Epidemiology And Surgical Outcomes Of Traumatic Corneal Perforation Cases In The United Kingdom: A Single-Centre Retrospective Study

Corneal perforation is one of the most frequent complications of ocular trauma cases and can cause significant irreversible visual impairment without the presence of timely treatment. However, there is a lack of up-to-date statistics that systematically summarise the epidemiology and clinical outcomes of traumatic corneal perforation in the United Kingdom (UK), particularly in the Midlands region. This study aims to evaluate the characteristics of such traumatic corneal perforation patients and review their surgical outcomes.

This study was conducted at Birmingham and Midland Eye Centre, Sandwell and West Birmingham NHS Trust (BMEC), a tertiary eye care centre, in Birmingham, Midlands UK. It mainly serves patients from the West Midlands region and is among the top three largest eye hospitals in the UK, receiving a diverse range of cases, including ocular trauma cases with its urgent care services.

A single-centre retrospective study was conducted on patients who visited BMEC Accident & Emergency services and were diagnosed with traumatic full-thickness corneal perforation between January 2022 and July 2024. The Birmingham Eye Trauma Classification (BETT) was adapted to describe the characteristics of the ocular trauma. Surgical outcomes were evaluated with best-corrected visual acuity (BCVA) and intra-ocular pressure (IOP) at presentation, immediately post-operation, and three months post-operation. 

A total of 24 cases (White, 41.7%; Asian, 33.3%; not specified, 25%) were recorded. The mean age was 42.2 years (SD=18.6). There were no differences in eye laterality (left, 54.2%). Males (85.7%) had a higher rate than females. 58.3% of all patients had globe rupture, 95.8% had open wounds, and 20.8% involved intraocular foreign bodies. At presentation, the mean BCVA was 2.24 logMAR, with no significant changes immediately post-operation (2.10) and 3-months post-operation (1.91). The average IOP at presentation was 5.71, and was improved and stabilised at 13.4 and 14 immediately post-operation and 3-months post-operation respectively.

This study presented the up-to-date epidemiology and surgical outcomes of traumatic corneal perforation cases in the UK Midland. Unfortunately, the majority (75%) had severe low vision upon presentation at our eye emergency centre, and their BCVA was not enhanced to within normal range despite surgery. In contrast, surgery was indeed able to enhance IOP in our patients and with a positive and stabilised outcome. This greatly highlights the importance of timely operation in these patients to effectively manage post-trauma hypotony, avoiding further damage to the structures of the eye and the potential development of any systemic damage or the need for prosthetic eye surgery.