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Muhammad Zain Chauhan, Hani Samarah, Hytham Al-Hindi, Riley Sanders, Sami H Uwaydat; Anatomic and Visual Outcomes of patients with Incomplete Closure of Zone 3 Scleral Lacerations. Invest. Ophthalmol. Vis. Sci. 2021;62(8):1352.
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© ARVO (1962-2015); The Authors (2016-present)
Prompt repair of post-traumatic scleral lacerations (SLs) is suggested to restore globe integrity. When a zone 3 SL extends posteriorly, repairs can be challenging (Fig. 1). We reviewed the visual outcomes of patients with and without complete repair of zone 3 posterior SLs treated with pars plana vitrectomy (PPV).
We reviewed 110 patients with ruptured globes who underwent globe exploration and/or repair, followed by PPV for the management of traumatic vitreoretinal sequelae (i.e., non-resolving vitreous hemorrhage, retinal detachment, lens rupture, intraocular foreign body) between 2008 and 2020. Demographic, surgical, perioperative, and visual acuity (VA) data were recorded. Patients whose SL could not be entirely closed, or with signs of posterior globe rupture based on examination, CT, or ultrasonography, were included in the study. At least 6-months follow-up post-PPV was required. Bivariate analysis between the incomplete closure and the complete closure group was used to identify differences between VA. Analysis was reported as mean ± SD. Two-tailed tests were evaluated with an alpha = 0.05.
Of the 110 patients identified with ruptured globes, 14 had an incompletely repaired zone 3 SL and met our follow-up criteria. The average age of patients with incomplete repair of a zone 3 SL was 43.28 ± 17.83 years. Most of these patients were men (85.71%). The average number of surgical interventions post-initial repair that these patients underwent was 2.92 ± 1.32. Mean VA at presentation in patients with an incomplete closure was logMAR 2.47 ± 0.28, compared to 2.36 ± 0.33 in the complete closure group (n=7). However, no significant difference in the mean initial VA between these two groups was detected (p=0.46). In addition, final VA measured on the most recent follow-up visit showed no significant difference between mean best corrected VA in the incomplete closure (2.03 ± 0.82) and complete closure (2.25 ± 0.32) groups (p=0.49). There were no documented cases of endophthalmitis, and one eye was enucleated. The mean final IOP in patients in the incomplete closure group was within normal limits (10.58 ± 5.93 mmHg).
Our study indicates that incomplete closure of posterior SLs can be compatible with good outcomes, provided early vitreoretinal intervention. Therefore, aggressive attempts at closing posterior SLs should be avoided.
This is a 2021 ARVO Annual Meeting abstract.
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