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Chauhan MZ, Georgiou M, Al-Hindi H, Uwaydat SH. Outcomes of pars plana vitrectomy following ocular trauma at varying surgical time points. Int J Retina Vitreous 2022; 8:49. [PMID: 35879788 PMCID: PMC9310478 DOI: 10.1186/s40942-022-00399-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 07/11/2022] [Indexed: 11/10/2022] Open
Abstract
Background The optimal timing of pars plana vitrectomy (PPV) following ocular trauma is an ongoing debate. Early vitrectomy post-trauma enables the rapid assessment of retinal disease by removing the scaffold that fosters proliferative vitreoretinopathy. On the other hand, late vitrectomy is less challenging as there is a lower risk of bleeding and posterior vitreous detachment induction is easier. The purpose of this work is to report the functional and anatomical outcomes following ocular traumatic injuries in a United States-based cohort, emphasizing the time of intervention. Methods This was a retrospective case series of 110 patients with traumatic ocular injuries who underwent PPV between 2008 to 2020. Patients were grouped into four timing categories: same day (0 days), early (1–7 days), delayed (8–14 days), and late (> 14 days). Multivariable regression models controlling for confounding were implemented to assess the impact of vitrectomy timing on anatomical and functional outcomes. Visual acuity (VA) at baseline and after surgery, proliferative vitreoretinopathy (PVR), and enucleation for each vitrectomy timing category were recorded. Results Patient demographics and severity of ocular trauma were comparable across timing categories. Final VA in LogMAR was found to have a stepwise worsening as the time of ocular trauma to vitrectomy was increased (p < 0.05). For every one-step increase in the vitrectomy timing category, there was an adjusted 0.24 (CI 0.04–0.44) increase in final VA. No patient in the same day vitrectomy group had an enucleation or PVR, while patients who had late vitrectomies had the largest number of both enucleations and PVR (44.4% and 52.0%, respectively). In adjusted analysis, there was 3.11 increased odds (CI 1.03–9.42) of developing PVR for a one-step increase in vitrectomy timing (p < 0.05). Conclusion Vitrectomy on the same day of injury has the best final VA, and the lowest incidence rates of PVR and enucleation in comparison to other timing categories, regardless of etiology. Supplementary Information The online version contains supplementary material available at 10.1186/s40942-022-00399-9.
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The Vitrectomy Timing Individualization System for Ocular Trauma (VTISOT). Sci Rep 2019; 9:12612. [PMID: 31471555 PMCID: PMC6717195 DOI: 10.1038/s41598-019-48862-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 08/14/2019] [Indexed: 01/16/2023] Open
Abstract
Ocular trauma is a major cause of monocular blindness worldwide. Vitrectomy at correct timing can significantly improve the efficacy and prognosis, but the timing of vitrectomy has remained highly controversial for decades. Trauma cases are different from each other, thus, a flexible timing system based on the details of each individual case is recommended. Unfortunately, no such a timing system is available for clinical application up to now. To establish the vitrectomy timing individualization system for ocular trauma (VTISOT), we first identified 6 independent tPVR risk factors (including Zone 3 Injury, Zone 3 retinal Laceration, Massive Vitreous Hemorrhage, Retinal Disorder, Timing of Vitrectomy and Type of Injury) by retrospective study. Then, the tPVR score was established by binary logistic regression analysis. Most importantly and critically, the vitrectomy timing individualization system for ocular trauma was established based on the identified tPVR risk factors and the tPVR score. The following evaluation of the VTISOT showed that the patients consistent with the VTISOT principles exhibited reduced tPVR incidence and better surgical results. In short, the VTISOT principles were established, which may provide a new approach to individualize the timing of vitrectomy and improve the prognosis after trauma.
