Abstract
Purpose
Convention is to perform open globe injury (OGI) repair within 24 h to minimize risk of endophthalmitis. However, there are limited data assessing how time to operative repair (OR) within 24 h impacts postoperative visual acuity (VA).
Methods
Manual retrospective chart review of 633 eyes at Massachusetts Eye and Ear (MEE) with a diagnosis of OGI between 2012 and 2022. Inclusion criteria were primary repair ≤ 24 h after injury and ≥1 month follow-up. Multivariate regression analysis was conducted with postoperative VA as primary outcome.
Results
Of the subjects, 489 (77.3%) were male and 496 (78.4%) were white. Demographics of OGI wounds included 320 (50.6%) rupture and 313 (49.4%) laceration; 126 (19.9%) with rAPD, 189 (29.9%) zone 3 injuries, 449 (71.2%) uveal prolapse, and 110 (17.4%) intraocular foreign body. Final postoperative LogMAR VAs consisted of 31% with a VA < 1.7, 9% with a VA of 1.9, 18% with a VA of 2.3, 27% with a VA of 2.7, and 11% with a VA of 3.0. Multivariate analysis showed no significant correlation between time to OR and postoperative VA (p = 0.800) [95%CI: −0.01,0.01]. Older age (p < 0.001) [95%CI: 0.00,0.01], worse presenting VA (p < 0.001) [95%CI: 0.17,0.32], rAPD (p < 0.001) [95%CI: 0.65,1.0], mechanism of rupture (p < 0.001) [95%CI: 0.19,0.54], higher zone of injury (p < 0.001) [95%CI: 0.25,0.45], and uveal prolapse (p = 0.003) [95%CI: 0.09,0.42] were significantly associated with worse final VA.
Conclusions
Time to repair of OGIs within 24 h does not influence final VA. Optimization of surgical and patient factors may contribute more significantly to final VA than prioritizing more rapid time to OR.
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Data availability
The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.
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Acknowledgements
We acknowledge the support of the Ophthalmology Department at Mass Eye and Ear and all those who contributed to the care of our patients with open globe injuries.
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KGM was responsible for conducting the search, screening potentially eligible studies, extracting and analysing data, interpreting results, updating reference lists, and writing the original draft. RAB was responsible for conducting the search, screening potentially eligible studies, extracting and analysing data, interpreting results, updating reference lists, and writing the original draft. GWA was responsible for designing the review protocol, conceptualizing the project, interpreting results, outlining research goals and methodology, and editing the draft. MCW was responsible for designing the review protocol, conceptualizing the project, interpreting results, outlining research goals and methodology, and editing the draft. AI was responsible for conducting the meta-regression analyses and developing the figures. FK was responsible for conducting the search and extracting data. TT was responsible for project administration, submitting the IRB, and supervision. ACL was responsible for conceptualizing the project, submitting the IRB, designing the review protocol, interpreting results, outlining research goals and methodology, supervision, and editing the draft.
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Makhoul, K.G., Bitar, R.A., Armstrong, G.W. et al. Effect of time to operative repair within twenty-four hours on visual acuity outcomes for open globe injuries. Eye 37, 2351–2355 (2023). https://doi.org/10.1038/s41433-022-02350-6
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DOI: https://doi.org/10.1038/s41433-022-02350-6
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