Prognostic factors for vision outcome after surgical repair of open globe injuries

Abstract

Purpose: To evaluate the factors influencing final visual outcome after surgical repair of open globe injuries.

Materials and methods: The study was carried out at a tertiary referral eye care center in Central India. In this retrospective study, case records of 669 patients with open globe injuries were analyzed. Different preoperative variables were correlated with the final visual outcome. Exclusion criteria were patients with less than four months follow up, previous ocular surgery, presence of intraocular foreign body or endophthalmitis at the time of presentation. Using statistical tests, the prognostic factors for vision outcome following surgical repair of open globe injuries were studied.

Results: Based on the Spearman's Rho correlation analysis, following factors were found to be significantly associated with the final visual acuity at univariate level: age (P<0.001), preoperative visual acuity (P=0.045), mode of injury (P=0.001), and time lag between the injury and surgery (P=0.003). None of the other clinical factors have statistically significant correlation with final visual acuity. On multivariate analysis using binary logistic regression, only age, mode of injury and the time lag between injury and surgery achieved statistically significant results.

Conclusion: In the current study, elapsed time between the injury and surgery, age of the patient, preoperative visual acuity and mode of injury were found to be adversely affecting the final visual outcome. Recognizing these factors prior to surgical intervention or intraoperatively can help the surgeon in evidence-based counseling of the trauma victim and family.

Graph 1

Distribution of preoperative in comparision visual acuity

Figure 1

Anterior segment photograph of the patient with (a) complex corneal laceration repaired elsewhere (b) corneal laceration who underwent primary repair by another eye specialist

Figure 2

Patient with full thickness corneal laceration involving visual axis and traumatic cataract

Figure 3

External photograph showing full thickness scleral laceration with uveal tissue prolapse

Figure 4

External photograph of a patient with extensive corneoscleral laceration

Figure 5

Photograph showing partial avulsion of upper lid

Figure 6

Presence of half chamber hyphaema with occult scleral dehiscence in superotemporal quadrant (not seen in this particular image)

Figure 7

Presence of ruptured traumatic cataract with small corneal laceration

Figure 8

Presence of ruptured traumatic cataract with foreign body in anterior chamber with small corneal laceration

Figure 9

(a) Clinical photograph of the patient with corneal laceration with eye lash in the corneal wound (b) Postoperative clinical photograph of the patient with corneal laceration repair

Figure 10

(a) Preoperative clinical photograph of the patient with full thickness corneal laceration and traumatic cataract with corneal edema of the inferior half of the cornea, (b) Post operative clinical photograph of the patient following corneal laceration repair with cataract extraction and scleral fixated intraocular lens

Figure 11

(a) Clinical image of the patient with corneal laceration with traumatic cataract (b) Postoperative clinical photograph of the patient with repaired corneal laceration with presence of post operative traumatic endophthalmitis