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Park SJ, Son BJ. The Relationship between Visual Outcome and Ocular Trauma Score after Open Globe Injuries in Children. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2018. [DOI: 10.3341/jkos.2018.59.11.1062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Su Jin Park
- Department of Ophthalmology, School of Medicine, Kyungpook National University, Daegu, Korea
- Department of Ophthalmology, Kyungpook National University Hospital, Daegu, Korea
| | - Byeong Jae Son
- Department of Ophthalmology, School of Medicine, Kyungpook National University, Daegu, Korea
- Department of Ophthalmology, Kyungpook National University Hospital, Daegu, Korea
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Sivkova N, Stavrev V. Hybrid 20/23-gauge vitrectomy in a patient with retained intraocular air-gun pellet. SPEKTRUM DER AUGENHEILKUNDE 2017. [DOI: 10.1007/s00717-017-0371-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Gupta B, Sian I, Agrawal R. Ophthalmic trauma: risk and management update. EXPERT REVIEW OF OPHTHALMOLOGY 2014. [DOI: 10.1586/17469899.2014.931808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Controversies in ocular trauma classification and management: review. Int Ophthalmol 2013; 33:435-45. [PMID: 23338232 DOI: 10.1007/s10792-012-9698-y] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2012] [Accepted: 12/06/2012] [Indexed: 01/01/2023]
Abstract
Ocular trauma is a topic of unresolved controversies and there are continuous controversial and debatable management strategies for open-globe injuries (OGIs). International classification of ocular trauma proposed almost 15 years ago needs to be reviewed and to be more robust in predicting the outcome in the setting of OGIs. Anterior segment trauma involves controversies related to patching for corneal abrasion, corneal laceration repair, and medical management of hyphema. Timing of cataract surgery and intraocular lens implantation in the setting of trauma is still debated worldwide. There are unresolved issues regarding the management of OGIs involving the posterior segment. Timing of vitrectomy has been and will continue to be debated by proponents of early versus delayed intervention. The use of prophylactic cryotherapy and scleral buckle is still practiced differently throughout the world. The role of intravitreal antibiotics in posterior segment trauma in the absence of infection is still debated. Similarly, the use of vitrectomy versus vitreous tap in the setting of traumatic endophthalmitis is not fully resolved. In optic neuropathy, the role of intravenous methylprednisolone versus conservative management is always debated and still there are no evidence-based guidelines about the beneficial role of pulse steroid therapy. The role of optic canal decompression in the setting of acute traumatic optic neuropathy is also not conclusive. Orbital and adnexal trauma has been shown to adversely affect the outcome of OGI patients but both lids and orbital injury are not taken as preoperative variables in international ocular trauma classification. The timing of intervention in blow-out fracture is still debated. The pediatric age group, owing to the high risk of amblyopia and intraocular inflammation as well as strong vitreoretinal adhesions, has to be managed by different principles. Although the risk of sympathetic ophthalmia is very rare, it is always one of the key debated issues while managing traumatized eyes with no light perception vision. Prospective, controlled clinical studies are not possible in the OGI setting and this article reviews pertinent data regarding these management issues and controversies, and provides recommendations for treatment based on the available published data and the authors' personal experience.
