Improved Visual Outcomes after Severe Open-Globe Injuries Associated with Perioperative Vitreoretinal Evaluation

Abstract

To investigate the impact of perioperative evaluation by a vitreoretinal surgeon on outcomes after severe open-globe injury (OGI). Retrospective, comparative study. Open-globe injury cohorts from 2 academic United States ophthalmology departments with disparate OGI management protocols and vitreoretinal referral patterns. Patients with severe OGI (presenting visual acuity [VA] of counting fingers or worse) from the University of Iowa Hospitals and Clinics (UIHC) were compared with patients with severe OGI from the Bascom Palmer Eye Institute (BPEI). At UIHC, almost all cases of OGI were repaired by anterior segment surgeons, with postoperative vitreoretinal referral at the surgeon's discretion. In contrast, at BPEI, all OGIs were both repaired and managed postoperatively by a vitreoretinal surgeon. Rate of vitreoretinal surgeon evaluation, rate of pars plana vitrectomy (PPV) (either primary or secondary), and VA at the last follow-up. Overall, 74 subjects from UIHC and 72 subjects from BPEI met the inclusion criteria. There were no differences in preoperative VA or rates of vitreoretinal pathology. The rate of vitreoretinal surgeon evaluation was 100% at BPEI and 65% at UIHC (P < 0.001), and the rate of PPV was 71% at BPEI and 40% at UIHC (P < 0.001). Median VA at the last follow-up in the BPEI cohort was 1.35 logarithm of the minimum angle of resolution (logMAR) (interquartile range [IQR], 0.53-2.30, corresponding to a Snellen VA of ∼ 20/500) compared with a median VA of 2.70 logMAR (IQR, 0.93-2.92, corresponding to a Snellen VA of light perception) in the UIHC cohort (P= 0.031). Overall, 68% of patients in the BPEI cohort had an improvement in VA from presentation to last follow-up versus 43% in the UIHC cohort (P= 0.004). Automatic perioperative evaluation by a vitreoretinal surgeon was associated with a higher rate of PPV and improved visual outcomes. Prompt evaluation by a vitreoretinal surgeon, either preoperatively or in the early postoperative period, should be considered, when logistically feasible, in severe OGIs because PPV is frequently indicated and may result in significant visual improvement. Proprietary or commercial disclosure may be found after the references.