Indications, Findings and Outcomes of Vitrectomy after Open Globe Injury

Abstract Purpose To determine the indications, findings and outcomes of patients with open globe injury (OGI) requiring pars plana vitrectomyDesign: Retrospective, single vitreoretinal surgeon case series Participants A total of 61 consecutive eyes with OGI that required vitrectomy Methods Retrospective chart review of consecutive patients who underwent vitrectomy following OGI between March 1, 2011 and August 1, 2017 treated at Massachusetts Eye and Ear by one surgeon Main Outcome Measures Final visual acuity and rates of recurrent retinal detachment and proliferative vitreoretinopathy Results Over a 6.5 year period, 61 eyes of 61 consecutive patients underwent vitrectomy after sustaining an OGI. Mean follow-up was 12.8 ± 12.1 months (range 0.5-65 months). At the time of presentation after OGI, 64% of eyes had light perception or worse vision. The indications for vitrectomy, which was performed on average 15 days after injury, included retinal detachment (RD) without retinal incarceration (39%), RD with retinal incarceration in the scleral and/or corneal wound (13%), media opacity without RD (28%), vitreous traction without RD (11%), intraocular foreign body (5%), and endophthalmitis (3%). At the time of vitrectomy, substantial comorbidities were noted, including corneal trauma (20%), hyphema (41%), iris trauma (62%), lens expulsion (54%), subretinal hemorrhage (51%), and choroidal hemorrhage (30%). Using multivariable analysis, the factors associated with retinal detachment after initial PPV were preoperative subretinal hemorrhage (OR 5.73, p=0.03), proliferative vitreoretinopathy found at initial vitrectomy (11.94, p=0.021) and retinectomy (OR 17.88, p=0.003). No cases were inoperable, as all patients left the operating room with complete retinal reattachment. Of the 35 eyes that presented with a retinal detachment, 19 eyes (54%) redetached due to proliferative vitreoretinopathy. Eighty percent of eyes with initial presentation of a retinal detachment (28/35 eyes) remained completely attached at last follow up, and 5 additional eyes remained partially attached (33/35, 94%). Of the 61 total eyes included in this study, 89% remained completely attached, and 42 eyes (69%) achieved visual acuity ≥ 20/200 at last follow up. Conclusions Despite substantial ocular comorbidities, vitrectomy surgery can result in retinal reattachment in even the most severe cases. Good visual outcomes can be achieved for a majority of patients who undergo vitreoretinal surgery after open globe trauma.