June 2020
Volume 61, Issue 7
Free
ARVO Annual Meeting Abstract  |   June 2020
Corneal Epithelial Defects Following Vitreoretinal Surgery: Long-Term Outcomes from the DISCOVER Study
Author Affiliations & Notes
  • Alison Martin
    Ophthalmology, Cleveland Clinic, Cleveland, Ohio, United States
  • Daniel Petkovsek
    Ophthalmology, Cleveland Clinic, Cleveland, Ohio, United States
  • William J. Dupps
    Ophthalmology, Cleveland Clinic, Cleveland, Ohio, United States
  • Jeffrey M. Goshe
    Ophthalmology, Cleveland Clinic, Cleveland, Ohio, United States
  • Sunil K Srivastava
    Ophthalmology, Cleveland Clinic, Cleveland, Ohio, United States
  • Alex Yuan
    Ophthalmology, Cleveland Clinic, Cleveland, Ohio, United States
  • Jamie Reese
    Ophthalmology, Cleveland Clinic, Cleveland, Ohio, United States
  • Justis P Ehlers
    Ophthalmology, Cleveland Clinic, Cleveland, Ohio, United States
  • Footnotes
    Commercial Relationships   Alison Martin, None; Daniel Petkovsek, None; William Dupps, Zeiss (F); Jeffrey Goshe, Zeiss (S); Sunil Srivastava, Allergan (F), Bausch and Lomb (C), Gilead (F), Leica (P), Regeneron (F), Santen (C); Alex Yuan, None; Jamie Reese, None; Justis Ehlers, Aerpio (F), Aerpio (C), Alcon (F), Alcon (C), Allegro (C), Allergan (F), Allergan (C), Genentech (F), Genentech/Roche (C), Leica (C), Leica (P), Novartis (F), Novartis (C), Regeneron (F), Regeneron (C), Santen (C), Thrombogenics/Oxurion (F), Thrombogenics/Oxurion (C), Zeiss (C)
  • Footnotes
    Support  RPB Unrestricted Grant to the Cole Eye Institute RPB1508DM and NIH K23 -EY022947
Investigative Ophthalmology & Visual Science June 2020, Vol.61, 175. doi:
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      Alison Martin, Daniel Petkovsek, William J. Dupps, Jeffrey M. Goshe, Sunil K Srivastava, Alex Yuan, Jamie Reese, Justis P Ehlers; Corneal Epithelial Defects Following Vitreoretinal Surgery: Long-Term Outcomes from the DISCOVER Study. Invest. Ophthalmol. Vis. Sci. 2020;61(7):175.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Corneal epithelial defects (CEDs) are a common finding in the early postoperative period following vitreoretinal surgery. Although most post-surgical CEDs heal quickly and without sequelae, some patients develop persistent epithelial defects that can result in scarring, discomfort, or recurring defects. This study aims to investigate the incidence, risk factors, and late outcomes of CED following vitreoretinal surgery.

Methods : The DISCOVER study is an IRB-approved prospective ophthalmic surgery study evaluating the role of intraoperative OCT. This study includes prospective collection of early postoperative data and enables collection of standard-of-care follow-up clinical data. This analysis included all subjects in the DISCOVER study who underwent vitreoretinal surgery with at least six months of follow-up. Clinical history, risk factors, exam data, clinical progression, and treatments were collected from the preoperative visit, operative reports, and postoperative visit notes up to one year after surgery. The primary outcome was the presence of CED on postoperative day one. Secondary outcomes included duration to epithelial defect resolution, presence of scarring at one year, cornea consult, and recurrence of defect. Regression analysis was used to identify predictive risk factors for primary and secondary outcomes.

Results : This study included 856 eyes that underwent vitreoretinal surgery. Of those 856, 156 (18.3%) were found to have CED following PPV. Significant predictive factors for CED were duration of surgery (> 3 hours, p < 0.001) and high (> 24) postoperative IOP (OR 5.60, p < 0.001). Of the 156 eyes with CED, 35 had persistent CED (22%), and 16 (10%) had corneal scarring noted at one year. Delayed defect closure time was significantly associated with scarring (p < 0.001). Bandage contact lens placement on postoperative day one was protective against scarring (OR 0.163, p < 0.014), and intraoperative placement was associated with reduced closure time (p = 0.037).

Conclusions : Increased duration of surgery was a major factor associated with the development of CED following PPV. Prolonged closure of these defects was associated with a greater risk of corneal scarring at one year. Early bandage contact lens placement appeared to be protective against corneal scarring and was associated with reduced time to defect closure.

This is a 2020 ARVO Annual Meeting abstract.

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