Open globe injuries: Epidemiology, visual and surgical predictive variables, prognostic models, and economic cost analysis.

BACKGROUND Open globe injuries (OGI) represent a visually and economically devastating cause of vision loss. We aimed to examine the epidemiology, predictive variables, prognostic models, and economic cost of surgically managed OGI. METHODS A retrospective tertiary centre study from 2008-2018 of 155 consecutive OGI aged 16 and older was performed. Medical record review, application of Ocular Trauma Score (OTS) and Classification and Regression Tree Analysis (CART) and cost analysis was undertaken. Key outcomes measured were visual acuity, number of operating theatre visits, prognostication using OTS and CART and estimated costs. RESULTS Younger males at work with inadequate protective eyewear (89.1%) and falls in the elderly were overrepresented. Inferior visual outcomes were associated with more severe OTS score, larger injury zone, increasing age, presence of retinal detachment, extraocular muscle involvement, intraocular foreign body, and globe rupture (R2 =0.723, p<0.001). Multiple operating theatre visits were required in presence of retinal detachment, lens or orbit involvement, work-related injury, globe rupture, and history of previous intraocular surgery (R2 =0.0423, p<0.001). Both OTS and CART prognosticated outcomes (p<0.001). The OTS predicted for no vision (no light perception/enucleation/evisceration) and profound visual loss (worse than 6/120; specificity: both 100%, sensitivity: 88.2%, 88% respectively) whereas the CART predicted for visual survival (light perception or better) and minimal-to-severe visual loss (6/120 or better; specificity: 88.5%, 81.7%, sensitivity: 97.7%, 100% respectively). Estimated annual OGI cost for Australia was AUD48.1-60.5 million (USD37.3-47.0 million). CONCLUSIONS The total cost of OGI is immense with young males and the elderly being disproportionately affected. Implementation of targeted government legislation and public health preventative measures maybe cost-effective in ameliorating the significant burden.