A single-center chart review of open globe injuries involving no light perception vision found minimal correlations between presenting clinical features and the likelihood of vision restoration, suggesting that primary globe repair may be warranted for these cases regardless of presentation in the hopes of reversing some vision loss.
Study Design
This retrospective cross-sectional study analyzed all patients 10 years of age and older who presented with open globe injury and no light perception vision at Massachusetts Eye and Ear from January 1999 through March 2022 (147 eyes). The study examined patient demographics and pre-, intra-, and postoperative characteristics, including type of injury, time to operating room, pars plana vitrectomy, lensectomy, and subsequent B-scan ultrasound findings of retinal detachment or disorganization of contents.
Outcomes
Twenty-five eyes (17%) regained some vision at the last follow-up, including 5 eyes that improved to 20/400 or better. Of eyes with improved vision, 60% only improved to light perception. Disorganized B-scan ultrasound was the only risk factor significantly associated with the likelihood of regaining vision (OR 0.170).
Limitations
The data is limited by 2 major issues. First, the extended timeframe (1999–2022) allowed for significant variability in record keeping, particularly associated with the introduction of electronic medical records. The authors chose to exclude patients with incomplete data, but they do not comment on how many were excluded. This may lead to a potential selection bias. Secondly, the choice of last follow-up visit to define visual recovery ignores patients who may have recovered temporarily after globe repair but who subsequently lost vision over time.
Clinical Significance
Despite these limitations, this study reinforces my practice patterns to attempt globe repair even in eyes initially presenting with no light perception, as some vision may be recoverable. Furthermore, using B-scan ultrasound to determine disorganization of an eye after repair is helpful in guiding prognostic discussions with patients.
Financial Disclosures: Dr. Rebecca Soares discloses no financial relationships.