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mohamud Ahmed qadi, Adrienne Scott, Jiangxia Wang, christina prescott; Effect of prior ophthalmic surgery and open globe injuries?. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):6040.
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To review the epidemiology and detect the impact of prior corneal, cataract, retinal, and refractive surgeries on visual recovery in patients with open globe injuries.
We performed a retrospective case review of the Johns Hopkins electronic medical records and found 39,000 ophthalmic surgeries and 4,000 open-globe injuries from January 1, 1997 to November 1, 2014. 400 patients who underwent ophthalmic surgeries had subsequent open globe injuries. 79 patients out of these 400 had prior ophthalmic surgeries for corneal transplant, cataract surgery, retinal surgery, or refractive surgery in the same eye.<br /> Gender, age, dates of prior ophthalmic surgeries, date of open-globe injury, initial uncorrected visual acuity (UCVA), initial best-corrected visual acuity (BCVA), type of open-globe injury, location of open-globe injury, cause of open globe-injury, and type of open globe repairs, were evaluated using logistic regression models for final UCVA and final BCVA.
A prognostic model for the impact of prior ophthalmic surgeries on open globe injuries was constructed. Multiple logistic models were performed for final visual acuity. The strongest predictive factors for enucleation as a final visual outcome were prior history of corneal transplant surgery, mainly penetrating keratoplasty (PKP) and Descemet's Stripping Endothelial Keratoplasty (DSEK). The greatest predictors for final best corrective visual acuity (BCVA) of 19/100 to 5/200 were prior history of cataract surgery (phacoemulsification and extracapsular).
Patients who have prior corneal transplant surgery may have worse visual outcomes after subsequent open globe injury compared to other types of ophthalmic surgeries. This should be useful in counseling patients and making clinical decisions regarding open globe injury management in patients with prior ophthalmic surgeries. This also demonstrates the importance of appropriate counseling when considering ophthalmic surgical interventions in patients at risk for ocular trauma, especially children.
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