To propose a new classification system for open globe injuries (OGIs) and analyse its management outcomes

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Alam, Bristi Majumdar This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7275066/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background : The BETTS and the OTS are time-tested tools for classifying and prognosticating mechanical ocular injuries. However, anatomical representation of the injuries, status of lens and individual posterior segment structures were not included. Objectives : To propose a new classification system for open globe injuries (OGIs) and analyse its management outcomes Methods : 102 OGI cases undergoing primary repair at a tertiary eye centre were included in this retrospective observational study. Injuries were classified according to the proposed system (zone of injury, presence of traumatic cataract, status of posterior segment and presence of intraocular foreign body (IOFB)) and the visual outcomes were compared. Zone 1 was subdivided in three subzones namely; 1c (central), 1pc (paracentral), and 1p (peripheral). Results : The mean best corrected visual acuity (BCVA) at presentation was 2.81 ± 1.08 and mean final BCVA was 1.75 ± 1.59 (p <0.001). Traumatic cataract was present in 41.2% cases and IOFB in 5.9% cases. The most frequently occurring groups were 1cL0P0FB0 (Zone 1c without traumatic cataract, posterior segment involvement or any IOFB) (7.8%), 1cL1P0FB0 (Zone 1c with traumatic cataract, without posterior segment involvement or any IOFB) (7.8%) and 1pL1P0FB0 (Zone 1p with traumatic cataract, without posterior segment involvement or any IOFB) (7.8%). Posterior segment was involved in 51.9% cases. The comparison between initial and final visual acuities was significant for the zones 1c, 1pc, 1p and 2 (p<0.05), but not for zone 3 (p= 0.1832) Conclusion : The new system provides a holistic approach to OGIs with a better overview of the final visual outcomes. Health sciences/Medical research Biological sciences/Physiology Figures Figure 1 Summary box What was already known: BETTS provided a standard system of classification for mechanical eye injuries, which did not include status of lens, posterior segment and presence of IOFB. Zone 1 in open globe injuries included the cornea as a whole What this study adds: Each injury can be represented by a single unique number which gives holistic idea to the anatomical status and outcome of the injury. Zone 1 has been subdivided into central, paracentral and peripheral subzones, whose visual outcomes can be individually significant. Addition of status of lens, individual posterior segment structures (including USG B scan features on post-operative day one) provide imperative details to the classification. Introduction Ocular trauma is linked to exposure to hazardous situations. The lack of awareness and knowledge about its specific management has led to it being one of the major causes of blindness worldwide. [ 1 ] In 1996, Kuhn et al brought forth a classification system for mechanical eye injuries, aiming to promote a uniform terminology. Open globe injuries (OGIs) were described as a full thickness injury to the eyeball, damaging the cornea, sclera or both. [ 2 ] The Ocular Trauma Classification Group standardised this system, taking into account anatomical and physiological variables as seen on initial assessment or during primary surgery, which came to be known as the Birmingham Eye Trauma Terminology System (or BETTS). [ 3 ] Although the BETTS classification and the Ocular Trauma Score (OTS), proposed by Kuhn et al., stand as time-tested systems for classifying and prognosticating mechanical ocular injuries respectively, certain fallacies have been noted. [ 3 ] The BETTS includes type of injury (rupture/ penetrating/intraocular foreign body/ perforating/ mixed), grade of injury (based on presenting visual acuity), pupil status (presence or absence of relative afferent pupillary defect), and zones of injury. [ 3 ] Various important factors related to globe injury, that is, status of lens and posterior segment injuries were however ignored. Injuries involving different segments of cornea in pure corneal injuries (zone 1) can also have variable visual outcomes. An injury involving the visual axis may have a different final visual outcome as compared to a pure peripheral corneal injury. Hence, considering whole of the cornea as zone 1 may not be correct. Assessing RAPD (relative afferent pupillary defect) in a case of open globe injury is not only difficult, but unreliable too. Thus, there was a need for a more holistic classification system for open globe injuries which would provide a complete picture about the ocular structures affected by trauma. The present study aims to provide such a system which can not only give a better idea about the anatomical status of the injury, but would also be more robust in predicting the final prognosis as far as vision is concerned. Materials and Methods This was a retrospective observational study of 102 open globe injuries in 102 patients presenting at a tertiary eye care centre. Data and values of all the patients presenting to the emergency department over a 5-year period were derived from the electronic medical records of the hospital. Written informed consent was obtained from all patients and their kin. Exclusion criteria included less than 3 months of follow up and surgery done elsewhere. All cases were operated within 24 hours of presentation, following the same standard pre-operative, intra-operative and post-operative management protocol. Close observation and monitoring of the records were maintained at all follow-up visits. Institutional review board approval was obtained and the study adhered to the tenets of the Declaration of Helsinki. was used for statistical calculations. Injuries were classified according to the following proposed module: Zone of injury : Zone 1 : Limited to cornea: Zone 1 was further subdivided in to following sub zones 1 c : Central corneal: Any injury crossing the pupillary axis 1 pc : Paracentral corneal: Any injury not crossing the pupillary axis but lying in an area within 4mm from the centre of the cornea 1 p : Peripheral corneal: Any injury not crossing the pupillary axis and lying beyond 4mm from centre of cornea and till limbus. Zone 2 From limbus to 5mm of sclera Zone 3 Beyond 5mm of sclera The proposed zones of classification of injuries have been represented in Fig. 1 (A). 2. Traumatic cataract (L) : L 0 Absence of traumatic cataract at presentation L 1 Presence of traumatic cataract at presentation 3. Posterior segment involvement (P) : Posterior segment involvement was assessed based on fundus findings at presentation (if possible) and fundus findings or ultrasonography findings done on the first post operative day. P 0 Posterior segment not involved If posterior segment was involved, it was further divided according to the structure(s) involved as: Pv, Pr, Pc, Ps and Pe- for involvement of the vitreous, retina, choroid, posterior scleral dehiscence and endophthalmitis, respectively. If more than one posterior segment structures were involved, the corresponding letters representing the structure or pathology was added in the subscript. E.g., Prc if both retina and choroid were involved. 4. Intraocular foreign body (FB) : FB 0 Absence of intraocular foreign body FB 1 Presence of intraocular foreign body Therefore, in the proposed classification system, cases of open globe injuries were recorded as follows: Zone: 1c/ 1pc/ 1p/ 2/ 3 Presence of Traumatic cataract: L0/ L1 Posterior segment involvement: P0/ Pv/r/c/s/e For example, an open globe injury involving zone 2 without lens trauma (L0) or involvement of posterior segment (P0) or an IOFB (FB0) and as confirmed on post-operative USB B-scan would be classified as 2L0P0FB0 (Fig. 1 B & C). Similarly, a zone 1c injury with traumatic cataract (L1) and hemorrhagic choroidals (Pc), without any IOFB (FB0) as seen on USG B-scan would be classified as 1cL1PcFB0 (Fig. 1 D & E). Hence each case of OGI was assigned a unique classification number. Data were recorded in MS Excel spreadsheet program and were presented in a graphical manner wherever appropriate. Student’s T- test and Chi-square test were used for statistical analysis. Statistical Package for the Social Sciences (SPSS) version 22 was used for analysis. Written informed consents for publication from the patient have been obtained. All procedures carried out were in accordance with the tenets of the Declaration of Helsinki. I Institutional review board approval was obtained. Results 102 eyes of 102 patients with open globe injuries were included in the study. Demographic details have been summarised in Table 1 . The mean presenting age was 24.06 ± 33.7 (SD) years. There were 84 males (82.4%) and 18 females (17.6%). All the cases presented with uniocular open globe injury with left (53, 52%) and right (49,48%) eyes almost equally involved. The mean duration between time of injury and time of presentation was 54.9 ± 118.2 hours. The mean best corrected visual acuity (BCVA) in log-MAR at presentation and at final follow up were 2.81 ± 1.0and1.75 ± 1.59 ( p < 0.001) respectively. Corneal tear was the most common presenting injury (60, 58.8%). Traumatic cataract was present in 42 (41.2%) cases. The statistical likelihood of developing traumatic cataract was significant ( p = 0.01) when compared between zones 1, 2, & 3; however, it was not significant between the subzones of zone 1. Table 1 Demographic details and visual outcomes of study population No. of subjects 102 Age (Mean ± SD) 24.06 ± 33.7 years (Median: 22, Range: 2–74) Gender Male 84 (82.4%) Female 18 (17.6%) Eye Right 49 (48%) Left 53 (52%) Duration between time of injury and presentation (Mean ± SD) 54.9 ± 118.2 hours (Median: 24, Range: 1-240) Mean VA at presentation (Mean ± SD) 2.81 ± 1.08 logMAR p < 0.001 Mean final VA (Mean ± SD) 1.75 ± 1.59 logMAR Type of injury at presentation Corneal tear 60 (58.8%) Scleral tear 20 (19.6%) Corneoscleral tear 22 (21.6%) Associated features Posterior segment involvement 53 (51.9%) Traumatic cataract 42 (41.2%) Adnexal injuries 12 (11.8%) Intraocular foreign body 6 (5.9%) Nature of offending agent Organic 27 (26.5%) Inorganic metallic 30 (29.4%) Inorganic non-metallic 45 (44.1%) Patients undergoing single surgery (51. 