Visual outcomes of vitreoretinal surgery in eyes with severe open-globe injury presenting with no-light-perception vision

  • Hani Salehi-Had
  • Christopher M. Andreoli
  • Michael T. Andreoli
  • Carolyn E. Kloek
  • Shizuo Mukai
Trauma

Abstract

Background

Severe ocular trauma causing no light perception (NLP) typically carries a dismal prognosis, and implies no further therapeutic intervention. We have identified a cohort of patients with verified NLP following open-globe injury who have recovered vision of light perception (LP) or better. We evaluated the outcomes of vitreoretinal surgery performed on eyes that were NLP post open-globe injury.

Methods

Retrospective review of outcomes of secondary vitreoretinal surgery performed at Massachusetts Eye and Ear Infirmary from 1 January 2001 to 31 December 2006 on all cases of open-globe repair (OGR) that had NLP prior to OGR or on the first post-operative day.

Results

A total of 648 cases of OGR were performed in the study period. Eighty-eight patients had NLP prior to OGR or on the first post-operative day after OGR. Twenty-three patients from the above group (26.1%) spontaneously recovered a vision of light perception (LP) or better. Eight of the 23 patients had a secondary vitreoretinal surgery. All eyes that did not undergo vitreoretinal surgery returned to NLP or became phthisical within 7 months. Among the eight eyes that underwent surgery, five had improvement, with vision ranging from hand motion to 20/70. Prognostic indicators for successful surgical outcome were hand motion or better vision prior to vitreoretinal surgery, recovery of vision within 5 days of OGR, and vitreoretinal intervention within 5 weeks of the initial open-globe injury.

Conclusion

Patients with severe open-globe injury and NLP occasionally recover LP or better vision. These patients may regain useful vision after vitreoretinal surgery if prompt referral and intervention is attempted and if the spontaneous visual recovery occurs within the first week after OGR.

Keywords

Ocular trauma Open globe injury Vitreoretinal surgery No light perception (NLP) 

