Abstract
Purpose :
To identify risk factors for retinal detachment (RD) following open globe injury (OGI) and evaluate outcomes of RD repair after OGI.
Methods :
A retrospective chart review was performed of all OGIs presenting to the University of Michigan between January 2000 and July 2022. A total of 789 eyes with OGI were surgically managed and had at least 30 days of follow-up. All eyes diagnosed with RD within this cohort were included in this study. Multivariable regression was performed to identify risk factors for RD following OGI and predictors of poor vision outcomes after RD repair.
Results :
Following OGI, 229/789 eyes were diagnosed with RD. Most patients were male (180/229) with mean age of 41.1 ± 22.8 years. The most common mechanism of injury was blunt trauma (147/229). Mean presenting logMAR visual acuity was 2.48 ± 0.71, a Snellen equivalent between hand motion (HM) and light perception. 34/229 eyes were diagnosed with RD on presentation, 99/229 eyes within 1 week, and 168/229 eyes within 1 month. Predictors of RD in multivariable regression include zone 3 injury (OR = 3.4, 95% CI [2.2, 5.1]), lens disruption (OR 1.6, 95% CI [1.1, 2.5]) vitreous hemorrhage (OR = 4.1, 95% CI [2.8, 6.1]), and presenting acuity worse than count fingers (CF) (OR = 3.0, 95% CI [1.7, 5.4]). RD repair took place in 147/229 eyes, followed by re-detachment in 45 eyes (30.6%). The mean logMAR visual acuity after RD repair was 1.92 ± 0.95, a Snellen equivalent between CF and HM. At last follow-up, 61/147 eyes achieved vision CF or better. Predictors of poor vision, defined as Snellen equivalent worse than CF, following RD repair in multivariable modeling include proliferative vitreoretinopathy (PVR) at time of surgery (OR 2.6, 95% CI [1.1, 5.8]), aphakia (OR 3.8, 95% CI [1.4, 10.2]) and re-detachment (OR 3.7, 95% CI [1.6, 8.5]).
Conclusions :
Retinal detachment typically occurs within the first month following OGI. Patients with posterior injuries, vitreous hemorrhage, lens disruption, or poor presenting visual acuity were more likely to develop RD after OGI. Anatomic success after RD repair was achieved in most cases and just under half of patients who underwent repair attained ambulatory vision, which suggests that surgery may be worth attempting in many cases of RD after OGI. PVR at the time of RD repair, aphakia and retinal re-detachment were risk factors for a poor visual outcome.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.