50.0%) Mean pre-op VA (Mean ± SD) 2.72 ± 1.18 logMAR p < 0.001 Mean post-op VA (Mean ± SD) 2.02 ± 1.74 logMAR Patients undergoing more than one surgery (51, 50.0%) Mean pre-op VA (Mean ± SD) 2.91 ± 0.94 logMAR p < 0.001 Mean post-op VA (Mean ± SD) 1.53 ± 1.37 logMAR Follow up period (Mean ± SD) 12.38 ± 10.43 months (Median: 10, Range: 3–49) logMAR logarithm of the minimum angle of resolution, SD Standard deviation. Intraocular foreign body (IOFB) was found in 6 (5.9%) cases. Twelve (11.8%) patients presented with adnexal injuries with lid tear (9, 75%) being the most common presentation. Fifty-one patients (50.0%) needed only single surgery whose mean pre-operative and post-operative logMAR BCVA were 2.72 ± 1.18 and 2.02 ± 1.74 respectively ( p < 0.001). Remaining fifty-one (50.0%) patients underwent more than one surgery, whose mean pre-operative and post-operative logMAR BCVA were 2.91 ± 0.94 and 1.53 ± 1.37 respectively ( p < 0.001). The mean follow-up period was12.38 ± 10.43 months. Table 2 shows the distribution of cases classified according to the proposed system, divided according to the new modified zone of injury. The most frequently occurring groups (8 each) were 1cL0P0FB0 (7.8%), 1cL1P0FB0 (7.8%) and 1pL1P0FB0 (7.8%). The most commonly involved zone was zone 2 and seen in32 (31.4%) cases. Posterior segment involvement was seen in 53(51.9%) cases where choroidal involvement was most common (26, 25.49%), followed by retina (21, 20.59%), vitreous (15, 14.7%), posterior scleral dehiscence (3, 2.9%) and endophthalmitis (1, 0.9%). Zone 3 had statistically highest likelihood of posterior segment involvement than zone 2 and zone 1 (p < 0.05). There was no statistical difference regarding the posterior segment involvement within the subzones of zone 1. Table 2 Proposed new system of classification and number of patients representing each unique number 1. Zone of Injury (Zone): 3. Posterior Segment (P): Zone 1: Limited to cornea: - 1 c: Central - 1 pc: Paracentral - 1 p: Peripheral Zone 2: From limbus to 5mm of sclera Zone 3: Beyond 5mm of sclera P0 - Posterior segment not involved Pv – Vitreous involvement Pr – Retinal involvement Pc – Choroidal involvement Ps - Posterior scleral dehiscence Pe - Endophthalmitis 2. Presence of Traumatic Cataract (L) : 4. Intraocular Foreign Body (FB) : L0 - Absence of traumatic cataract at presentation L1 - Presence of traumatic cataract at presentation FB0 - Absence of intraocular foreign body FB1 - Presence of intraocular foreign body Number (n, %) of cases assigned according to unique number divided according to proposed zones 1c 1pc 1p 2 3 1cL0P0FB0 (8, 7.8%) 1pcL0P0FB0 (5, 4.9%) 1pL0P0FB0 (4, 3.9%) 2L0P0FB0 (7, 6.8%) 3L0P0FB0 (1, 0.9%) 1cL0PvFB0 (1, 0.9%) 1pcL0PcFB0 (1, 0.9%) 1pL0PrFB0 (2, 1.8%) 2L0PvFB0 (2, 1.8%) 3L0PvFB0 (3, 2.9%) 1cL0PcFB0 (2, 1.8%) 1pcL1P0FB0 (2, 1.8%) 1pL0PrFB1 (1, 0.9%) 2L0PvFB1 (1, 0.9%) 3L0PrFB0 (2, 1.8%) 1cL1P0FB0 (8, 7.8%) 1pcL1P0FB1 (1, 0.9%) 1pL0PcFB0 (2, 1.8%) 2L0PrFB0 (6, 5.8%) 3L0PrFB1 (1, 0.9%) 1cL1PvFB0 (1, 0.9%) 1pcL1PvFB0 (2, 1.8%) 1pL1P0FB0 (8, 7.8%) 2L0PcFB0 (3, 2.9%) 3L0PsFB0 (3, 2.9%) 1cL1PcFB0 (1, 0.9%) 1pcL1PrFB0 (1, 0.9%) 1pL1PvFB0 (1, 0.9%) 2L0PcFB1 (1, 0.9%) 3L1P0FB0 (1, 0.9%) 1pcL0PrFB0 (2, 1.8%) 1pL1PrFB0 (2, 1.8%) 2L0PeFB0 (1, 0.9%) 1pL1PrFB1 (1, 0.9%) 2L1P0FB0 (4, 3.9%) 1pL1PcFB0 (2, 1.8%) 2L1PvFB0 (4, 3.9%) 2L1PrFB0 (2, 1.8%) 2L1PcFB0 (1, 0.9%) Ocular Trauma Score (OTS) likelihood scale, as proposed by Kuhn et al., [ 4 ] was calculated for all cases and tabulated according to the proposed zones (Table 3 ). The highest OTS score was 77, seen in 2 cases (1.9%) and lowest score was 20, seen in 1 case (0.9%). The visual outcome predicted by OTS was tabulated alongside the mean final outcome and the range of vision for each group. Table 3 OTS likelihood of vision classified according to zones of injury Zone Score 0–44 Category 1 Score 45–65 Category 2 Score 66–80 Category 3 Total (N = 102) n (%) Most likely chances of final visual outcome at 6 months according to OTS (based on category containing maximum cases) Snellen equivalent of mean VA at final visit Snell equivalent of range of final vision 1 14 (13.7%) 32 (31.4%) 11 (10.7%) 58 (56.9%) Category 2 NoPL (27%), PL/HM (26%) 3/60– 4/60 NoPL – 6/6 1c 4 (3.9%) 14 (13.7%) 3 (2.9%) 21 (20.6%) Category 2 NoPL (27%), PL/HM (26%) 4/60 − 5/60 PL- 6/6 1pc 3 (2.9%) 6 (5.8%) 5 (4.9%) 14 (13.7%) Category 2 NoPL (27%), PL/HM (26%) 2/60 − 3/60 PL- 6/6 1p 7 (6.8%) 11 (10.7%) 3 (2.9%) 23 (22.5%) Category 2 NoPL (27%), PL/HM (26%) 2/60 − 3/60 NoPL – 6/6 2 12 (11.7%) 17 (16.7%) 3 (2.9%) 32 (31.4%) Category 2 NoPL (27%), PL/HM (26%) CFCF-CF1ft NoPL – 6/6 3 6 (5.8%) 5 (4.9%) 1 (0.9%) 12 (11.8%) Category 1 NoPL (74%) HM NoPL – 6/18 OTS Ocular Trauma Score, VA Visual Acuity, NoPL No Perception of Light, PL Perception of Light, HM Hand Movement (close to face), CFCF Counting Fingers Close to Face, CF1ft Counting Fingers at 1 feet The likelihood of visual acuities for each zone along with the pre- and postoperative visual acuities are shown in Table 4 . Cases were classified according to their raw scores and grouped based on their final visual acuity into each vision category, as given by BETTS. This gave a likelihood scale based on our findings. All zone 1 injury cumulatively had a mean pre-operative and post-operative logMAR visual acuities of 2.59 ± 1.16 and 1.31 ± 1.51 respectively ( p < 0.001) When further classified, pre- and postoperative visual acuities (in logMAR units) with corresponding p- values were as follows: for zone 1c, 2.81 ± 0.98 and 1.16 ± 1.4 ( p < 0.001); for zone 1pc, 2.18 ± 1.31and 1.33 ± 1.74 ( p = 0.018) and for zone 1p, 2.64 ± 1.21 and 1.44 ± 1.52 ( p < 0.001) respectively. For zone 2, mean pre- and postoperative visual acuities were 3.08 ± 0.88 and 2.18 ± 1.54 logMAR units, respectively ( p < 0.001). The mean pre- and postoperative visual acuities for zone 3 were, 3.19 ± 0.96 and 2.77 ± 1.43 logMAR units, respectively ( p = 0.1832). The effect size when comparing the initial and final visual outcome was the greatest for zone 1c (1.44), followed by zone 1p, zone 2, zone 1pc and zone 3. Table 4 Likelihood of vision according to zones of injury Zone G = Grade of visual acuity at presentation (n, %) Mean pre-op VA (logMAR) Mean post op VA (logMAR) Snellen equivalent of mean pre-op VA Snellen equivalent of mean post-op VA P value Effect size G5 No PL n (%) G4 PL-CF2ft n (%) G3 1/60 − 6/36 n (%) G2 6/24 − 6/15 n (%) G1 6/12 − 6/9 n (%) Total (N = 102) n (%) 1 5, 4.9% 40, 39.2% 5, 4.9% 7, 6.9% 1, 0.9% 58, 56.9% 2.59 ± 1.16 1.31 ± 1.51 CFCF - HM 4/60– 3/60 < 0.001 1.04 1c 3, 2.9% 15, 14.7% 2, 1.9% 1, 0.9% 0 21, 20.6% 2.81 ± 0.98 1.16 ± 1.4 HM-PL 5/60 − 4/60 < 0.001 1.44 1pc 1, 0.9% 8, 7.8% 2, 1.9% 3, 2.9% 0 14, 13.7% 2.18 ± 1.31 1.33 ± 1.74 CF1ft-CFCF 3/60 − 2/60 0.018 0.72 1p 1, 0.9% 17, 16.7% 1, 0.9% 3, 2.9% 1, 0.9% 23, 22.5% 2.64 ± 1.21 1.44 ± 1.52 CFCF-HM 3/60 − 2/60 < 0.001 0.94 2 3, 2.9% 27, 26.5% 0 1, 0.9% 1, 0.9% 32, 31.4% 3.08 ± 0.88 2.18 ± 1.54 HM- PL CF1ft-CFCF < 0.001 0.78 3 2, 1.9% 9, 8.8% 0 1, 0.9% 0 12, 11.8% 3.19 ± 0.96 2.77 ± 1.43 HM-PL HM 0.1832 0.41 Table 5 summarises the analysis of salient parameters of the study and describes the number of cases with no perception of light at presentation, the mean final visual acuity, presence of traumatic cataract, posterior segment involvement and IOFB for each zone. There was no statistical difference for an eye becoming no perception of light at final visit among the groups ( p = 0.22 for zone 1,2, &3; and 0.21 for subzones of zone 1). Table 5 Summary of significant parameters according to zone of injury Zone ( N = total number in each zone) Final visual acuity ≥ 6/12 (n, %) Traumatic cataract (n, %) Posterior segment involvement (n, %) IOFB (n, %) No PL at final visit (n, %) 1 (N = 58) 15 (25.8%) 30 (51.7%) 22 (37.9%) 3 (5.2%) 6 (10.3%) 1c (N = 21) 2 (9.5%) 10 (47.6%) 5 (23.8%) 0 1 (4.7%) 1pc (N = 14) 8 (57.14%) 6 (42.8%) 6 (42.8%) 1 (7.1%) 3 (21.4%) 1p (N = 23) 5 (21.73%) 14 (60.8%) 11 (47.8%) 2 (8.7%) 2 (8.69%) 2 (N = 32) 0 11 (34.3%) 21 (65.6%) 2 (1.9%) 7 (21.8%) 3 (N = 12) 1 (8.3%) 1 (8.3%) 10 (83.3%) 1 (0.9%) 3 (25%) Discussion The BETTS classification, proposed for both open and closed globe injuries, included type, zone, and grade of injury with presence or absence of RAPD. It defined zone 1 in open globes as injury involving any part of the cornea and limbus. [ 3 ] However, considering the whole cornea as one zone may not yield accurate prediction of final visual outcomes. In the present study with the proposed new system, where only OGIs were considered; Zone 1, has been sub-classified into ‘central’, ‘paracentral’ and ‘peripheral’. Definitions of zone 2 and 3 remain the same as given by BETTS. The presence of traumatic cataract, posterior segment status (as seen on presentation or on the first postoperative day, clinically or on USG B-scan) and presence of intraocular foreign body (IOFB) were included. Hence, a complete classification could be stated for each OGI only after the first postoperative day if the posterior segment was not visible at presentation. The zone of injury may also change based on intraoperative observation, as was seen with the BETTS classification too. [ 3 ] In a study on wound size and location for penetrating injuries by Gao et al., the central 3 mm diameter area of cornea was considered as zone I, the posterior 1.5 mm next to it was zone II and the border of zone II to 6 mm posterior of the corneoscleral limbus was zone III. A final visual acuity of more than 0.1 Snellen acuity units (< 1 logMAR units) was classified as a ‘success’ and highest rates of success were noted for wound locations involving the central 3mm of cornea. [ 5 ] In the present study, the comparison between initial and final BCVA was significant not only for zone 1 as a whole, but also for the individual sub-zones which emphasizes the fact that the outcome of separate corneal zones may be different. The effect size comparing the same was the maximum for zone 1c (any corneal injury crossing the pupillary axis).The International Globe and Adnexal Trauma Epidemiology Study (IGATES) group [ 6 ] has also proposed a new classification system for all eye injuries in which, zones have been classified as zone 1a (centre 4mm), 1b (between a and c) and 1c (outer 3mm including limbus);zone 2; and zone 3a and 3b. In our study, the need for classifying zone 1c as any injury crossing the pupillary axis was seen as more important since it will have a much greater bearing on the final outcome. We did not sub classify zone 3, where posterior segment intervention was invariably needed in almost all cases. In a 2-round Delphi survey, Hoskin et al. [ 6 ] concluded that there was a consensus among a panel of 69 ophthalmologists specialising in ocular trauma, for the need for inclusion of lens trauma or posterior segment involvement. However, consensus for the method of classifying the presence of lens injury or involvement of individual posterior segment structures was not reached, which has been addressed in the present study. Furthermore, both BETTS and IGATES have acknowledged only the presence of “severity indicators”, namely- severe adnexal trauma, lens injury, endophthalmitis, retinal detachment (‘RD’) and RAPD. In the present study, we have included the scope of describing the posterior segment involvement beyond RD and endophthalmitis, represented by a single number unique to that case. We did not include adnexal injuries in the classification system since they hardly have any bearing on the final visual outcome. The status of posterior segment structures in trauma has important implications in the visual outcome. In cases of non-assessment of the posterior segment clinically during initial examination or intra-operatively, post-operative ultrasonography (USG) B-scan may provide useful information, therefore we have included this as a part of our classification. In the study, fundus could be seen in thirty-six cases at presentation and in twenty more cases on post-operative day one. The abnormal findings included vitreous haemorrhage (VH), total or sectoral retinal detachment (RD), and IOFB with RD or VH. USG B-scan was done on post-operative day 1 for eighty-seven cases. Abnormal findings included vitreous echoes (haemorrhage, dislocated lens matter, exudates of endophthalmitis, IOFB), choroidal