Outcomes Following Pars Plana Vitrectomy for Severe Ocular Trauma
Purpose: To investigate outcomes and presenting characteristics for subjects undergoing pars plana vitrectomy for ocular trauma.
Methods: Retrospective study of 113 patients who underwent pars plana vitrectomy for severe ocular trauma at [name deleted to maintain the integrity of the review process] between 1999 and 2018. Data were collected on age, gender, initial and final visual acuity (LogMAR), mode of injury, type of injury, number of surgeries performed, follow-up duration, type of tamponade, presence of phthisis, and retinal detachment. The Birmingham Eye Trauma Terminology System (BETTS) was employed.
Results: We identified assault and contusion injuries to be the most common mode and type of ocular injury in our cohort. Furthermore, through follow-up we noted a varied number of operations required by patients presenting with ocular trauma and a statistically significant improvement in visual acuity from 1.73 (±0.86) LogMAR to 1.17 (±1.03; p <0.01) LogMAR. A statistically significant difference in final visual acuity was also noted between BETTS classified type of injury groups (p < 0.01). Notably, only 7.3% and 8.2% of patients developed phthisis or a persisting retinal detachment, respectively, during follow-up.
Conclusion: Our study demonstrates that ocular trauma requiring pars plana vitrectomy can require a varied number of operations with a guarded visual prognosis. However, a small percentage will proceed to develop phthisis following intervention.
Ocular Trauma, Visual Outcome, Vitrectomy
1. Négrel A, Thylefors B. The global impact of eye injuries. Ophthalmic Epidemiol 1998;5:143–169.
2. RNIB (Royal National Institute for the Blind). Future sight loss UK (1): the economic impact of partial sight and blindness in the UK adult population [Internet]. London, UK: RNIB; 2009 [cited 2019 October 27]. Available from: https://www.rnib.org.uk/sites/default/files/ FSUK_Report.pdf
3. Desai P, MacEwen CJ, Baines P, Minassian DC. Incidence of cases of ocular trauma admitted to hospital and incidence of blinding outcome. Br J Ophthalmol 1996;80:592–596.
4. Rejdak R, Juenemann A, Natarajan S. Posterior segment ocular trauma: timing and indications for vitrectomy. J Ophthalmol 2017;2017:1–2.
5. Fujikawa A, Mohamed Y, Kinoshita H, Matsumoto M, Uematsu M, Tsuiki E, et al. Visual outcomes and prognostic factors in open-globe injuries. BMC Ophthalmol 2018;18:138.
6. Mansouri MR, Tabatabaei SA, Soleimani M, Kiarudi MY, Molaei S, Rouzbahani M, et al. Ocular trauma treated with pars plana vitrectomy: early outcome report. Int J Ophthalmol 2016;9:738–742.
7. Banerjee P, Cornelius V, Phillips R, Lo J, Bunce C, Kelly J, et al. Adjunctive intraocular and peri-ocular steroid (triamcinolone acetonide) versus standard treatment in eyes undergoing vitreoretinal surgery for open globe trauma (ASCOT): study protocol for a phase III, multicentre, double-masked randomised controlled trial. Trials 2016;17:339.
8. Schmidt G, Broman A, Hindman H, Grant M. Vision Survival after open globe injury predicted by classification and regression tree analysis. Ophthalmology 2008;115:202– 209.
9. Rostomian K, Thach A, Isfahani A, Pakkar A, Pakkar R, Borchert M. Open globe injuries in children. J AAPOS 1998;2:234–238.
10. Guven S, Durukan AH, Erdurman C, Kucukevcilioglu M. Prognostic factors for open-globe injuries: variables for poor visual outcome. Eye 2019;33:392–397.
11. Scott R. The ocular trauma score. Community Eye Health 2015;28:44–45.
12. Kuhn F, Morris R, Witherspoon C, Heimann K, Jeffers J, Treister G. A standardized classification of ocular trauma. Ophthalmology 1996;103:240–243.
13. Aghadoost D. A brief overview of ocular trauma. Arch Trauma Res 2014;3:e21639.
14. Pandita A, Merriman M. Ocular trauma epidemiology: 10- year retrospective study. N Z Med J 2012;125:61–69.
15. Serinken M, Turkcuer S, Yilmaz A, Cetin E, Elicabuk H, Karcioglu O. Causes and characteristics of work-related eye injuries in western Turkey. Indian J Ophthalmol 2013;61:497.
16. Xia T, Bauza A, Soni NG, Zarbin MA, Langer PD, Bhagat N. Surgical management and outcome of open globe injuries with posterior segment complications: a 10-year review. Semin Opthamol 2018;33:351–356.
17. Page R, Gupta S, Jenkins T, Karcioglu Z. Risk factors for poor outcomes in patients with open-globe injuries. Clin Ophthalmol 2016;10:1461–1466.
18. Jiang T, Jiang J, Wang R, Lei J, Zhou Y. Visual outcomes and prognostic factors after pars plana vitrectomy for traumatic endophthalmitis. BioMed Res Int 2017;2017:1–4.
19. Vaziri K, Schwartz S, Kishor K, Flynn H. Tamponade in the surgical management of retinal detachment. Clin Ophthalmol 2016;10:471–476.
20. Agrawal R, Wei H, Teoh S. Prognostic factors for open globe injuries and correlation of Ocular Trauma Score at a tertiary referral eye care centre in Singapore. Indian J Ophthalmol 2013;61:502.
21. Han SB, Yu HG. Visual outcome after open globe injury and its predictive factors in Korea. J Trauma 2010;69:66– 72.
22. Ryan S, Allen A. Pars plana vitrectomy in ocular trauma. Am J Ophthalmol 1979;88:483–491.
23. Brinton G, Aaberg T, Reeser F, Topping T, Abrams G. Surgical Results in ocular trauma involving the posterior segment. Am J Ophthalmol 1982;93:271–278.
24. Ahmadieh H, Soheilian M, Sajjadi H, Azarmina M, Abrishami M. Vitrectomy in ocular trauma. Retina 1993;13:107–113.