Purpose
To describe the characteristics of open globe injuries (OGIs) requiring pars plana vitrectomy (PPV) for posterior segment trauma including epidemiology, presentation, management, outcomes and complications.
Methods
Retrospective chart review of PPV after OGI presenting to Institute of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, NJ between 2003 and 2012 was conducted. Data was collected on demographics, clinical presentation, and surgical procedures. Main outcome measures are visual acuity (VA), retinal attachment based on fundascopic exam, and additional retinal surgeries. Chi-square analysis and student t-tests were performed with significance of p <0.05.
Results
One-hundred-twenty eyes (mean age, 39 years; 84% male, 16% female) underwent PPV after OGI. They were divided into three groups: 64 (53%) early RD (within 30 days), 30 (25%) delayed RD (after 30 days) and 26 (22%) no RD patients. Injuries were categorized to penetrating (35%, n=43), rupture (50%, n=60), and penetrating injuries with retained intraocular foreign body (IOFB) (14%, n=17). Injuries in Zone I, II and III were seen in 35% (n=40), 34% (n=38) and 31% (n=35), respectively. Ocular trauma scores were statistically significantly different between these groups (p<0.01). Mean presenting and mean final logMAR VA were 2.20± 0.63 and 1.87 ±0.60 respectively (p <0.01) with a mean follow up of 1168 days. Eighty-eight eyes (73%) underwent one PPV, 23 two (19%) PPV, eight three (7%) PPV, and one four (1%) PPV. Final overall anatomic success after surgeries was 98% for early RD, and 95% for delayed RD. Other posterior segment procedures with PPV included scleral buckles (n=13), retinectomy/retinotomy (n=13), and enucleation (n=7).
Conclusions
Overall functional and anatomic success for eyes with posterior segment trauma that undergo PPV, are poor and comparable to other studies. Delayed presenting RD may have poorer final visual and anatomic success compared to the eyes presenting with early RD. Further studies are needed to analyze these differences.