or retinal detachment or involvement of more than one structure. Choroidal involvement was most common (26, 25.49%). Three cases with posterior scleral dehiscence and one case of endophthalmitis were noted. Posterior segment involvement was seen in 22 (37.9%) cases of zone 1, 21 (65.6%) cases of zone 2 and 10 (83.3%) cases of zone 3. In zone 1, minimum involvement was seen for zone 1c (5, 23.8%) and maximum for 1p (11, 47.8%). Brinton et al. noted that zone 3 was most associated with RD. [ 7 ] Xia et al. noted that early and late retinal detachments (RD) were seen mostly in zone 2 or zone 3 injuries. [ 8 ] Most eyes developing delayed RD had vitreous hemorrhage on presentation. [ 8 ] In this study too, zone 2 and 3 were most affected, but it should be noted that the corneal zone 1p too had a significant number of cases with posterior segment involvement. The survey conducted by the IGATES group reached a consensus on inclusion of retinal involvement only, as a part of an updated classification. [ 6 ] The presence of traumatic cataract affects the initial visual acuity. This may improve drastically if primary globe repair is combined with cataract extraction. In our study, lens aspiration was a part of both primary repair and second surgery for lens trauma. IOL implantation, if needed, was only done as a secondary procedure. In a study conducted in central and western India, management of traumatic cataracts in cases of open globe injuries yielded better final visual outcomes than in closed globe injuries. [ 9 ] Significant correlation between the timing of cataract extraction and the final visual acuity has not been noted in these cases. [ 10 ] None of the cases in our study underwent IOL implantation during primary globe repair. Intraocular foreign body (IOFB) injuries account for 18–41% of all open globe injuries. [ 11 ] In the present study IOFB was seen on the retina during examination at presentation in one case and on post-operative USG B scan in the remaining five cases. IOFB may be removed during the primary surgery or during a second surgery, after repair of open globe. [ 11 , 12 ] USG B-scan may have a greater chance of detecting glass or metal IOFB and posterior segment IOFBs as compared to clinical examination alone. [ 12 ] Assessment of RAPD has not been reported to be always accurate in the setting of trauma with varied inter-observer differences. [ 13 , 14 ] Bruegger et al. showed that RAPDs could be identified in only 40% of cases. [ 13 ] A study also showed that non-experts only found 12% of patients with RAPD as compared to a higher number detected by well-trained experts. [ 14 ] Since RAPD is both difficult to assess and is unreliable in cases of OGIs, the present study did not include RAPD as a part of classification system. The OTS or Ocular Trauma Score was given by Kuhn et al [ 4 ] to prognosticate and give a realistic expectation to patient and their kin regarding the final visual outcome. Factors considered in their report were initial visual acuity, type of injury (rupture or perforating), presence of endophthalmitis, retinal detachment and afferent pupillary defect. The likelihood scale of final visual acuity in the present study, calculated using the same method, revealed some differences with the likelihood scale formed by Kuhn and colleagues. Most zone 1 and zone 2 injuries obtained an OTS score of 45–65 (OTS Category 2) and zone 3 injuries had mostly a score of 0–44 (Category 1). However, the actual final outcome and the range of vision was much better than predicted. Limitations of the OTS were noted as a 1-in-5 chance of a wrong prediction of final visual acuity and non-inclusion of factors from results of ancillary tests like USG B scan or radiography, which are useful in the absence of view of the posterior segment. [ 15 ] The current study hence uses post-operative day 1 USG B-scan as an aid in the classification system. The zone in which the maximum number of cases achieved a final visual acuity of more than 20/40 (6/12) was zone 1 pc (57.14%). Traumatic cataract was encountered most commonly in zone 1p (60.8%). Posterior segment involvement was seen most commonly with zone 1 p of all corneal sub-zones and a final visual acuity of no perception of light was seen the least in case of zone 1c injuries. The change in final visual acuity with respect to the initial is significant not only for zone 1 as a whole but also the sub-zones, individually, with different effect sizes. Conclusion The study focuses on the need for a new holistic classification for OGIs which can provide a better overview of the prognosis. The modifications include defined sub-classifications of zones of injury, exclusion of RAPD, inclusion of lens trauma and IOFB and elaboration of posterior segment involvement. The classification system suggested in this study, provides more comprehensive and crucial information on open globe injury and offers an overall better idea about the visual prognosis of the case. Declarations Competing Interests statement : No competing financial interests Conflicts of interest: No competing financial interests Funding: None Author contribution statement : MS conceived the idea, designed the methodology of study, review protocol and conducted the final review of all data analysis and manuscript details. BM was responsible for drafting the manuscript, data extraction, recording and analysing the data, and writing the report. References Négrel AD, Thylefors B. The global impact of eye injuries. Ophthalmic Epidemiol. 1998;5(3):143–69. Kuhn F, Morris R, Witherspoon CD, Heimann K, Jeffers JB, Treister G. A standardized classification of ocular trauma. Ophthalmology. 1996;103(2):240–3. Pieramici DJ, Sternberg P Jr, Aaberg TM Sr, Bridges WZ Jr, Capone A Jr, Cardillo JA, et al . A system for classifying mechanical injuries of the eye (globe). The Ocular Trauma Classification Group. Am J Ophthalmol. 1997;123(6):820–31 Kuhn F, Maisiak R, Mann L, Mester V, Morris R, Witherspoon CD. The Ocular Trauma Score (OTS). Ophthalmol Clin North Am. 2002;15(2):163–5. Gao X, Zhang Q, Wang F, Li X, Ma C, Li Y, et al . Wound size and location affect the prognosis of penetrating ocular injury. BMC Ophthalmol. 2023;23(1):257. Hoskin AK, Fliotsos MJ, Rousselot A, Ng SMS, Justin GA, Blanch R, et al. ; International Globe and Adnexal Trauma Epidemiology Study (IGATES) Ophthalmic Trauma Terminology Consensus Group. Globe and Adnexal Trauma Terminology Survey. JAMA Ophthalmol. 2022;140(8):819–826. Brinton GS, Aaberg TM, Reeser FH, Topping TM, Abrams GW. Surgical results in ocular trauma involving the posterior segment. Am J Ophthalmol. 1982;93(3):271–8. Xia T, Bauza A, Soni NG, Zarbin MA, Langer PD, Bhagat N. Surgical Management and Outcome of Open Globe Injuries with Posterior Segment Complications: A 10-Year Review. Semin Ophthalmol. 2018;33(3):351–356. Shah MA, Shah SM, Shah SB, Patel CG, Patel UA, Appleware A, et al . Comparative study of final visual outcome between open- and closed-globe injuries following surgical treatment of traumatic cataract. Graefes Arch Clin Exp Ophthalmol. 2011;249(12):1775–81. Rodricks D, Loya A, Mohamed M, Al-Mohtaseb Z. Visual outcomes of open globe injury patients with traumatic cataracts. Int Ophthalmol. 2022;42(7):2039–2046. Williams DF, Mieler WF, Abrams GW, Lewis H. Results and prognostic factors in penetrating ocular injuries with retained intraocular foreign bodies. Ophthalmology. 1988 Patel SN, Langer PD, Zarbin MA, Bhagat N. Diagnostic value of clinical examination and radiographic imaging in identification of intraocular foreign bodies in open globe injury. Eur J Ophthalmol. 2012 Mar-Apr;22(2):259–68. Bruegger D, Grabe HM, Vicini R, Dysli M, Lussi D, Abegg M. Detection of Relative Afferent Pupillary Defects Using Eye Tracking and a VR Headset. Transl Vis Sci Technol. 2023;12(6):22. Hennessy AL, Katz J, Ramakrishnan R, Krishnadas R, Thulasiraj RD, Tielsch JM, et al . The utility of relative afferent pupillary defect as a screening tool for glaucoma: prospective examination of a large population-based study in a south Indian population. Br J Ophthalmol. 2011;95(9):1203–1206 Scott R. The Ocular Trauma Score. Community Eye Health. 2015;28(91):44–5 Additional Declarations There is no conflict of interest Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7275066","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":506728987,"identity":"6fa69433-a841-4c25-be4e-756ea27ecc5b","order_by":0,"name":"Md. Alam","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA50lEQVRIiWNgGAWjYFACHgZmBgNmBj4GBsYHIC4f0VrYGBiYDUBcNuK0MIC1sEmA+AS16PafPfi5oMBano39dFrl1xw7GTYG5oePbuDRYnYjL1l6hkG6YRtP7rbbstuSgQ5jMzbOwauFx0Cax+AwYxsDUIvkNmagFh42abxazp8x/g3UYt/G/3ZbseS2eiK0HMgxA9mS2CaRu43x47bDRGi5kWNmzWOQntwm8XazNOO24zxszIT8AnTYbZ4/1rb9/LkbP/7cVm3Pz9788DE+LSiAmQdMEqscBBh/kKJ6FIyCUTAKRgwAAIhaQNuQGM/zAAAAAElFTkSuQmCC","orcid":"https://orcid.org/0000-0001-7849-2808","institution":"Aditya Birla Sankara Nethralaya","correspondingAuthor":true,"prefix":"","firstName":"Md.","middleName":"","lastName":"Alam","suffix":""},{"id":506728988,"identity":"e98d257a-1f80-417e-aa4e-129af6aed495","order_by":1,"name":"Bristi Majumdar","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Bristi","middleName":"","lastName":"Majumdar","suffix":""}],"badges":[],"createdAt":"2025-08-02 02:55:11","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7275066/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7275066/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":90801011,"identity":"1922295d-62a1-4c48-9d58-d2ab4dbefa9e","added_by":"auto","created_at":"2025-09-08 10:13:04","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":557396,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eA-\u003c/strong\u003e \u003cstrong\u003eProposed modified system of classification of zones\u003c/strong\u003e: Zone 1 (limited to cornea) includes 1c (central), 1 pc (paracentral) and1p (peripheral). Zone 2 includes injuries from limbus to 5mm of sclera and zone 3 includes injuries beyond 5mm of sclera.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eB,C- 2L0P0FB0: \u003c/strong\u003eZone 2 injury without lens trauma (B) or involvement of posterior segment or an IOFB and as confirmed on post-operative USB B-scan (C)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eD,E\u003c/strong\u003e- \u003cstrong\u003e1cL1PcFB0: \u003c/strong\u003eZone 1c injury with traumatic cataract (D) and hemorrhagic choroidals \u0026nbsp;and without any IOFB as seen on post-operative day 1 USG B-scan, (E)\u003c/p\u003e","description":"","filename":"Figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-7275066/v1/99f72dcb691ff1e59e7795a8.png"},{"id":93040904,"identity":"2feb0eb7-baa7-48f6-b19f-72bebcf8b21e","added_by":"auto","created_at":"2025-10-08 12:12:09","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1741690,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7275066/v1/6c81bf2f-d6b2-409e-83fe-3efc358b2f63.pdf"}],"financialInterests":"There is no conflict of interest","formattedTitle":"To propose a new classification system for open globe injuries (OGIs) and analyse its management outcomes","fulltext":[{"header":"Summary box","content":"\u003cp\u003eWhat was already known:\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eBETTS provided a standard system of classification for mechanical eye injuries, which did not include status of lens, posterior segment and presence of IOFB.