This article is more than 5 years old. Information may no longer be current.
Open-globe injuries require long-term surveillance, extensive surgical follow-up
Click Here to Manage Email Alerts
Most patients undergoing multiple operations for open-globe injuries had worse postoperative visual acuity compared to patients requiring a single operation, a large study found.
“We feel that the guarded prognosis of an open-globe injury should be shared with the patient preoperatively to ensure realistic expectations of recovery,” the study authors said. “This should include preoperative discussion that the initial repair will likely be only the first step to a successful recovery.”
The retrospective analysis included 1,415 surgical procedures performed for 848 open-globe injuries incurred by 846 patients. The mean follow-up interval was 19.7 months, encompassing 6,017 office visits.
Study results showed that the average patient required 1.7 operations and 7.1 follow-up visits.
According to the data, 466 injuries (55%) required only open-globe repair; follow-up operations were required in the remaining 382 injuries (45%). One additional operation subsequent to primary repair was performed in 262 patients (31%); the remaining 120 patients (14%) underwent at least two additional procedures. The highest number of operations performed on one patient was nine.
High ocular trauma severity scores, worse preoperative visual acuity, retinal hemorrhage, and anterior vitrectomy, pars plana vitrectomy or lensectomy performed during primary repair were factors that best predicted the need for follow-up surgery.
Patients with zone 2 injury, hemorrhagic choroidal detachment or history of previous ocular surgery were the least likely to require follow-up surgery.
Patients who underwent vitreoretinal follow-up surgery had the worst postoperative visual outcomes.
Worse preoperative visual acuity, postoperative afferent pupillary defect, advanced age, scleral laceration and retinal detachment correlated most strongly with poor visual outcomes, the authors said.
Perspective
Back to TopJulian D. Perry, MD
The requirement for further surgery in almost half of patients undergoing open globe repair and the poorer visual outcomes in these patients highlight the need for careful guidance of patient expectations by the surgeon. We should inform our patients that the primary goal of surgery represents salvaging the globe and that while we can offer secondary surgeries, patients who require more surgery generally have worse visual outcomes due to the nature of their initial injury. Patients should understand that the year following open globe repair may be a challenging one for them, calling for multiple office visits and possibly multiple surgeries. Finally, the initial discussion should describe the reality that despite heroic intervention, the patient may still lose the eye, even years after the injury. This study provides useful data to validate our preoperative discussion with patients who suffer from open globe injuries.
Collapse
Am J Ophthalmol. 2012;153(5):856-860.
Click Here to Manage Email Alerts