Relationship of Neutrophil-to-Lymphocyte and Platelet-to-Lymphocyte Ratio With Visual Acuity After Surgical Repair of Open Globe Injury

Abstract

Purpose: To assess the relationship and prognostic value of the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) with poor final best-corrected visual acuity (BCVA) after surgical repair of open globe injuries (OGI) in adults. Design: Retrospective analysis of data from an ongoing prospective cohort of consecutive patients. Methods: In a tertiary university hospital, 197 eyes of 197 patients were included between 2013 and 2017. NLR and PLR were obtained from pre-operative blood tests to analyze its relationship with poor final BCVA. Results: Severe visual impairment (SVI) was defined as ≤20/200, and was observed in 96 (48.7%) patients after surgical repair of OGI. SVI patients had higher NLR (7.4 ± 6.6 vs. 4.0 ± 3.2, p < 0.001), and PLR (167 ± 92 vs. 139 ± 64; p = 0.021) than non-SVI. NLR ≥ 3.47 and PLR ≥ 112.2 were the best cut-off values for SVI, were univariate risk factors for SVI, and had sensitivity: 69.0, 71.4, and specificity: 63.6, 44.8, respectively. In multivariate analysis, only OTS, athalamia, and hyphema remained as risk factors. NLR had significant correlation with ocular trauma score (OTS) (r = -0.389, p < 0.001) and final BCVA (r = 0.345, p < 0.001). Limitations: Simultaneous trauma in other parts of the body that could influence the laboratory findings. Conclusion: Patients with SVI after a repaired OGI had increased pre-operative NLR and PLR levels. High NLR and PLR are risk factors for SVI in univariate analysis. It is confirmed that low OTS is a risk factor for SVI. High NLR and PLR could be used as a prognostic tool to identify patients at higher risk for SVI after repair of OGI.

Keywords: neutrophil lymphocyte ratio (NLR); ocular injury; ocular trauma; open globe injury (OGI); platelet lymphocyte ratio (PLR); prognostic; severe visual impairment.

Figure 1

(A) Scatterplot of the initial LogMAR best corrected visual acuity (BCVA) with the final LogMAR BCVA. Patients with better initial BCVA were more likely to have better final BCVA. The majority that ended with severe visual impairment (SVI) had poor initial BCVA (LogMAR >2.00 equivalent to count fingers or worst). Only 2 patients with initial BCVA better than count fingers ended with SVI. (B) Receiver Operating Characteristics (ROC) curve analysis for discrimination between patients with SVI and Non-SVI (NSVI) in all patients. (C) ROC curve analysis for discrimination between patients with SVI and NSVI only in patients with no comorbidities. (D) ROC curve analysis for discrimination between patients with SVI and NSVI only in patients with comorbidities. (E) Scatterplot and linear regression of neutrophil to lymphocyte ratio (NLR) with the ocular trauma score (OTS) raw points. (F) Scatterplot and linear regression of platelet to lymphocyte ratio (PLR) with the OTS raw points. (G) Scatterplot and linear regression of NLR with the final BCVA. (H) Scatterplot and linear regression of PLR with the final BCVA.