\u003c/li\u003e\n \u003cli\u003eZone 1 in open globe injuries included the cornea as a whole\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eWhat this study adds:\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eEach injury can be represented by a single unique number which gives holistic idea to the anatomical status and outcome of the injury.\u003c/li\u003e\n \u003cli\u003eZone 1 has been subdivided into central, paracentral and peripheral subzones, whose visual outcomes can be individually significant.\u003c/li\u003e\n \u003cli\u003eAddition of status of lens, individual posterior segment structures (including USG B scan features on post-operative day one) provide imperative details to the classification.\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"Introduction","content":"\u003cp\u003eOcular trauma is linked to exposure to hazardous situations. The lack of awareness and knowledge about its specific management has led to it being one of the major causes of blindness worldwide.\u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003eIn 1996, Kuhn et al brought forth a classification system for mechanical eye injuries, aiming to promote a uniform terminology. Open globe injuries (OGIs) were described as a full thickness injury to the eyeball, damaging the cornea, sclera or both.\u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e The Ocular Trauma Classification Group standardised this system, taking into account anatomical and physiological variables as seen on initial assessment or during primary surgery, which came to be known as the Birmingham Eye Trauma Terminology System (or BETTS).\u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eAlthough the BETTS classification and the Ocular Trauma Score (OTS), proposed by Kuhn et al., stand as time-tested systems for classifying and prognosticating mechanical ocular injuries respectively, certain fallacies have been noted.\u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e The BETTS includes type of injury (rupture/ penetrating/intraocular foreign body/ perforating/ mixed), grade of injury (based on presenting visual acuity), pupil status (presence or absence of relative afferent pupillary defect), and zones of injury.\u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e Various important factors related to globe injury, that is, status of lens and posterior segment injuries were however ignored. Injuries involving different segments of cornea in pure corneal injuries (zone 1) can also have variable visual outcomes. An injury involving the visual axis may have a different final visual outcome as compared to a pure peripheral corneal injury. Hence, considering whole of the cornea as zone 1 may not be correct. Assessing RAPD (relative afferent pupillary defect) in a case of open globe injury is not only difficult, but unreliable too.\u003c/p\u003e\u003cp\u003eThus, there was a need for a more holistic classification system for open globe injuries which would provide a complete picture about the ocular structures affected by trauma. The present study aims to provide such a system which can not only give a better idea about the anatomical status of the injury, but would also be more robust in predicting the final prognosis as far as vision is concerned.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003eThis was a retrospective observational study of 102 open globe injuries in 102 patients presenting at a tertiary eye care centre. Data and values of all the patients presenting to the emergency department over a 5-year period were derived from the electronic medical records of the hospital. Written informed consent was obtained from all patients and their kin. Exclusion criteria included less than 3 months of follow up and surgery done elsewhere. All cases were operated within 24 hours of presentation, following the same standard pre-operative, intra-operative and post-operative management protocol. Close observation and monitoring of the records were maintained at all follow-up visits. Institutional review board approval was obtained and the study adhered to the tenets of the Declaration of Helsinki.\u003c/p\u003e\u003cp\u003ewas used for statistical calculations. Injuries were classified according to the following proposed module:\u003c/p\u003e\u003cp\u003e\u003col\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eZone of injury\u003c/b\u003e:\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003c/ol\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eZone 1\u003c/b\u003e: Limited to cornea: Zone 1 was further subdivided in to following sub zones\u003c/p\u003e\u003cp\u003e\u003cb\u003e1 c\u003c/b\u003e: Central corneal: Any injury crossing the pupillary axis\u003c/p\u003e\u003cp\u003e\u003cb\u003e1 pc\u003c/b\u003e: Paracentral corneal: Any injury not crossing the pupillary axis but lying in an area within 4mm from the centre of the cornea\u003c/p\u003e\u003cp\u003e\u003cb\u003e1 p\u003c/b\u003e: Peripheral corneal: Any injury not crossing the pupillary axis and lying beyond 4mm from centre of cornea and till limbus.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eZone 2\u003c/strong\u003e\u003cp\u003eFrom limbus to 5mm of sclera\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eZone 3\u003c/strong\u003e\u003cp\u003eBeyond 5mm of sclera\u003c/p\u003e\u003c/p\u003e\u003cp\u003eThe proposed zones of classification of injuries have been represented in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e(A).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e2. Traumatic cataract (L)\u003c/b\u003e:\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eL 0\u003c/strong\u003e\u003cp\u003eAbsence of traumatic cataract at presentation\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eL 1\u003c/strong\u003e\u003cp\u003ePresence of traumatic cataract at presentation\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e3. Posterior segment involvement (P)\u003c/b\u003e:\u003c/p\u003e\u003cp\u003ePosterior segment involvement was assessed based on fundus findings at presentation (if possible) and fundus findings or ultrasonography findings done on the first post operative day.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eP 0\u003c/strong\u003e\u003cp\u003ePosterior segment not involved\u003c/p\u003e\u003c/p\u003e\u003cp\u003eIf posterior segment was involved, it was further divided according to the structure(s) involved as:\u003c/p\u003e\u003cp\u003e\u003cb\u003ePv, Pr, Pc, Ps and Pe-\u003c/b\u003e for involvement of the vitreous, retina, choroid, posterior scleral dehiscence and endophthalmitis, respectively.\u003c/p\u003e\u003cp\u003eIf more than one posterior segment structures were involved, the corresponding letters representing the structure or pathology was added in the subscript. E.g., \u003cb\u003ePrc\u003c/b\u003e if both retina and choroid were involved.\u003c/p\u003e\u003cp\u003e\u003cb\u003e4. Intraocular foreign body (FB)\u003c/b\u003e:\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eFB 0\u003c/strong\u003e\u003cp\u003eAbsence of intraocular foreign body\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eFB 1\u003c/strong\u003e\u003cp\u003ePresence of intraocular foreign body\u003c/p\u003e\u003c/p\u003e\u003cp\u003eTherefore, in the proposed classification system, cases of open globe injuries were recorded as follows:\u003c/p\u003e\u003cp\u003eZone: 1c/ 1pc/ 1p/ 2/ 3\u003c/p\u003e\u003cp\u003ePresence of Traumatic cataract: L0/ L1\u003c/p\u003e\u003cp\u003ePosterior segment involvement: P0/ Pv/r/c/s/e\u003c/p\u003e\u003cp\u003eFor example, an open globe injury involving zone 2 without lens trauma (L0) or involvement of posterior segment (P0) or an IOFB (FB0) and as confirmed on post-operative USB B-scan would be classified as 2L0P0FB0 (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eB \u0026amp; C). Similarly, a zone 1c injury with traumatic cataract (L1) and hemorrhagic choroidals (Pc), without any IOFB (FB0) as seen on USG B-scan would be classified as 1cL1PcFB0 (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eD \u0026amp; E). Hence each case of OGI was assigned a unique classification number.\u003c/p\u003e\u003cp\u003eData were recorded in MS Excel spreadsheet program and were presented in a graphical manner wherever appropriate. Student\u0026rsquo;s T- test and Chi-square test were used for statistical analysis. Statistical Package for the Social Sciences (SPSS) version 22 was used for analysis. Written informed consents for publication from the patient have been obtained. All procedures carried out were in accordance with the tenets of the Declaration of Helsinki. I Institutional review board approval was obtained.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e102 eyes of 102 patients with open globe injuries were included in the study. Demographic details have been summarised in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The mean presenting age was 24.06\u0026thinsp;\u0026plusmn;\u0026thinsp;33.7 (SD) years. There were 84 males (82.4%) and 18 females (17.6%). All the cases presented with uniocular open globe injury with left (53, 52%) and right (49,48%) eyes almost equally involved. The mean duration between time of injury and time of presentation was 54.9\u0026thinsp;\u0026plusmn;\u0026thinsp;118.2 hours. The mean best corrected visual acuity (BCVA) in log-MAR at presentation and at final follow up were 2.81\u0026thinsp;\u0026plusmn;\u0026thinsp;1.0and1.75\u0026thinsp;\u0026plusmn;\u0026thinsp;1.59 (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) respectively. Corneal tear was the most common presenting injury (60, 58.8%). Traumatic cataract was present in 42 (41.2%) cases. The statistical likelihood of developing traumatic cataract was significant (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.01) when compared between zones 1, 2, \u0026amp; 3; however, it was not significant between the subzones of zone 1.