Poor visual acuity may result from wound dehiscence in elderly ECCE patients

Am J Ophthalmol. 2011;152(2):229-233.

Wound dehiscence is a significant source of visual disability among elderly patients who sustain ocular trauma after previous extracapsular cataract extraction, a study found.

"Surgical scleral wounds are susceptible to dehiscence with blunt trauma," the study authors said. "Rupture [extracapsular cataract extraction] wound patients have a poor visual prognosis. Fortunately, patients with phacoemulsification site dehiscence appear to regain the majority of their vision after open-globe repair."

The retrospective study included 846 patients with 848 open-globe injuries treated between 2000 and 2009. Investigators analyzed time from original surgery to wound dehiscence, type of initial surgery, ocular trauma score, age, gender, cause of injury and visual acuity.

Sixty-three patients (7.4%) who sustained open-globe injuries had previously undergone cataract surgery. The vast majority of cataract wounds (89%) were from extracapsular cataract extraction (ECCE), and 11% of wounds were from phacoemulsification. Mean patient age in the wound rupture group was 78.2 years.

Causes of open-globe injury included falls (65%), blunt trauma (23%) and automobile accidents (7%).

The mean interval from primary cataract surgery to ocular trauma was 127 months in the ECCE group and 3.7 months in the phacoemulsification group.

Study results showed that the wound dehiscence patients had a median raw ocular trauma score of 47. Patients in the wound dehiscence group presented with visual acuity of light perception.

Best visual acuity after open-globe repair surgery was perception of hand motions among wound dehiscence patients and 20/40 among the remaining patients. The difference was statistically significant (P = .0002).

Median visual acuity among phacoemulsification patients was 20/60.