Vitreoretinal Surgery After Primary Open Globe Repair

Abstract

Purpose: : To review the demographics, mechanisms, interventions and outcomes of patients who underwent primary repair of a traumatic open followed by vitreoretinal surgical intervention.

Methods: : After institutional review board approval, a retrospective chart review of all patients who underwent open globe repair at Harborview Medical Center between January 1, 2007 and October 31, 2009 was done. Those who had vitreoretinal surgery after primary open globe repair were included. Statistics calculated with Fisher’s exact test.

Results: : 196 patients underwent primary open globe repair during this time period. 31 eyes of 30 patients underwent subsequent vitreoretinal surgery. The mean age at time of injury was 31 (Range 3-72). 8 (26%) were women while 23 (74%) were men. 24 patients had penetrating injuries, 5 were due to blunt trauma, and 3 were perforating injuries. When obtainable, visual acuity after primary repair and prior to vitreoretinal intervention ranged from 20/40 to light perception. Indications for retinal surgery included vitreous hemorrhage 28 (90%), retinal detachment 23 (74%), PVR 18 (58%), intraocular foreign body 6 (19%), and endophthalmitis 1 (3.2%). Vitreoretinal interventions included pars plana vitrectomy in 29 patients (94%), endolaser in 23 patients (74%), silicone oil in 19 patients (61%) and scleral buckle in 14 patients (45%). There was 1 case of intraoperative suprachoroidal hemorrhage. Average time from primary open globe repair to 1^st vitreoretinal surgery was 60 days (range 5-314 days). 12 patients had at least 2 vitreoretinal surgeries. Follow up averaged 305 days from 1^st vitreoretinal surgery, and 246 from final surgery. Visual acuity at final follow up ranged from 20/20 to NLP in 2 patients. 18 patients had improvement from pre-retinal surgery visual acuity. 8 patients with isolated vitreous hemorrhage were more likely to have improvement than the 23 patients with retinal detachment p=0.01. No patients in this study underwent enucleation.

Conclusions: : Open globe injuries often carry a poor prognosis after primary repair but vitreoretinal surgery can improve visual acuity. Patients with isolated vitreous hemorrhage alone had better outcomes than those with retinal detachments. Still nearly half those with retinal detachments improved. Vitreoretinal surgery should be considered in previously traumatized eyes.

Keywords: trauma • retina • clinical (human) or epidemiologic studies: outcomes/complications