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDemographic details and visual outcomes of study population\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo. of subjects\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003e102\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003e24.06\u0026thinsp;\u0026plusmn;\u0026thinsp;33.7 years (Median: 22, Range: 2\u0026ndash;74)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eGender\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e84 (82.4%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e18 (17.6%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eEye\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRight\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e49 (48%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLeft\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e53 (52%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDuration between time of injury and presentation (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003e54.9\u0026thinsp;\u0026plusmn;\u0026thinsp;118.2 hours (Median: 24, Range: 1-240)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMean VA at presentation (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.81\u0026thinsp;\u0026plusmn;\u0026thinsp;1.08 logMAR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c4\" namest=\"c3\" rowspan=\"2\"\u003e\u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMean final VA (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.75\u0026thinsp;\u0026plusmn;\u0026thinsp;1.59 logMAR\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eType of injury at presentation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCorneal tear\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e60 (58.8%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eScleral tear\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e20 (19.6%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCorneoscleral tear\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e22 (21.6%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003eAssociated features\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePosterior segment involvement\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e53 (51.9%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTraumatic cataract\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e42 (41.2%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAdnexal injuries\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e12 (11.8%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIntraocular foreign body\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e6 (5.9%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eNature of offending agent\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOrganic\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e27 (26.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eInorganic metallic\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e30 (29.4%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eInorganic non-metallic\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e45 (44.1%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003ePatients undergoing single surgery (51. 50.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMean pre-op VA (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.72\u0026thinsp;\u0026plusmn;\u0026thinsp;1.18 logMAR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMean post-op VA (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.02\u0026thinsp;\u0026plusmn;\u0026thinsp;1.74 logMAR\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003ePatients undergoing more than one surgery (51, 50.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMean pre-op VA (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.91\u0026thinsp;\u0026plusmn;\u0026thinsp;0.94 logMAR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMean post-op VA (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.53\u0026thinsp;\u0026plusmn;\u0026thinsp;1.37 logMAR\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFollow up period (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003e12.38\u0026thinsp;\u0026plusmn;\u0026thinsp;10.43 months (Median: 10, Range: 3\u0026ndash;49)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e\u003cp\u003e\u003cem\u003elogMAR logarithm of the minimum angle of resolution, SD Standard deviation.\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eIntraocular foreign body (IOFB) was found in 6 (5.9%) cases. Twelve (11.8%) patients presented with adnexal injuries with lid tear (9, 75%) being the most common presentation. Fifty-one patients (50.0%) needed only single surgery whose mean pre-operative and post-operative logMAR BCVA were 2.72\u0026thinsp;\u0026plusmn;\u0026thinsp;1.18 and 2.02\u0026thinsp;\u0026plusmn;\u0026thinsp;1.74 respectively (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Remaining fifty-one (50.0%) patients underwent more than one surgery, whose mean pre-operative and post-operative logMAR BCVA were 2.91\u0026thinsp;\u0026plusmn;\u0026thinsp;0.94 and 1.53\u0026thinsp;\u0026plusmn;\u0026thinsp;1.37 respectively (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The mean follow-up period was12.38\u0026thinsp;\u0026plusmn;\u0026thinsp;10.43 months.\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e shows the distribution of cases classified according to the proposed system, divided according to the new modified zone of injury. The most frequently occurring groups (8 each) were 1cL0P0FB0 (7.8%), 1cL1P0FB0 (7.8%) and 1pL1P0FB0 (7.8%). The most commonly involved zone was zone 2 and seen in32 (31.4%) cases. Posterior segment involvement was seen in 53(51.9%) cases where choroidal involvement was most common (26, 25.49%), followed by retina (21, 20.59%), vitreous (15, 14.7%), posterior scleral dehiscence (3, 2.9%) and endophthalmitis (1, 0.9%). Zone 3 had statistically highest likelihood of posterior segment involvement than zone 2 and zone 1 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). There was no statistical difference regarding the posterior segment involvement within the subzones of zone 1.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eProposed new system of classification and number of patients representing each unique number\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003e1. Zone of Injury (Zone):\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e\u003cp\u003e3. Posterior Segment (P):\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003eZone 1: Limited to cornea:\u003c/p\u003e\u003cp\u003e- 1 c: Central\u003c/p\u003e\u003cp\u003e- 1 pc: Paracentral\u003c/p\u003e\u003cp\u003e- 1 p: Peripheral\u003c/p\u003e\u003cp\u003eZone 2: From limbus to 5mm of sclera\u003c/p\u003e\u003cp\u003eZone 3: Beyond 5mm of sclera\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e\u003cp\u003eP0 - Posterior segment not involved\u003c/p\u003e\u003cp\u003ePv \u0026ndash; Vitreous involvement\u003c/p\u003e\u003cp\u003ePr \u0026ndash; Retinal involvement\u003c/p\u003e\u003cp\u003ePc \u0026ndash; Choroidal involvement\u003c/p\u003e\u003cp\u003ePs - Posterior scleral dehiscence\u003c/p\u003e\u003cp\u003ePe - Endophthalmitis\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003e2. Presence of Traumatic Cataract (L)\u003c/b\u003e:\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e\u003cp\u003e\u003cb\u003e4. Intraocular Foreign Body (FB)\u003c/b\u003e:\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003eL0 - Absence of traumatic cataract at presentation\u003c/p\u003e\u003cp\u003eL1 - Presence of traumatic cataract at presentation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e\u003cp\u003eFB0 - Absence of intraocular foreign body\u003c/p\u003e\u003cp\u003eFB1 - Presence of intraocular foreign body\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNumber (n, %) of cases assigned according to unique number divided according to proposed zones\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1c\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1pc\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e1p\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1cL0P0FB0 (8, 7.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1pcL0P0FB0 (5, 4.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e1pL0P0FB0 (4, 3.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2L0P0FB0 (7, 6.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3L0P0FB0 (1, 0.9%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1cL0PvFB0 (1, 0.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1pcL0PcFB0 (1, 0.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e1pL0PrFB0 (2, 1.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2L0PvFB0 (2, 1.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3L0PvFB0 (3, 2.9%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1cL0PcFB0 (2, 1.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1pcL1P0FB0 (2, 1.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e1pL0PrFB1 (1, 0.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2L0PvFB1 (1, 0.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3L0PrFB0 (2, 1.8%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1cL1P0FB0 (8, 7.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1pcL1P0FB1 (1, 0.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e1pL0PcFB0 (2, 1.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2L0PrFB0 (6, 5.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3L0PrFB1 (1, 0.9%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1cL1PvFB0 (1, 0.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1pcL1PvFB0 (2, 1.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e1pL1P0FB0 (8, 7.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2L0PcFB0 (3, 2.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3L0PsFB0 (3, 2.9%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1cL1PcFB0 (1, 0.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1pcL1PrFB0 (1, 0.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e1pL1PvFB0 (1, 0.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2L0PcFB1 (1, 0.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3L1P0FB0 (1, 0.9%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1pcL0PrFB0 (2, 1.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e1pL1PrFB0 (2, 1.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2L0PeFB0 (1, 0.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e1pL1PrFB1 (1, 0.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2L1P0FB0 (4, 3.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e1pL1PcFB0 (2, 1.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2L1PvFB0 (4, 3.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2L1PrFB0 (2, 1.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2L1PcFB0 (1, 0.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eOcular Trauma Score (OTS) likelihood scale, as proposed by Kuhn et al.,\u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e was calculated for all cases and tabulated according to the proposed zones (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). The highest OTS score was 77, seen in 2 cases (1.9%) and lowest score was 20, seen in 1 case (0.9%). The visual outcome predicted by OTS was tabulated alongside the mean final outcome and the range of vision for each group.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eOTS likelihood of vision classified according to zones of injury\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"8\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eZone\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eScore 0\u0026ndash;44\u003c/p\u003e\u003cp\u003eCategory 1\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eScore 45\u0026ndash;65\u003c/p\u003e\u003cp\u003eCategory 2\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eScore 66\u0026ndash;80\u003c/p\u003e\u003cp\u003eCategory 3\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eTotal (N\u0026thinsp;=\u0026thinsp;102)\u003c/p\u003e\u003cp\u003en (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eMost likely chances of final visual outcome at 6 months according to OTS (based on category containing maximum cases)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eSnellen equivalent of mean VA at final visit\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eSnell equivalent of range of final vision\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e14 (13.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e32 (31.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e11 (10.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e58 (56.