References

  1. 1.
    May DR, Kuhn FP, Morris RE, Witherspoon CD, Danis RP, Matthews GP, Mann L (2000) The epidemiology of serious eye injuries from the United States Eye Injury Registry. Graefes Arch Clin Exp Ophthalmol 238(2):153–157. doi:10.1007/PL00007884 PubMedCrossRefGoogle Scholar
  2. 2.
    Babar TF, Khan MT, Marwat MZ, Shah SA, Murad Y, Khan MD (2007) Patterns of ocular trauma. J Coll Physicians Surg Pak 17(3):148–153PubMedGoogle Scholar
  3. 3.
    Thylefors B (1992) Epidemiological patterns of ocular trauma. Aust N Z J Ophthalmol 20(2):95–98, doi:10.1111/j.1442-9071.1992.tb00718.x PubMedCrossRefGoogle Scholar
  4. 4.
    Kim JH, Yang SJ, Kim DS, Kim JG, Yoon YH (2007) Fourteen-year review of open globe injuries in an urban Korean population. J Trauma 62(3):746–749, doi:10.1097/01.ta.0000231557.58471.e3 PubMedCrossRefGoogle Scholar
  5. 5.
    Matthews GP, Das A, Brown S (1998) Visual outcome and ocular survival in patients with retinal detachments secondary to open- or closed-globe injuries. Ophthalmic Surg Lasers 29(1):48–54PubMedGoogle Scholar
  6. 6.
    Rofail M, Lee GA, O’Rourke P (2006) Prognostic indicators for open globe injury. Clin Experiment Ophthalmol 34(8):783–786, doi:10.1111/j.1442-9071.2006.01309.x PubMedCrossRefGoogle Scholar
  7. 7.
    Kuhn F, Maisiak R, Mann L, Mester V, Morris R, Witherspoon CD (2002) The Ocular Trauma Score (OTS). Ophthalmol Clin North Am 15(2):163–165, doi:10.1016/S0896-1549(02)00007-X PubMedCrossRefGoogle Scholar
  8. 8.
    Entezari M, Rabei HM, Badalabadi MM, Mohebbi M (2006) Visual outcome and ocular survival in open-globe injuries. Injury 37(7):633–637, doi:10.1016/j.injury.2006.02.043 PubMedCrossRefGoogle Scholar
  9. 9.
    De Juan E Jr, Sternberg P Jr, Michels RG (1983) Penetrating ocular injuries. Types of injuries and visual results. Ophthalmology 90(11):1318–1322PubMedGoogle Scholar
  10. 10.
    Pieramici DJ, MacCumber MW, Humayun MU, Marsh MJ, de Juan E Jr (1996) Open-globe injury. Update on types of injuries and visual results. Ophthalmology 103(11):1798–1803PubMedGoogle Scholar
  11. 11.
    Schmidt GW, Broman AT, Hindman HB, Grant MP (2008) Vision Survival after Open Globe Injury Predicted by Classification and Regression Tree Analysis. Ophthalmology 115(1):202–209, doi:10.1016/j.ophtha.2007.04.008 PubMedCrossRefGoogle Scholar
  12. 12.
    Gilbert CM, Soong HK, Hirst LW (1987) A two-year prospective study of penetrating ocular trauma at the Wilmer Ophthalmological Institute. Ann Ophthalmol 19(3):104–106PubMedGoogle Scholar
  13. 13.
    Esmaeli B, Elner SG, Schork MA, Elner VM (1995) Visual outcome and ocular survival after penetrating trauma. A clinicopathologic study. Ophthalmology 102(3):393–400PubMedGoogle Scholar
  14. 14.
    Rahman I, Maino A, Devadason D, Leatherbarrow B (2006) Open globe injuries: factors predictive of poor outcome. Eye 20(12):1336–1341, doi:10.1038/sj.eye.6702099 PubMedCrossRefGoogle Scholar
  15. 15.
    Sternberg P Jr, de Juan E Jr, Michels RG, Auer C (1984) Multivariate analysis of prognostic factors in penetrating ocular injuries. Am J Ophthalmol 98(4):467–472, doi:10.1016/0002-9394(84)90133-8 PubMedCrossRefGoogle Scholar
  16. 16.
    Liggett PE, Gauderman WJ, Moreira CM, Barlow W, Green RL, Ryan SJ (1990) Pars plana vitrectomy for acute retinal detachment in penetrating ocular injuries. Arch Ophthalmol 108(12):1724–1728PubMedGoogle Scholar
  17. 17.
    Sobaci G, Mutlu FM, Bayer A, Karagül S, Yildirim E (2000) Deadly weapon-related open-globe injuries: outcome assessment by the ocular trauma classification system. Am J Ophthalmol 129(1):47–53, doi:10.1016/S0002-9394(99)00254-8 PubMedCrossRefGoogle Scholar
  18. 18.
    Moshfeghi DM, Moshfeghi AA, Finger PT (2000) Enucleation. Surv Ophthalmol 44(4):277–301, doi:10.1016/S0039-6257(99)00112-5 PubMedCrossRefGoogle Scholar
  19. 19.
    Grant WF Jr, Swan KG (1980) Gunshot wounds of the orbit. J Trauma 20(9):809–811, doi:10.1097/00005373-198009000-00019 PubMedCrossRefGoogle Scholar
  20. 20.
    du Toit N, Motala MI, Richards J, Murray AD, Maitra S (2008) The risk of sympathetic ophthalmia following evisceration for penetrating eye injuries at Groote Schuur Hospital. Br J Ophthalmol 92(1):61–63, doi:10.1136/bjo.2007.120600 PubMedCrossRefGoogle Scholar
  21. 21.
    Hui Y, Wang L, Shan W (1996) Exploratory vitrectomy for traumatized eyes with no light perception and dense vitreous hemorrhage. Zhonghua Yan Ke Za Zhi 32(6):450–452PubMedGoogle Scholar
  22. 22.
    Brinton GS, Aaberg TM, Reeser FH, Topping TM, Abrams GW (1982) Surgical results in ocular trauma involving the posterior segment. Am J Ophthalmol 93(3):271–278PubMedGoogle Scholar
  23. 23.
    Coleman DJ (1982) Early vitrectomy in the management of the severely traumatized eye. Am J Ophthalmol 93(5):543–551PubMedGoogle Scholar
  24. 24.
    Mieler WF, Mittra RA (1997) The role and timing of pars plana vitrectomy in penetrating ocular trauma. Arch Ophthalmol 115(9):1191–1192PubMedGoogle Scholar
  25. 25.
    de Bustros S, Michels RG, Glaser BM (1990) Evolving concepts in the management of posterior segment penetrating ocular injuries. Retina 10(Suppl 1):S72–S75, doi:10.1097/00006982-199001010-00014 PubMedGoogle Scholar
  26. 26.
    Pieramici DJ (2002) Vitreoretinal trauma. Ophthalmol Clin North Am 15(2):225–234, doi:10.1016/S0896-1549(02)00012-3 PubMedCrossRefGoogle Scholar
  27. 27.
    Bajaire B, Oudovitchenko E, Morales E (2006) Vitreoretinal surgery of the posterior segment for explosive trauma in terrorist warfare. Graefes Arch Clin Exp Ophthalmol 244(8):991–995, doi:10.1007/s00417-005-0186-1 PubMedCrossRefGoogle Scholar
  28. 28.
    Martin DF, Meredith TA, Topping TM, Sternberg P Jr, Kaplan HJ (1991) Perforating (through-and-through) injuries of the globe. Surgical results with vitrectomy. Arch Ophthalmol 109(7):951–956PubMedGoogle Scholar
  29. 29.
    Winthrop SR, Cleary PE, Minckler DS, Ryan SJ (1980) Penetrating eye injuries: a histopathological review. Br J Ophthalmol 64(11):809–817, doi:10.1136/bjo.64.11.809 PubMedCrossRefGoogle Scholar
  30. 30.
    Cleary PE, Ryan SJ (1979) Histology of wound, vitreous, and retina in experimental posterior penetrating eye injury in the rhesus monkey. Am J Ophthalmol 88(2):221–231PubMedGoogle Scholar
  31. 31.
    Gürdal C, Erdener U, Irkeç M, Orhan M (2002) Incidence of sympathetic ophthalmia after penetrating eye injury and choice of treatment. Ocul Immunol Inflamm 10(3):223–227, doi:10.1076/ocii.10.3.223.15600 PubMedCrossRefGoogle Scholar
  32. 32.
    Bellan L (1999) Sympathetic ophthalmia: a case report and review of the need for prophylactic enucleation. Can J Ophthalmol 34(2):95–98PubMedGoogle Scholar
  33. 33.
    Albert DM, Diaz-Rohena R (1989) A historical review of sympathetic ophthalmia and its epidemiology. Surv Ophthalmol 34(1):1–14, doi:10.1016/0039-6257(89)90125-2 PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Hani Salehi-Had
    • 1
  • Christopher M. Andreoli
    • 1
  • Michael T. Andreoli
    • 2
  • Carolyn E. Kloek
    • 1
  • Shizuo Mukai
    • 1
    • 3
  1. 1.Department of Ophthalmology, Harvard Medical SchoolMassachusetts Eye and Ear InfirmaryBostonUSA
  2. 2.Boston University School of MedicineBostonUSA
  3. 3.Retina ServiceMassachusetts Eye and Ear InfirmaryBostonUSA

Personalised recommendations