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Anna Marmalidou, Elizabeth Rossin, Leo A. Kim, David M Wu, John B Miller; Modern Visual and Clinical Outcomes of Vitrectomy after Open Globe Injury. Invest. Ophthalmol. Vis. Sci. 2019;60(9):6564. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
To explore the clinical features, visual outcomes, and prognostic factors of visual impairment of eyes that underwent vitrectomy after open globe injuries (OGIs).
A retrospective review was conducted of consecutive cases that underwent pars plana vitrectomy (PPV) after OGIs at Massachusetts Eye and Ear (MEE) over 2 years. Demographic and clinical data including age, gender, type and zone of injury, presenting visual acuity (VA), vitreous hemorrhage (VH), hemorrhagic choroidals (HC), retinal detachment (RD), retinal incarceration (RI), length of follow-up, and final VA were recorded.
37 eyes of 37 patients (27 male) presented with a mean age of 50.6 yo (19-88) and a mean follow-up of 438 days (89-1293). Types of injury included blunt rupture (48.7%), penetrating laceration (29.7%), and intraocular foreign body (21.6%). The injuries requiring vitrectomy were most often in zones II and III, with only 7 (27%) presenting with isolated zone I injuries. The majority of eyes had severe vision loss prior to PPV, with VA better than counting fingers in only 27%. No eyes were deemed inoperable or required subsequent enucleation. Final retinal attachment rate was 82% at last follow-up. Overall, final VA showed significant improvement with 62.2% better than counting fingers and 37.8% better than 20/50. We further stratified eyes into 2 groups based on the presence of RD at the time of initial PPV: group 1 (n=18) had no RD while group 2 (n=19) did have an RD. In group 2 with RD, there was a statistically significant improvement in average VA (logMAR 3.08 at presentation compared to 1.4 at final follow-up, p=0.00025). Those who re-detached had worse final VA (median logMAR 2.7 compared to 1.35, p=0.06), and a strong predictor of re-detachment was the appearance of PVR after the first vitrectomy (p=0.001), while the presence of PVR before the first vitrectomy did not predict ultimate re-detachment (p=1). Presence of retinal incarceration and funnel RD trended toward higher risk of re-detaching and worse final VA, but did not reach statistical significance.
OGIs often require retina surgery after the initial open globe repair. Modern pars plana vitrectomy can lead to globe salvage and improvement in vision in even the most severe cases, suggesting that in select cases, vitrectomy after OGR may be warranted.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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