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eCategory 2\u003c/p\u003e\u003cp\u003eNoPL (27%), PL/HM (26%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e3/60\u0026ndash; 4/60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eNoPL \u0026ndash; 6/6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1c\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4 (3.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14 (13.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3 (2.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e21 (20.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eCategory 2\u003c/p\u003e\u003cp\u003eNoPL (27%), PL/HM (26%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e4/60\u0026thinsp;\u0026minus;\u0026thinsp;5/60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003ePL- 6/6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1pc\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3 (2.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6 (5.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5 (4.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e14 (13.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eCategory 2\u003c/p\u003e\u003cp\u003eNoPL (27%), PL/HM (26%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e2/60\u0026thinsp;\u0026minus;\u0026thinsp;3/60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003ePL- 6/6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1p\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7 (6.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11 (10.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3 (2.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e23 (22.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eCategory 2\u003c/p\u003e\u003cp\u003eNoPL (27%), PL/HM (26%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e2/60\u0026thinsp;\u0026minus;\u0026thinsp;3/60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eNoPL \u0026ndash; 6/6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12 (11.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e17 (16.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3 (2.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e32 (31.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eCategory 2\u003c/p\u003e\u003cp\u003eNoPL (27%), PL/HM (26%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eCFCF-CF1ft\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eNoPL \u0026ndash; 6/6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6 (5.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5 (4.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1 (0.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e12 (11.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eCategory 1\u003c/p\u003e\u003cp\u003eNoPL (74%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eHM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eNoPL \u0026ndash; 6/18\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e\u003cp\u003e\u003cem\u003eOTS\u003c/em\u003e Ocular Trauma Score, \u003cem\u003eVA\u003c/em\u003e Visual Acuity, \u003cem\u003eNoPL\u003c/em\u003e No Perception of Light, \u003cem\u003ePL\u003c/em\u003e Perception of Light, \u003cem\u003eHM\u003c/em\u003e Hand Movement (close to face), \u003cem\u003eCFCF\u003c/em\u003e Counting Fingers Close to Face, \u003cem\u003eCF1ft\u003c/em\u003e Counting Fingers at 1 feet\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe likelihood of visual acuities for each zone along with the pre- and postoperative visual acuities are shown in Table \u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e. Cases were classified according to their raw scores and grouped based on their final visual acuity into each vision category, as given by BETTS. This gave a likelihood scale based on our findings. All zone 1 injury cumulatively had a mean pre-operative and post-operative logMAR visual acuities of 2.59\u0026thinsp;\u0026plusmn;\u0026thinsp;1.16 and 1.31\u0026thinsp;\u0026plusmn;\u0026thinsp;1.51 respectively (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) When further classified, pre- and postoperative visual acuities (in logMAR units) with corresponding p- values were as follows: for zone 1c, 2.81\u0026thinsp;\u0026plusmn;\u0026thinsp;0.98 and 1.16\u0026thinsp;\u0026plusmn;\u0026thinsp;1.4 (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001); for zone 1pc, 2.18\u0026thinsp;\u0026plusmn;\u0026thinsp;1.31and 1.33\u0026thinsp;\u0026plusmn;\u0026thinsp;1.74 (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.018) and for zone 1p, 2.64\u0026thinsp;\u0026plusmn;\u0026thinsp;1.21 and 1.44\u0026thinsp;\u0026plusmn;\u0026thinsp;1.52 (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) respectively. For zone 2, mean pre- and postoperative visual acuities were 3.08\u0026thinsp;\u0026plusmn;\u0026thinsp;0.88 and 2.18\u0026thinsp;\u0026plusmn;\u0026thinsp;1.54 logMAR units, respectively (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The mean pre- and postoperative visual acuities for zone 3 were, 3.19\u0026thinsp;\u0026plusmn;\u0026thinsp;0.96 and 2.77\u0026thinsp;\u0026plusmn;\u0026thinsp;1.43 logMAR units, respectively (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.1832). The effect size when comparing the initial and final visual outcome was the greatest for zone 1c (1.44), followed by zone 1p, zone 2, zone 1pc and zone 3.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eLikelihood of vision according to zones of injury\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"14\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c13\" colnum=\"13\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c14\" colnum=\"14\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eZone\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"6\" nameend=\"c7\" namest=\"c2\"\u003e\u003cp\u003eG\u0026thinsp;=\u0026thinsp;Grade of visual acuity at presentation (n, %)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eMean pre-op VA (logMAR)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eMean post op VA (logMAR)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c10\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eSnellen equivalent of mean pre-op VA\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c11\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eSnellen equivalent of mean post-op VA\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c12\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c13\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eEffect size\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"1\" nameend=\"c14\" namest=\"c14\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eG5 No PL n (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eG4 PL-CF2ft n (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eG3 1/60\u0026thinsp;\u0026minus;\u0026thinsp;6/36 n (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eG2 6/24\u0026thinsp;\u0026minus;\u0026thinsp;6/15 n (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eG1 6/12\u0026thinsp;\u0026minus;\u0026thinsp;6/9 n (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eTotal (N\u0026thinsp;=\u0026thinsp;102)\u003c/p\u003e\u003cp\u003en (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"1\" nameend=\"c14\" namest=\"c14\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5, 4.9%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e40, 39.2%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5, 4.9%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e7, 6.9%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1, 0.9%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e58, 56.9%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e2.59\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;1.16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e1.31\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;1.51\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eCFCF - HM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e4/60\u0026ndash; 3/60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e1.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c14\" namest=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1c\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3, 2.9%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15, 14.7%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2, 1.9%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1, 0.9%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e21, 20.6%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e2.81\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;0.98\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e1.16\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;1.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eHM-PL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e5/60\u0026thinsp;\u0026minus;\u0026thinsp;4/60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e1.44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c14\" namest=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1pc\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1, 0.9%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8, 7.8%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2, 1.9%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3, 2.9%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e14, 13.7%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e2.18\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;1.31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e1.33\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;1.74\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eCF1ft-CFCF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e3/60\u0026thinsp;\u0026minus;\u0026thinsp;2/60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e0.018\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e0.72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c14\" namest=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1p\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1, 0.9%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e17, 16.7%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1, 0.9%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3, 2.9%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1, 0.9%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e23, 22.5%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e2.64\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;1.21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e1.44\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;1.52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eCFCF-HM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e3/60\u0026thinsp;\u0026minus;\u0026thinsp;2/60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e0.94\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c14\" namest=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3, 2.9%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e27, 26.5%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1, 0.9%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1, 0.9%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e32, 31.4%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e3.08\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;0.88\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e2.18\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;1.54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eHM- PL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eCF1ft-CFCF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e0.78\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c14\" namest=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2, 1.9%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9, 8.8%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1, 0.9%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e12, 11.8%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e3.19\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;0.96\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e2.77\u003c/p\u003e\u003cp\u003e\u0026plusmn;\u0026thinsp;1.43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eHM-PL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eHM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e0.1832\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e0.41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c14\" namest=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e summarises the analysis of salient parameters of the study and describes the number of cases with no perception of light at presentation, the mean final visual acuity, presence of traumatic cataract, posterior segment involvement and IOFB for each zone. There was no statistical difference for an eye becoming no perception of light at final visit among the groups (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.22 for zone 1,2, \u0026amp;3; and 0.21 for subzones of zone 1).