To investigate the impact of perioperative evaluation by a vitreoretinal surgeon on outcomes after severe open globe injury (OGI).
Retrospective, comparative study SUBJECTS: OGI cohorts from two academic US ophthalmology departments with disparate OGI management protocols and vitreoretinal referral patterns.
Patients with severe OGI (presenting VA of CF or worse) from the University of Iowa Hospitals and Clinics (UIHC) were compared to patients with severe OGI from Bascom Palmer Eye Institute (BPEI). At UIHC, almost all cases of OGI were repaired by anterior segment surgeons, with post-operative vitreoretinal referral at the surgeon’s discretion. In contrast, at BPEI all OGIs were both repaired and managed post-operatively by a vitreoretinal surgeon.
Rate of vitreoretinal surgeon evaluation, rate of PPV (either primary or secondary), and VA at last follow-up.
74 subjects from UIHC and 72 subjects from BPEI met inclusion criteria. There were no differences in pre-operative VA or rates of vitreoretinal pathology. The rate of vitreoretinal surgeon evaluation was 100% at BPEI vs. 65% at UIHC (P<0.001), and the rate of PPV was 71% at BPEI and 40% at UIHC (P<0.001). Median VA at last follow-up in the BPEI cohort was 1.35 LogMAR (0.53-2.30 interquartile range [IQR], which corresponded to a Snellen VA of approximately 20/500) compared to a median VA of 2.70 LogMAR (0.93-2.92 IQR, corresponding to a Snellen VA of LP) in the UIHC cohort (P=0.031). Overall, 68% of patients in the BPEI cohort had an improvement in VA from presentation to last follow-up versus 43% in the UIHC cohort (P=0.004).
Automatic perioperative evaluation by a vitreoretinal surgeon was associated with a higher rate of PPV and improved visual outcomes. Prompt evaluation by a vitreoretinal surgeon, either pre-operatively or in the early post-operative period, should be considered, when logistically feasible, in severe OGIs because PPV is frequently indicated and may result in significant visual improvement.

Copyright © 2023. Published by Elsevier Inc.