Purchase this article with an account.
C. Westerfeld, N. Kim, M.T. Andreoli, C.M. Andreoli; Visual Recovery in Patients with Open Globe Injuries and Poor Initial Acuity . Invest. Ophthalmol. Vis. Sci. 2006;47(13):3966.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
A review of the recent literature regarding the management of open globe injuries reveals a correlation between presenting visual acuity and final acuity after repair. This has led to the conclusion that poor initial acuity can be used as a criterion for primary enucleation. Our concern is that patients who may have ultimately achieved useful vision are instead receiving primary enucleation on this basis. We have observed a segment of our patients with very poor initial acuity following open globe injury who ultimately attained useful vision following surgical repair.
We performed a retrospective review of 220 consecutive open globe patients who presented to a major eye trauma center. Review of presenting vision revealed: 22 patients with an initial vision of no light perception, 61 patients with an initial vision of light perception, and 40 patients with an initial vision of hand motions. The charts of these patients were reviewed with particular attention to final visual acuity (defined as visual acuity on last recorded follow–up). Resultant visual acuities were categorized into three groups as follows: count fingers or better, > 20/200, and > 20/40.
Of the 22 patients with an initial vision of no light perception, only one patient demonstrated improvement to light perception following surgical repair. However, of the 61 patients who presented with light perception vision, 39% ultimately developed CF or better, 21% developed > 20/200, and 5% developed > 20/40. Of the 40 patients who presented with hand motions vision, 70% achieved CF or better following repair, 45% developed > 20/200, and 28% developed > 20/40.
The severity of initial vision loss is predictive of final visual acuity outcome. In our study, none of the patients whose vision was initially no light perception were able to obtain useful vision in the eye. However, there was a significant percentage of patients with both light perception and hand motions vision who ultimately developed useful vision and even ambulatory vision. Furthermore, a small but substantial percentage of these patients developed sufficient acuity to pass a driving test. This suggests that despite the severity of initial injury, patients with very poor acuity, even to the level of bare light perception, can ultimately develop useful vision if treated with prompt repair and appropriate management. Therefore, we recommend prompt attempt at surgical repair and avoidance of primary enucleation in all patients with light perception vision or better.
This PDF is available to Subscribers Only