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M. Englander, S. R. Montezuma, M. T. Andreoli, D. Vavvas, A. S. Shah, C. M. Andreoli; Clinical Features and Outcomes of Retinal Detachment Following Open Globe Injuries. Invest. Ophthalmol. Vis. Sci. 2010;51(13):6025.
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To describe the clinical features and outcomes of retinal detachment following open-globe injuries.
This is a retrospective review of 852 patients with open-globe injuries and repairs done at the Massachusetts Eye and Ear Infirmary between 1999 and 2009. Univariate analysis was used to find significant differences between patients who developed retinal detachment and those who did not. Also, a logistic regression model was used to determine the odds ratio (OR) of clinical features for developing retinal detachment after open-globe injury.
Of the 852 patients reviewed, 127 (14.9%) developed retinal detachment. Logistic regression modeling showed that zones II (OR 1.7, p=0.02) and III (OR 3.2, p<0.0001) injuries as well as the presence of vitreous hemorrhage (OR 2.1, p=0.0079) and intraocular foreign body (OR 3.0, p=0.0001) are significant risk factors for developing retinal detachment. Age and pre-operative visual acuity did not predict development of retinal detachment, while zone I injuries were unlikely to be associated with retinal detachment (OR 0.57, p=0.02). In addition, statistically significant differences between the outcomes of patients who developed retinal detachment versus those who did not included poor post-operative visual acuity (20/200 or worse, p<0.0001), development of phthisis bulbi (p= <0.0001), and need for further surgical intervention including vitrectomy and scleral buckle (p<0.0001). No statistically significant differences were seen in the rates of enucleation and endophthalmitis between the two groups (p=0.88 and p=0.83, respectively).
Risk factors for developing retinal detachment after open-globe injury included zones II and III injuries, vitreous hemorrhage, and intraocular foreign body. Patients who develop retinal detachment were more likely to have poor visual outcome, require additional surgeries, and develop phthisis bulbi. These findings can be used to counsel patients with open-globe injuries about their prognosis even after successful globe repair.
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