June 2022
Volume 63, Issue 7
Open Access
ARVO Annual Meeting Abstract  |   June 2022
Outcomes of Far Posterior Open Globe Injuries: The Case for Zone 4
Author Affiliations & Notes
  • Isaac Bleicher
    Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts, United States
  • Grayson Wilkes Armstrong
    Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts, United States
  • Eric D. Gaier
    Ophthalmology, Boston Children's Hospital, Boston, Massachusetts, United States
    Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts, United States
  • Footnotes
    Commercial Relationships   Isaac Bleicher None; Grayson Armstrong McKinsey & Company, Code C (Consultant/Contractor), Xenon-VR, Code C (Consultant/Contractor), Ophthalytics, Code C (Consultant/Contractor), Kriya Technologies, Code C (Consultant/Contractor), Ocular Technologies Inc., Code O (Owner), American Medical Association, Code S (non-remunerative); Eric Gaier Luminopia, Inc., Code C (Consultant/Contractor), Stoke Therapeutics Inc., Code C (Consultant/Contractor), Luminopia, Inc., Code P (Patent)
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science June 2022, Vol.63, 3546 – A0126. doi:
  • Views
  • Share
  • Tools
    • Alerts
      This feature is available to authenticated users only.
      Sign In or Create an Account ×
    • Get Citation

      Isaac Bleicher, Grayson Wilkes Armstrong, Eric D. Gaier; Outcomes of Far Posterior Open Globe Injuries: The Case for Zone 4. Invest. Ophthalmol. Vis. Sci. 2022;63(7):3546 – A0126.

      Download citation file:

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

  • Supplements

Purpose : Open globe injuries (OGIs) are categorized by zone of injury, with Zone 3 (Z3) defined as ≥5mm posterior to the corneal limbus. Heterogeneity in outcomes of Z3 OGIs precludes precise prognostication and surgical management decisions. We hypothesized that Z3 OGIs with far posterior wounds would have worse visual and anatomic outcomes.

Methods : We performed a retrospective review of Z3 OGIs with at least 30 days of follow-up treated at a tertiary care center over a 10-year period. Far posterior OGIs (pZ3) were defined as those with wounds extending ≥10mm posterior from the corneal limbus. Secondary surgeries, visual outcomes, and anatomic outcomes were compared between pZ3 and anterior Z3 (aZ3) eyes at presentation, the 3 months and the latest available timepoints after injury. Fisher’s exact and Mann-Whitney U tests were used to compare pZ3 and aZ3 outcomes.

Results : Of 264 Z3 OGI eyes, 215 met inclusion criteria. Of these, 132/215 (61%) were classified as pZ3. pZ3 and aZ3 eyes underwent means (±SD) of 1.6±1.6 and 1.4±1.5 secondary procedures, respectively (p>0.4). At 3 months after injury, pZ3 eyes were less likely to maintain light perception or better vision (pZ3: 53%, aZ3: 77%), count fingers or better vision (pZ3: 28%, aZ3: 49%), or have ≥20/400 Snellen acuity (pZ3: 18%, aZ3: 39%)(p values≤0.01). These relationships were also seen at final follow-up for light perception (pZ3: 53%, aZ3: 71%), count fingers (pZ3: 27%, aZ3: 46%), and ≥20/400 acuities (pZ3: 17%, aZ3: 36%) (p values≤0.01). The effect of zonal group on count fingers and ≥20/400 acuity persisted even when excluding patients presenting without light perception (p values≤0.02). After OGI repair, pZ3 eyes were less likely to have improved visual acuity (pZ3: 34%, aZ3: 49%) and more likely to have reduced visual acuity (pZ3: 20%, aZ3: 7.2%) from presentation (p<0.01). A significantly greater proportion of pZ3 eyes became phthisical or were eviscerated/enucleated compared with aZ3 eyes (56% vs 40%, p=0.02).

Conclusions : Eyes with OGIs extending ≥10 mm posterior to the corneal limbus have poorer visual and anatomic outcomes compared to those limited to the more anterior Z3. While the potential for recovery in posterior OGIs necessitates careful assessment and emergent repair in all cases, further zonal categorization within zone 3 injuries may help improve prognostic precision and refine surgical approaches.

This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.


This PDF is available to Subscribers Only

Sign in or purchase a subscription to access this content. ×

You must be signed into an individual account to use this feature.