status of the lens was also statistically significant (p=0.001). The main causes of bad visual outcome (BCVA worse than 6/60) were irregular astigmatism, vitreous hemorrhage and corneal scar in the visual axis and dense traumatic cataracts. Males were more than twice at risk of getting injured. Age and gender were risk factors for injury with males below 40 years of age being more at risk of injury. The main causes of injury were vegetative matter and metallic objects. There was a statistically significant association between object of injury and gender (p=0.016). Conclusions The results showed that the proportion of patients that achieved good visual outcomes (BCVA of 6/60 or better) at Sekuru Kaguvi Hospital after surgical repair for penetrating corneal injury was 59% during the study period. Irregular corneal astigmatism, vitreous hemorrhage and central corneal scarring were the major causes of visual outcomes worse than 6/60. Males were affected more than females by a ratio of 2.7:1. The causes of injuries could suggest gender roles in society, where males were injured mostly by metallic objects and females by vegetative material.