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Lee KH, Lee WH, Jeong JH, Park YM. The Statistical Observation of Ocular Injury in the Military. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2013. [DOI: 10.3341/jkos.2013.54.9.1416] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Kwan Hoon Lee
- Department of Ophthalmology, Dankook University College of Medicine, Cheonan, Korea
| | - Won Hyuk Lee
- Department of Ophthalmology, Armed Forces Cpital Hospital, Seongnam, Korea
| | - Jae Hoon Jeong
- Department of Ophthalmology, Armed Forces Cpital Hospital, Seongnam, Korea
| | - Young Min Park
- Department of Ophthalmology, School of Medicine, Pusan National University & Medical Research Institute, Pusan National University Hospital, Busan, Korea
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Shin YI, Lee YH, Kim KN, Lee SB. The Availability of Modified Ocular Trauma Score in Korean Patients with Open Globe Injury. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2013. [DOI: 10.3341/jkos.2013.54.12.1902] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Yong Il Shin
- Department of Ophthalmology, Chungnam National University College of Medicine, Daejeon, Korea
| | - Yeon Hee Lee
- Department of Ophthalmology, Chungnam National University College of Medicine, Daejeon, Korea
- Research Institute for Biomedical Engineering, Chungnam National University, Daejeon, Korea
| | - Kyoung Nam Kim
- Department of Ophthalmology, Chungnam National University College of Medicine, Daejeon, Korea
- Research Institute for Biomedical Engineering, Chungnam National University, Daejeon, Korea
| | - Sung Bok Lee
- Department of Ophthalmology, Chungnam National University College of Medicine, Daejeon, Korea
- Research Institute for Biomedical Engineering, Chungnam National University, Daejeon, Korea
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Lee YH, Kwag JY, Lee SB. The Predictability of Ocular Trauma Score and Prognostic Factors of Open Globe Injury. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2012. [DOI: 10.3341/jkos.2012.53.6.825] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Yeon Hee Lee
- Department of Ophthalmology, Chungnam National University College of Medicine, Daejeon, Korea
- Institute for Medical Sciences, Chungnam National University Research, Daejeon, Korea
| | - Joo Young Kwag
- Department of Ophthalmology, Chungnam National University College of Medicine, Daejeon, Korea
| | - Sung Bok Lee
- Department of Ophthalmology, Chungnam National University College of Medicine, Daejeon, Korea
- Institute for Medical Sciences, Chungnam National University Research, Daejeon, Korea
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Schmidt GW, Broman AT, Hindman HB, Grant MP. Vision survival after open globe injury predicted by classification and regression tree analysis. Ophthalmology 2007; 115:202-9. [PMID: 17588667 DOI: 10.1016/j.ophtha.2007.04.008] [Citation(s) in RCA: 143] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2006] [Revised: 04/04/2007] [Accepted: 04/04/2007] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVE To assist ophthalmologists in treating ocular trauma patients, this study developed and validated a prognostic model to predict vision survival after open globe injury. DESIGN Retrospective cohort review. PARTICIPANTS Two hundred fourteen patients who sought treatment at the Wilmer Ophthalmological Institute with open globe injuries from January 1, 2001, through December 31, 2004, were part of the data set used to build the classification tree model. Then, to validate the classification tree, 51 patients were followed up with the goal to compare their actual visual outcome with the outcome predicted by the tree grown from the classification and regression tree analysis. METHODS Binary recursive partitioning was used to construct a classification tree to predict visual outcome after open globe injury. The retrospective cohort treated for open globe injury from January 1, 2001, through December 31, 2004, was used to develop the prognostic tree and constitutes the training sample. A second independent sample of patient eyes seen from January 1, 2005, through October 15, 2005, was used to validate the prognostic tree. MAIN OUTCOME MEASURES Two main visual outcomes were assessed: vision survival (range, 20/20-light perception) and no vision (included no light perception, enucleation, and evisceration outcomes). RESULTS A prognostic model for open globe injury outcome was constructed using 214 open globe injuries. Of 14 predictors determined to be associated with a no vision outcome in univariate analysis, presence of a relative afferent pupillary defect and poor initial visual acuity were the most predictive of complete loss of vision; presence of lid laceration and posterior wound location also predicted poor visual outcomes. In an independent cohort of 51 eyes, the prognostic model had 85.7% sensitivity to predict no vision correctly and 91.9% specificity to predict vision survival correctly. CONCLUSIONS The open globe injury prognostic model constructed in this study demonstrated excellent predictive accuracy and should be useful in counseling patients and making clinical decisions regarding open globe injury management.
