A recent retrospective study found no correlation between time to repair and post-op visual acuity in patients with various types of open globe injury operated on within 24 hours. Photo: Kristen Walton, OD. Click image to enlarge.

It’s known that patients with open globe injuries who do not undergo operative repair within 24 hours are subject to a higher risk of endophthalmitis. Now, researchers wondered if postoperative visual acuity may also be affected by a delay in surgery. To investigate, a team recently performed a manual retrospective chart review at Massachusetts Eye and Ear of patients from 2012 to 2022 who had open globe injuries repaired within 24 hours. The findings, recently published in The Royal College of Ophthalmologists, showed that time to repair did not influence final visual acuity outcomes of open globe injuries.

The study included 633 eyes. The cohort was predominantly white and male (78.4% and 77.3%, respectively). Just over half of patients (50.6%) with open globe injuries presented with a rupture and 49.4% with a laceration. Additionally, 19.9% had relative afferent pupillary defect, 29.9% had zone three injuries, 71.2% had uveal prolapse and 17.4% had an intraocular foreign body.

The researchers performed a multivariate analysis and reported in their paper that it showed no significant correlation between time to primary repair and postoperative visual acuity. They did note several factors that were significantly associated with worse final visual acuity, including older age, worse presenting visual acuity, relative afferent pupillary defect, mechanism of rupture, higher zone of injury and uveal prolapse.

The study had several limitations that the authors pointed out in their paper. First, data was only included from patients with open globe injuries who received operative repair within the recommended 24-hour window. In addition, the cohort of mostly male, non-Hispanics is not representative of the US population. Finally, the team noted that the “data analyzed included only initial and final vision, which did not take into account changes in vision in the interim, as some final follow-up visits were many months or years after the primary open globe injury repair.”

In conclusion, while time to repair didn’t seem to have an effect on visual acuity outcomes in patients with open globe injuries, this data does suggest that variables such as age, presenting visual acuity and type of injury may impact visual outcomes.

Makhoul KG, Bitar RA, Armstrong GW, et al. Effect of time to operative repair within twenty-four hours on visual acuity outcomes for open globe injuries. The Royal College of Ophthalmologists. December 21, 2022. [Epub ahead of print].