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Karen Michelle Wai, Noha A Sherif, Marisa Tieger, Grayson Wilkes Armstrong; Recovery of Vision in Open Globe Injury Patients with Initial No Light Perception Vision. Invest. Ophthalmol. Vis. Sci. 2022;63(7):4301.
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© ARVO (1962-2015); The Authors (2016-present)
The recovery of vision in open globe injuries (OGI) in patients who present with no light perception (NLP) vision is poorly understood. These patients often undergo primary enucleation or evisceration to mitigate the risk of sympathetic ophthalmia. We conducted a retrospective chart review to identify patient characteristics, OGI features, and surgical events that may predict the recovery of any vision in patients initially presenting with NLP vision to inform clinical management.
The Massachusetts Eye and Ear (MEE) OGI Database was used to identify patients with NLP vision at presentation from January 1999 to December 2019. The medical records of these patients were analyzed to identify demographic characteristics; zone of injury; time from injury to surgical repair; need for vitrectomy; presence of retinal detachment, vitreous hemorrhage, intraocular foreign body (IOFB), hyphema, amongst 17 other features; and visual acuity (VA) at last follow-up appointment. Logistic regression was used to analyze the relationship between regained vision at the most recent follow-up visit and the above dependent variables (Python 3.10.1). Patients without a documented VA at most recent follow-up were excluded.
A total of 294 OGI cases with NLP at presentation that met inclusion criteria were identified, of which, 119 cases (35.95%) regained better than NLP vision at most recent follow-up. Regained vision ranged from VAs of 20/70 (3.36%) to LP (35.29%). Nine (3.06%%) Zone I, 52 (17.69%) Zone II, 118 (40.14%) Zone III, and 115 (29.12%) Zone unknown injuries were documented. Vitrectomy was positively associated with regained vision (B=2.2, p=0.002), while previous intraocular surgery was negatively associated with regained vision (B=-0.9, p=0.03). Both the presence of an IOFB and OGI repair within ten hours of injury approached statistical significance for association with regained vision (B=-1.5, p=0.08 and B=0.9, p=0.09, respectively).
While OGIs cause severe ocular morbidity, a significant proportion of OGIs with initial NLP vision regained some vision during follow-up care. Previous intraocular surgery was negatively associated with return of vision, while vitrectomy was positively associated. These findings argue for primary closure of OGIs given potential for return of vision rather than primary enucleation, even in the presence of NLP vision at initial presentation.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.
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