Visual Outcomes of Vitreoretinal Surgery in Eyes With Severe Open-Globe Injury Initially Presenting With No Light Perception Vision

Abstract

Purpose:: Severe ocular trauma causing no light perception (NLP) typically carries a dismal prognosis and implies no further therapeutic intervention. We have identified a cohort of patients with verified NLP following open-globe injury that has recovered vision of light perception (LP) or better. There are no studies looking at prognosis or the role of vitreoretinal surgery in these patients. We evaluated the outcomes of vitreoretinal procedures performed on eyes that were once NLP post open-globe injury.

Methods:: Retrospective review of all cases of open-globe repair (OGR) performed at the Massachusetts Eye and Ear Infirmary (MEEI) from 1/1/2001 to 11/1/2006 that had a recorded visual acuity of NLP prior to OGR or on post-operative day one that recovered vision of LP or better.

Results:: There were a total of 648 cases of OGR performed at MEEI in the study period. Fifty-seven patients had documented NLP vision prior to OGR and 85 had NLP vision on the first post-operative day (including 40 from the pre-operative NLP group). Twenty-seven patients from the above group recovered a vision of LP or better in the days following the OGR. Nine of the 27 patients had vitreoretinal procedures; seven for repair of a retinal detachment with or without choroidal detachment, one for endophthalmitis, and one had vitrectomy and anterior chamber washout for fibrin clot and dens vitreous hemorrhage. All eyes that did not undergo vitreoretinal surgery had stable vision at LP for a period ranging from 4 days to 7 months and then either went to NLP or became phthisical. Among the eight eyes that underwent surgery, four had improved vision ranging from count finger at 1 foot to 20/160. The remaining four eyes had vision of LP (two eyes) or declined to NLP. The main difference between the successful and failed surgical interventions were better than LP vision prior to vitreoretinal surgery, recovery of LP or better vision within three days of OGR, and vitreoretinal intervention within five weeks of the initial open-globe injury.

Conclusions:: Patients with severe open-globe injury and NLP occasionally recover LP or better vision. If the spontaneous visual recovery occurs within the first few days after OGR, these patients may regain some useful vision with prompt referral and vitreoretinal surgery.

Keywords: trauma • vitreoretinal surgery • retinal detachment