Effect of time to operative repair within twenty-four hours on visual acuity outcomes for open globe injuries

• Published in: Eye (London) Vol. 37; no. 11; pp. 2351 - 2355
• Main Authors: Makhoul, Kevin G., Bitar, Racquel A., Armstrong, Grayson W., Weinert, Marguerite C., Ivanov, Alexander, Kahale, Francesca, Ta, Thong, Lorch, Alice C.
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.08.2023; Nature Publishing Group
• Subjects: 692/1807/1482; 692/308/409; 692/499; 692/700/784; 706/648/160; Acuity; Endophthalmitis; Eye; Eye Injuries, Penetrating - diagnosis; Female; Humans; Injuries; Laboratory Medicine; Male; Medicine; Medicine & Public Health; Multivariate analysis; Ophthalmology; Pharmaceutical Sciences/Technology; Prognosis; Random Amplified Polymorphic DNA Technique; Retrospective Studies; Rupture; Surgery; Surgical Oncology; Visual Acuity
• ISSN: 0950-222X; 1476-5454; 1476-5454
• DOI: 10.1038/s41433-022-02350-6

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.