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Hugh Emmett Wright, Ellen Ngo, Ahmed Sallam, Horace Spencer, Sami Uwaydat; Factors Affecting Outcomes in Traumatic Eye Injuries. Invest. Ophthalmol. Vis. Sci. 2017;58(8):5512. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
An often debated topic in traumatic eye injuries is the medical and surgical management after primary wound closure, including timing of secondary pars plana vitrectomy (PPV) and the benefit of systemic corticosteroids. We investigated the impact of early PPV and the use of oral prednisone (OP) on the rate of enucleation and the final best corrected visual acuity (BCVA) in open and closed-globe injuries.
This a retrospective chart review of all globe injuries that had initial repair or exploration and subsequent PPV between 2009 and 2015. Data elements collected were vision at presentation, zone of injury, date of initial closure (primary intervention) of the open globe, timing to the secondary intervention (PPV) from initial injury, use of high dose OP, BCVA at last follow up, and rate of enucleation.
This study included 87 eyes (87 patients). Mean patients’ age was 42.7 years (range: 5-90); with 71 (81.61%) males. Vision at presentation was as follows: NLP in 10 eyes (11.49%), LP to CF in 61 eyes (70.11%), and ≥ 20/400 in 10 (11.49%). Oral prednisone intake was recorded in 36 patients (41.38 %) whereas in 51 patients (58.62%) it was not documented in the chart. Nine eyes (10.34%) were enucleated. NLP vision at presentation was associated with increased risk for enucleation (p<0.0001) with 60 % of enucleated eyes having NLP vision at presentation. The use of OP did not significantly affect the rate of enucleation; 3 out of the 9 patients that underwent enucleation received OP, whereas 6 patient did not receive OP ( p=0.7302; Fisher’s Exact Test).At the last follow up,10 eyes (12.34%) had NLP vision, 38 (46.91%) has vision of LP-CF, and 33 (40.74%) had vision ≥20/400. There was a strong correlation between vision at presentation and final BCVA (Spearman correlation coefficient of 0.61099; p<0.0001). Our analysis showed that earlier secondary intervention (PPV) was associated with a better final BCVA (Spearman correlation factor of -0.23189; p = 0.0361). Use of OP did not seem to affect final visual acuity (Spearman correlation coefficient -0.06724, p = 0.5361).
A worse VA at presentation is correlated with a higher rate of enucleation and a worse BCVA at final follow up. Earlier PPV after globe injury may lead to better final BCVA outcomes. Despite inconsistent documentation, high dose OP does not seem to have any beneficial effect on final BCVA or rate of enucleation.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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