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eSummary of significant parameters according to zone of injury\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eZone\u003c/p\u003e\u003cp\u003e(\u003cem\u003eN\u003c/em\u003e\u0026thinsp;=\u0026thinsp;total number in each zone)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFinal visual acuity\u0026thinsp;\u0026ge;\u0026thinsp;6/12\u003c/p\u003e\u003cp\u003e(n, %)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eTraumatic cataract\u003c/p\u003e\u003cp\u003e(n, %)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePosterior segment involvement (n, %)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eIOFB\u003c/p\u003e\u003cp\u003e(n, %)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eNo PL at final visit\u003c/p\u003e\u003cp\u003e(n, %)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1 \u003cem\u003e(N\u0026thinsp;=\u0026thinsp;58)\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e15 (25.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e30 (51.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e22 (37.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3 (5.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e6 (10.3%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1c \u003cem\u003e(N\u0026thinsp;=\u0026thinsp;21)\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2 (9.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10 (47.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5 (23.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1 (4.7%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1pc \u003cem\u003e(N\u0026thinsp;=\u0026thinsp;14)\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8 (57.14%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6 (42.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6 (42.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1 (7.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3 (21.4%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1p \u003cem\u003e(N\u0026thinsp;=\u0026thinsp;23)\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5 (21.73%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14 (60.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e11 (47.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2 (8.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2 (8.69%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2 \u003cem\u003e(N\u0026thinsp;=\u0026thinsp;32)\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11 (34.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e21 (65.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2 (1.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e7 (21.8%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3 \u003cem\u003e(N\u0026thinsp;=\u0026thinsp;12)\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (8.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (8.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10 (83.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1 (0.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3 (25%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe BETTS classification, proposed for both open and closed globe injuries, included type, zone, and grade of injury with presence or absence of RAPD. It defined zone 1 in open globes as injury involving any part of the cornea and limbus.\u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e However, considering the whole cornea as one zone may not yield accurate prediction of final visual outcomes. In the present study with the proposed new system, where only OGIs were considered; Zone 1, has been sub-classified into \u0026lsquo;central\u0026rsquo;, \u0026lsquo;paracentral\u0026rsquo; and \u0026lsquo;peripheral\u0026rsquo;. Definitions of zone 2 and 3 remain the same as given by BETTS. The presence of traumatic cataract, posterior segment status (as seen on presentation or on the first postoperative day, clinically or on USG B-scan) and presence of intraocular foreign body (IOFB) were included. Hence, a complete classification could be stated for each OGI only after the first postoperative day if the posterior segment was not visible at presentation. The zone of injury may also change based on intraoperative observation, as was seen with the BETTS classification too.\u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e In a study on wound size and location for penetrating injuries by Gao et al., the central 3 mm diameter area of cornea was considered as zone I, the posterior 1.5 mm next to it was zone II and the border of zone II to 6 mm posterior of the corneoscleral limbus was zone III. A final visual acuity of more than 0.1 Snellen acuity units (\u0026lt;\u0026thinsp;1 logMAR units) was classified as a \u0026lsquo;success\u0026rsquo; and highest rates of success were noted for wound locations involving the central 3mm of cornea.\u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003eIn the present study, the comparison between initial and final BCVA was significant not only for zone 1 as a whole, but also for the individual sub-zones which emphasizes the fact that the outcome of separate corneal zones may be different. The effect size comparing the same was the maximum for zone 1c (any corneal injury crossing the pupillary axis).The International Globe and Adnexal Trauma Epidemiology Study (IGATES) group\u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e has also proposed a new classification system for all eye injuries in which, zones have been classified as zone 1a (centre 4mm), 1b (between a and c) and 1c (outer 3mm including limbus);zone 2; and zone 3a and 3b. In our study, the need for classifying zone 1c as any injury crossing the pupillary axis was seen as more important since it will have a much greater bearing on the final outcome. We did not sub classify zone 3, where posterior segment intervention was invariably needed in almost all cases.\u003c/p\u003e\u003cp\u003eIn a 2-round Delphi survey, Hoskin et al.\u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e concluded that there was a consensus among a panel of 69 ophthalmologists specialising in ocular trauma, for the need for inclusion of lens trauma or posterior segment involvement. However, consensus for the method of classifying the presence of lens injury or involvement of individual posterior segment structures was not reached, which has been addressed in the present study. Furthermore, both BETTS and IGATES have acknowledged only the presence of \u0026ldquo;severity indicators\u0026rdquo;, namely- severe adnexal trauma, lens injury, endophthalmitis, retinal detachment (\u0026lsquo;RD\u0026rsquo;) and RAPD. In the present study, we have included the scope of describing the posterior segment involvement beyond RD and endophthalmitis, represented by a single number unique to that case. We did not include adnexal injuries in the classification system since they hardly have any bearing on the final visual outcome.\u003c/p\u003e\u003cp\u003eThe status of posterior segment structures in trauma has important implications in the visual outcome. In cases of non-assessment of the posterior segment clinically during initial examination or intra-operatively, post-operative ultrasonography (USG) B-scan may provide useful information, therefore we have included this as a part of our classification. In the study, fundus could be seen in thirty-six cases at presentation and in twenty more cases on post-operative day one. The abnormal findings included vitreous haemorrhage (VH), total or sectoral retinal detachment (RD), and IOFB with RD or VH. USG B-scan was done on post-operative day 1 for eighty-seven cases. Abnormal findings included vitreous echoes (haemorrhage, dislocated lens matter, exudates of endophthalmitis, IOFB), choroidal or retinal detachment or involvement of more than one structure. Choroidal involvement was most common (26, 25.49%). Three cases with posterior scleral dehiscence and one case of endophthalmitis were noted. Posterior segment involvement was seen in 22 (37.9%) cases of zone 1, 21 (65.6%) cases of zone 2 and 10 (83.3%) cases of zone 3. In zone 1, minimum involvement was seen for zone 1c (5, 23.8%) and maximum for 1p (11, 47.8%). Brinton et al. noted that zone 3 was most associated with RD. \u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003eXia et al. noted that early and late retinal detachments (RD) were seen mostly in zone 2 or zone 3 injuries.\u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e Most eyes developing delayed RD had vitreous hemorrhage on presentation.\u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e In this study too, zone 2 and 3 were most affected, but it should be noted that the corneal zone 1p too had a significant number of cases with posterior segment involvement. The survey conducted by the IGATES group reached a consensus on inclusion of retinal involvement only, as a part of an updated classification.\u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eThe presence of traumatic cataract affects the initial visual acuity. This may improve drastically if primary globe repair is combined with cataract extraction. In our study, lens aspiration was a part of both primary repair and second surgery for lens trauma. IOL implantation, if needed, was only done as a secondary procedure. In a study conducted in central and western India, management of traumatic cataracts in cases of open globe injuries yielded better final visual outcomes than in closed globe injuries.\u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003eSignificant correlation between the timing of cataract extraction and the final visual acuity has not been noted in these cases.