Deadly Weapon–Related Open-Globe Injuries: Outcome Assessment by the Ocular Trauma Classification System GU ¨ NGO ¨ R SOBACI, MD, F. MEHMET MUTLU, MD, ATILLA BAYER, MD, SUAT KARAGU ¨ L, MD, AND EROL YILDIRIM, MD ● PURPOSE: To describe mechanisms and injury charac- teristics influencing visual outcomes in eyes with open- globe injuries caused by deadly weapons and to apply the classification system introduced by the Ocular Trauma Classification Group. ● METHODS: Two-hundred-twenty-eight eyes of 212 consecutive patients, who were mostly injured in military confrontation, were analyzed. Mechanism and injury characteristics were evaluated for predicting visual out- come according to the recently studied classification system as well as other variables pertinent to this specific clinical setting of severe eye trauma. Final visual acuities were defined as favorable (5/200 or better) or unfavor- able (less than 5/200, including enucleation). ● RESULTS: The mean age of patients was 23 years, and the mean follow-up was 5.7 months. The predictors for favorable visual outcome were type B, grade 1, zone I, and relative afferent pupillary defect-negative injuries. The predictors for unfavorable outcome were type A, grade 5, zone III, and relative afferent pupillary defect- positive injuries. Land mine and hand grenade injuries had the worst outcome among causative agents. Prolifer- ative vitreoretinopathy, comprising 30.4% of postopera- tive failures, was the most common complication. ● CONCLUSION: Deadly weapon–related open-globe in- juries, especially those associated with land mines and hand grenades, have devastating visual results. Evalua- tion of trauma mechanism and injury characteristics according to the Ocular Trauma Classification System seems to predict visual outcomes in this series of severe open-globe injuries. (Am J Ophthalmol 2000;129: 47–53. © 2000 by Elsevier Science Inc. All rights reserved.) O CULAR TRAUMA CONSTITUTES ONE OF THE MOST common causes of unilateral morbidity and blind- ness in the world today. Despite huge advances in vitreoretinal surgery in recent years, a dismal prognosis still persists in certain injuries. Eye injuries resulting from violence are increasing in both civilian and wartime settings in recent years. 1–3 The heterogeneity of the inju- ries in ocular trauma has made it difficult to interpret results of clinical studies with respect to intervention and prevention of blindness. Recently, a classification system for standardized assessment of ocular trauma was intro- duced. 4 If validated, this system, or a similar classification system, would allow objective assessment for both clinical prognosis and interventional studies. We aimed to identify patient and injury characteristics in deadly weapon-related eye injuries according to the Ocular Trauma Classification System, as well as other variables pertinent to this unusual type of severe eye trauma, at a principal center for military medicine in Turkey. PATIENTS AND METHODS WE CONDUCTED A RETROSPECTIVE REVIEW OF ALL PA- tients presenting with open-globe injury to the Ophthal- mology Department of Gu ¨lhane Military Medical Academy and Medical School between March 1991 and April 1997. We identified 228 eyes of 212 patients who underwent surgical repair of open-globe injuries in our institution. An open-globe injury was defined as a full- thickness wound of the eyewall (through-and-through injury of the sclera, cornea, or both). 4 The hospital inpatient and outpatient records of these patients were reviewed in detail with respect to prognostic variables indicated by the Ocular Trauma Classification System 4 as well as other variables of prognostic value in open-globe injuries. The variables studied were type (mechanism) of injury, grade (visual acuity at presentation) of injury, zone (location and extent) of injury, presence or absence of Accepted for publication June 29, 1999. From the Department of Ophthalmology, Gu ¨lhane Military Medical Academy and Medical School, Ankara, Turkey. Reprint requests to Gu ¨ngo ¨r Sobaci, MD, GATA Go ¨z Klinigi, 06018 Etlik, Ankara, Turkey; fax: 90 312 321 7778; e-mail: gsobaci@gata.edu.tr © 2000 BY ELSEVIER SCIENCE INC.ALL RIGHTS RESERVED. 0002-9394/00/$20.00 47 PII S0002-9394(99)00254-8