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Affiliation(s)
- G W Schmidt
- Wilmer Ophthalmological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA
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Rumelt S, Karatas M, Ophir A. Potential Applications of Optical Coherence Tomography in Posterior Segment Trauma. Ophthalmic Surg Lasers Imaging Retina 2005. [DOI: 10.3928/1542-8877-20050701-11] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Roters S, Szurman P, Hermes S, Thumann G, Bartz-Schmidt KU, Kirchhof B. Outcome of combined penetrating keratoplasty with vitreoretinal surgery for management of severe ocular injuries. Retina 2003; 23:48-56. [PMID: 12652231 DOI: 10.1097/00006982-200302000-00008] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE To assess the effectiveness of a combined procedure (pars plana vitrectomy with temporary keratoprosthesis, vitreoretinal surgery, and penetrating keratoplasty) and to determine which factors influence corneal transplant success rates. METHODS Records for 34 severely injured eyes of 31 consecutive patients who underwent penetrating keratoplasty in combination with vitreoretinal surgery between 1991 and 1998, with a follow-up of at least 12 months, were evaluated retrospectively. Analysis was focused on ocular history, functional and anatomic anterior and posterior segment outcome, and complications. RESULTS Penetrating keratoplasty was performed in 10 eyes (29%) within 8 weeks of trauma and in 24 eyes (71%) as a secondary procedure. Initial improvement in visual acuity (VA) was achieved in 47% of eyes; at the end of the follow-up, 74% of the eyes had attained equal or better VA than the initial postsurgical VA. Reasons for poor final VA were hypotony or phthisis (35%) and recurrent retinal detachment (11%). Corneal grafts remained clear for 1 year in 65% of eyes. Transplant failure was less in eyes that did not need a permanent silicone oil tamponade, when the retina was attached before surgery, and in eyes that were grafted later after trauma and received no further surgery. These were some conditions that were associated with a longer mean graft survival time, but without statistical significance. There was no difference in eyes according to the trauma mechanism, preoperative intraocular pressure, or graft size. CONCLUSIONS Penetrating keratoplasty in severely injured eyes is often complicated by ciliary body malfunction and secondary transplant failure. Although the functional outcome of a combined procedure is limited by primary and secondary tissue destruction, preserving ambulatory vision is possible and thus improves the quality of life, at least in patients with single remaining eyes.
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Affiliation(s)
- Sigrid Roters
- Center of Ophthalmology, University of Cologne, Germany
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Mittra RA, Mieler WF. Controversies in the management of open-globe injuries involving the posterior segment. Surv Ophthalmol 1999; 44:215-25. [PMID: 10588440 DOI: 10.1016/s0039-6257(99)00104-6] [Citation(s) in RCA: 71] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
There are numerous unresolved issues and controversies regarding the management of open-globe injuries involving the posterior segment. These areas include, but are not limited to, the following issues. Although vitrectomy has been shown to improve visual outcomes and allow retention of the eye in many cases, the extent of visual improvement is often limited because of the nature of the injury. Timing of vitrectomy surgery has been and will continue to be debated by proponents of early versus delayed intervention. The multiple features of acute ocular injury make it very difficult to interpret retrospective data regarding the most appropriate timing for surgical intervention. The use of prophylactic cryotherapy, in the setting of a scleral laceration with possible retinal damage, is not as controversial at present, as there is now sufficient data indicating that cryotherapy may actually exacerbate intraocular proliferation and worsen the situation. The role and benefit of a prophylactic scleral buckle is very widely contested, and it is not known if it truly decreases the risk of subsequent retinal detachment. Another area of debate centers on the use of antibiotics. When there is a known clinical infection, intravitreal antibiotics are the mainstays of therapy. However, in the absence of clinical infection, the use of prophylactic antibiotics and their routes of administration are quite controversial. Although there are significant data regarding the use of antibiotics in the postoperative setting, this information cannot be extrapolated into the setting of open-globe injuries, as organisms and virulence factors differ. Similarly, the use of vitrectomy versus vitreous tap in the setting of traumatic endophthalmitis is not fully resolved, although vitrectomy is used in most cases to repair concurrent damage from the injury itself. Finally, the placement of intraocular lenses in the acute trauma setting is controversial, as the risk of complications is quite high. Prospective, controlled clinical studies have not been done. This article reviews pertinent data regarding these management issues and controversies, and provides recommendations for treatment based on the available published data and the authors' personal experience.
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Affiliation(s)
- R A Mittra
- Retina Associates of Cleveland, Ohio, USA
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