Purpose:
To evaluate the demographics, characteristics, and outcomes of delayed open globe repair.
Methods:
Retrospective chart review of open globe injuries with delayed repair of 3 or more days that presented to University Hospital, Newark between 2001-2010.
Results:
Thirty six patients were identified who underwent open globe repair 3 or more days after the injury; the mean duration of delay was 6.3 days (range, 3-21). The average age of patients was 39.6 years (range, 1-86), and 67% were male. The reason for delay ranged from delay in seeking treatment by the patient (61%), outside referral (31%), unstable medical condition for surgery (6%), and patient's initial refusal to undergo surgery (3%). There were 26 accidental injuries, 5 violent assaults, 2 motor vehicle accidents, 2 unspecified injuries, and 1 wound dehiscence. Eighteen injuries were classified as penetrations, 15 as ruptures, and 3 intraocular foreign bodies (IOFB). There were 20 zone 1 injuries, 6 zone 2, 9 zone 3 injuries, and 1 unspecified zone. Retinal detachment was diagnosed in 8 eyes, and endophthalmitis in 3 eyes. All 3 cases of endophthalmitis were diagnosed on admission; the mean duration from injury to surgery was 5.7 days, and all 3 cases were zone 1 injuries. One case was misdiagnosed elsewhere, and 2 cases did not initially seek medical treatment. Metallic IOFB was diagnosed in 1 of these cases of endophthalmitis, the other patients were injured by glass bottle and lightbulb fragments, but without IOFB. Ten patients underwent pars-plana vitrectomy; 6 during primary repair. Five of these 10 patients achieved anatomic success as of last follow-up. The average presenting initial visual acuity was 1.67 logMAR, and the average final corrected visual acuity was 1.21 logMAR.
Conclusions:
Endophthalmitis was noted in 8.3% of eyes in our study group that had delayed surgical repair by 3 or more days. Other confounding factors such as a dirty wound, IOFB, or uveal prolapse may have also affected the development of endophthalmitis in this group.
Keywords: clinical (human) or epidemiologic studies: outcomes/complications • endophthalmitis • vitreoretinal surgery