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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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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.
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.
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).
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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