\u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e None of the cases in our study underwent IOL implantation during primary globe repair.\u003c/p\u003e\u003cp\u003eIntraocular foreign body (IOFB) injuries account for 18\u0026ndash;41% of all open globe injuries.\u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e In the present study IOFB was seen on the retina during examination at presentation in one case and on post-operative USG B scan in the remaining five cases. IOFB may be removed during the primary surgery or during a second surgery, after repair of open globe. \u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e USG B-scan may have a greater chance of detecting glass or metal IOFB and posterior segment IOFBs as compared to clinical examination alone.\u003csup\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eAssessment of RAPD has not been reported to be always accurate in the setting of trauma with varied inter-observer differences.\u003csup\u003e[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003eBruegger et al. showed that RAPDs could be identified in only 40% of cases.\u003csup\u003e[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003e A study also showed that non-experts only found 12% of patients with RAPD as compared to a higher number detected by well-trained experts.\u003csup\u003e[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003e Since RAPD is both difficult to assess and is unreliable in cases of OGIs, the present study did not include RAPD as a part of classification system.\u003c/p\u003e\u003cp\u003eThe OTS or Ocular Trauma Score was given by Kuhn et al \u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e to prognosticate and give a realistic expectation to patient and their kin regarding the final visual outcome. Factors considered in their report were initial visual acuity, type of injury (rupture or perforating), presence of endophthalmitis, retinal detachment and afferent pupillary defect. The likelihood scale of final visual acuity in the present study, calculated using the same method, revealed some differences with the likelihood scale formed by Kuhn and colleagues. Most zone 1 and zone 2 injuries obtained an OTS score of 45\u0026ndash;65 (OTS Category 2) and zone 3 injuries had mostly a score of 0\u0026ndash;44 (Category 1). However, the actual final outcome and the range of vision was much better than predicted. Limitations of the OTS were noted as a 1-in-5 chance of a wrong prediction of final visual acuity and non-inclusion of factors from results of ancillary tests like USG B scan or radiography, which are useful in the absence of view of the posterior segment.\u003csup\u003e[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/sup\u003e The current study hence uses post-operative day 1 USG B-scan as an aid in the classification system.\u003c/p\u003e\u003cp\u003eThe zone in which the maximum number of cases achieved a final visual acuity of more than 20/40 (6/12) was zone 1 pc (57.14%). Traumatic cataract was encountered most commonly in zone 1p (60.8%). Posterior segment involvement was seen most commonly with zone 1 p of all corneal sub-zones and a final visual acuity of no perception of light was seen the least in case of zone 1c injuries. The change in final visual acuity with respect to the initial is significant not only for zone 1 as a whole but also the sub-zones, individually, with different effect sizes.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe study focuses on the need for a new holistic classification for OGIs which can provide a better overview of the prognosis. The modifications include defined sub-classifications of zones of injury, exclusion of RAPD, inclusion of lens trauma and IOFB and elaboration of posterior segment involvement. The classification system suggested in this study, provides more comprehensive and crucial information on open globe injury and offers an overall better idea about the visual prognosis of the case.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eCompeting Interests statement\u003c/strong\u003e: No competing financial interests\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of interest:\u003c/strong\u003e No competing financial interests\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u0026nbsp;\u003c/strong\u003eNone\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contribution statement\u003c/strong\u003e: MS conceived the idea, designed the methodology of study, review protocol and conducted the final review of all data analysis and manuscript details. BM was responsible for drafting the manuscript, data extraction, recording and analysing the data, and writing the report.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eN\u0026eacute;grel AD, Thylefors B. The global impact of eye injuries. Ophthalmic Epidemiol. 1998;5(3):143\u0026ndash;69.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKuhn F, Morris R, Witherspoon CD, Heimann K, Jeffers JB, Treister G. A standardized classification of ocular trauma. Ophthalmology. 1996;103(2):240\u0026ndash;3.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePieramici DJ, Sternberg P Jr, Aaberg TM Sr, Bridges WZ Jr, Capone A Jr, Cardillo JA, \u003cem\u003eet al\u003c/em\u003e. A system for classifying mechanical injuries of the eye (globe). The Ocular Trauma Classification Group. Am J Ophthalmol. 1997;123(6):820\u0026ndash;31\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKuhn F, Maisiak R, Mann L, Mester V, Morris R, Witherspoon CD. The Ocular Trauma Score (OTS). Ophthalmol Clin North Am. 2002;15(2):163\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGao X, Zhang Q, Wang F, Li X, Ma C, Li Y, \u003cem\u003eet al\u003c/em\u003e. Wound size and location affect the prognosis of penetrating ocular injury. BMC Ophthalmol. 2023;23(1):257.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHoskin AK, Fliotsos MJ, Rousselot A, Ng SMS, Justin GA, Blanch R, \u003cem\u003eet al.\u003c/em\u003e; International Globe and Adnexal Trauma Epidemiology Study (IGATES) Ophthalmic Trauma Terminology Consensus Group. Globe and Adnexal Trauma Terminology Survey. JAMA Ophthalmol. 2022;140(8):819\u0026ndash;826.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBrinton GS, Aaberg TM, Reeser FH, Topping TM, Abrams GW. Surgical results in ocular trauma involving the posterior segment. Am J Ophthalmol. 1982;93(3):271\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eXia T, Bauza A, Soni NG, Zarbin MA, Langer PD, Bhagat N. Surgical Management and Outcome of Open Globe Injuries with Posterior Segment Complications: A 10-Year Review. Semin Ophthalmol. 2018;33(3):351\u0026ndash;356.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eShah MA, Shah SM, Shah SB, Patel CG, Patel UA, Appleware A,\u003cem\u003eet al\u003c/em\u003e. Comparative study of final visual outcome between open- and closed-globe injuries following surgical treatment of traumatic cataract. Graefes Arch Clin Exp Ophthalmol. 2011;249(12):1775\u0026ndash;81.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRodricks D, Loya A, Mohamed M, Al-Mohtaseb Z. Visual outcomes of open globe injury patients with traumatic cataracts. Int Ophthalmol. 2022;42(7):2039\u0026ndash;2046.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWilliams DF, Mieler WF, Abrams GW, Lewis H. Results and prognostic factors in penetrating ocular injuries with retained intraocular foreign bodies. Ophthalmology. 1988\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePatel SN, Langer PD, Zarbin MA, Bhagat N. Diagnostic value of clinical examination and radiographic imaging in identification of intraocular foreign bodies in open globe injury. Eur J Ophthalmol. 2012 Mar-Apr;22(2):259\u0026ndash;68.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBruegger D, Grabe HM, Vicini R, Dysli M, Lussi D, Abegg M. Detection of Relative Afferent Pupillary Defects Using Eye Tracking and a VR Headset. Transl Vis Sci Technol. 2023;12(6):22.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHennessy AL, Katz J, Ramakrishnan R, Krishnadas R, Thulasiraj RD, Tielsch JM,\u003cem\u003eet al\u003c/em\u003e. The utility of relative afferent pupillary defect as a screening tool for glaucoma: prospective examination of a large population-based study in a south Indian population. Br J Ophthalmol. 2011;95(9):1203\u0026ndash;1206\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eScott R. The Ocular Trauma Score. Community Eye Health. 2015;28(91):44\u0026ndash;5\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-7275066/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7275066/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e: The BETTS and the OTS are time-tested tools for classifying and prognosticating mechanical ocular injuries. However, anatomical representation of the injuries, status of lens and individual posterior segment structures were not included.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjectives\u003c/strong\u003e: To propose a new classification system for open globe injuries (OGIs) and analyse its management outcomes\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: 102 OGI cases undergoing primary repair at a tertiary eye centre were included in this retrospective observational study. Injuries were classified according to the proposed system (zone of injury, presence of traumatic cataract, status of posterior segment and presence of intraocular foreign body (IOFB)) and the visual outcomes were compared. Zone 1 was subdivided in three subzones namely; 1c (central), 1pc (paracentral), and 1p (peripheral).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: The mean best corrected visual acuity (BCVA) at presentation was 2.81 ± 1.08 and mean final BCVA was 1.75 ± 1.59 (p \u0026lt;0.001). Traumatic cataract was present in 41.2% cases and IOFB in 5.9% cases. The most frequently occurring groups were 1cL0P0FB0 (Zone 1c without traumatic cataract, posterior segment involvement or any IOFB) (7.8%), 1cL1P0FB0 (Zone 1c with traumatic cataract, without posterior segment involvement or any IOFB) (7.8%) and 1pL1P0FB0 (Zone 1p with traumatic cataract, without posterior segment involvement or any IOFB) (7.8%). Posterior segment was involved in 51.9% cases. The comparison between initial and final visual acuities was significant for the zones 1c, 1pc, 1p and 2 (p\u0026lt;0.05), but not for zone 3 (p= 0.1832)\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e: The new system provides a holistic approach to OGIs with a better overview of the final visual outcomes.\u003c/p\u003e","manuscriptTitle":"To propose a new classification system for open globe injuries (OGIs) and analyse its management outcomes","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-08 10:12:59","doi":"10.21203/rs.3.rs-7275066/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a383d54d-deba-410b-a318-b3ff7de240ae","owner":[],"postedDate":"September 8th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":53820722,"name":"Health sciences/Medical research"},{"id":53820723,"name":"Biological sciences/Physiology"}],"tags":[],"updatedAt":"2025-10-08T12:10:18+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-08 10:12:59","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7275066","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7275066","identity":"rs-7275066","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}