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Levi Kanu, Yi Jiang, William F Mieler; Posterior-involving open-globe injury prognostic factors and outcomes. Invest. Ophthalmol. Vis. Sci. 2018;59(9):880.
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© ARVO (1962-2015); The Authors (2016-present)
Posterior segment ocular trauma resulting in open globe injury (OGI), remains a challenging clinical scenario, frequently associated with limited anatomic and visual outcomes. Optimal management is still a matter of debate, and advances in vitreoretinal surgical-techniques continue to change the management options. The purpose of this study is to evaluate recent trends in the treatment of OGI requiring pars plana vitrectomy (PPV), and report their outcomes.
A retrospective cohort study of incident cases of OGI involving PPV attended by a single vitreoretinal surgeon (WFM) was performed. Cases with less than six months of follow-up were excluded. Patient demographics, case details, and outcomes data were collected and analyzed.
A total of 29 eyes were studied. The study population was primarily male (86.2%), with a mean age 41 +/- 22 years old. From the time of injury to time of PPV, a mean of 25 +/- 19 days passed. The most common indications for PPV were retinal detachment (RD, 62.1%) and vitreous hemorrhage (55.2%). 23G PPV was most common (47.6%), followed by 25G (28.6%) and 20G (23.8%). Pre-operative, 1-month post-operative, and 6-month post-operative visual acuities (VA) on LogMAR scale were 2.6 +/ 0.5, 1.9 +/- 1.0 (p<0.0001), and 1.7 +/- 1.2 (p<0.0001), respectively (p values by paired t-test). A large proportion of eyes (51.7%) experienced improvement of ≥2 lines of vision, and anatomic reattachment was achieved in 78.5%. A repeat PPV was necessary in 37.9% of cases, most frequently due to recurrent RD (46.2%). Hypotony occurred in 28.6%. Of significant prognostic value were presence of intraocular or intraorbital foreign body, retinotomy or retinectomy, and laceration size, which were associated with relatively worse 6 month VA (p=0.0145, p=0.0151, and p=0.0131 respectively). PPV instrumentation size was not significantly associated with visual outcome or re-operation rate (by ANOVA and chi-squared test respectively). Time to PPV did not correlate significantly with visual outcomes. However, cases requiring eventual re-operation were associated with worse initial VA (p = 0.03).
Posterior-involving OGIs present with a diverse array of pathologies, and as such specific management varies on a case by case basis. In spite of numerous advances in the management of such injuries, anatomic and visual outcomes may still be limited in a significant number of cases.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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