Sarah C Miller1, Michael J Fliotsos1, Grant A Justin2, Yoshihiro Yonekawa3, Ariel Chen1, Annette K Hoskin4, Richard J Blanch5, Kara Cavuoto6, Prajna Meeralakshmi7, Rebecca Low8, Matthew Gardiner9, Tin Yan Alvin Liu1, Rupesh Agrawal10, Fasika A Woreta11. 1. Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. 2. Department of Ophthalmology, Walter Reed National Military Medical Center, Bethesda, Maryland, USA. 3. Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University School of Medicine, Philadelphia, Pennsylvania, USA. 4. Save Sight Institute, University of Sydney, Sydney, New South Wales, Australia; Lions Eye Institute, University of Western Australia, Perth, Western Australia, Australia. 5. Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, UK; University Hospitals Birmingham, Birmingham, UK; Neuroscience and Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK. 6. Bascom Palmer Eye Institute, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida, USA. 7. Aravind Eye Hospital, Madurai, Tamil Nadu, India. 8. Department of Ophthalmology, Tan Tock Seng Hospital, Singapore. 9. Massachusetts Eye and Ear, Boston, Massachusetts, USA. 10. Aravind Eye Hospital, Madurai, Tamil Nadu, India; Singapore Eye Research Institute, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Duke National University of Singapore (NUS) Medical School, Singapore. Electronic address: Rupesh_agrawal@ttsh.com.sg. 11. Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. Electronic address: fworeta1@jhmi.edu.
Abstract
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.
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.
Authors: Sarah C Miller; Prajna Meeralakshmi; Michael J Fliotsos; Grant A Justin; Yoshihiro Yonekawa; Ariel Chen; Annette K Hoskin; Richard J Blanch; Kara M Cavuoto; Rebecca Low; Ximin Li; Matthew Gardiner; T Y Alvin Liu; Ankoor S Shah; James D Auran; Rupesh Agrawal; Fasika A Woreta Journal: Clin Ophthalmol Date: 2022-09-26