TIMING INFLUENCE ON OUTCOMES OF VITRECTOMY FOR OPEN-GLOBE INJURY: A Prospective Randomized Comparative Study. Issue 4 (April 2020)

• Record Type: Journal Article
• Authors: He, Yan; Zhang, Ling; Wang, Fang; Zhu, Meidong; Wang, Yi; Liu, Yong
• Is Part Of: Retina. Volume 40:Issue 4(2020)
• Publication Date: 2020-04
• Subjects: open-globe injury -- timing -- randomized clinical trial -- vitrectomy; Retina -- Diseases -- Periodicals; Retinal Diseases; Vitreous Body; 617.735
• DOI: 10.1097/IAE.0000000000002447
• Languages: English
• ISSNs: 0275-004X

Abstract

Abstract : Purpose: To compare the impact of surgical timing on anatomical and functional outcomes of vitrectomy for open-globe injury. Methods: Fifty-three patients were entered into this prospective open-label study, with 26 patients randomized into early surgery group (vitrectomy conducted within 4 days) and 27 into delayed surgery group (vitrectomy performed between 10–14 days after injury). Six-month data were available for 46 patients and 7 were lost to follow-up. The main outcome measures were incidence of traumatic proliferative vitreoretinopathy assessed intraoperatively and postoperatively, reattachment of retina, eye enucleation, improvement of the best-corrected visual acuity, and complications. Results: Patient demographics and surgical intervention were similar in both groups. Final analysis of 46 patients demonstrated higher rates of traumatic proliferative vitreoretinopathy assessed both intraoperatively and postoperatively in the delayed group ( P = 0.000; P = 0.054). In the early surgery group, 18 of 21 patients had retinal detachment, of which 15 patients (83%) achieved retinal reattachment by the first vitreoretinal surgery, 2 patients (11%) by a second surgery, and 1 (6%) received enucleation. In the delayed surgery group, 22 of 25 patients had retinal detachment. Retinal reattachment was achieved in 7 (32%) and 8 (36%) with the first and the second surgery, respectively, and 7 patients (32%) received enucleation ( P = 0.005). In the early surgery group, best-corrected visual acuity improved significantly, moderately, and decreased in 8 patients (38%), 11 eyes (52%) and 2 eyes (10%), respectively. In the delayed surgery group, best-corrected visual acuity improved significantly, moderately, and worsened in 3 eyes (12%), 12 eyes (48%), and 10 eyes (40%) ( P = 0.041), respectively. No statistically significant difference was observed in the rate of postoperative complications between the two groups. Conclusion: Early vitrectomy after open-globe injury leads to better anatomical and functional outcomes. Abstract : This prospective open-label randomized controlled study showed that early vitrectomy could reduce the risk of traumatic proliferative vitreoretinopathy and increase the likelihood of retinal reattachment. Patients achieved better visual acuity at last follow-up with early intervention. No statistically significant difference was observed in the rate of intraoperative and postoperative complications.