HARVARD DEPARTMENT OF OPHTHALMOLOGY
Category : Clinical Research Candidate : Isaac Bleicher Poster #: C3
Outcomes of Far Posterior Open Globe Injuries : The Case for Zone 4
Isaac Bleicher , Laurel Tainsh , Eric D . Gaier , Grayson Armstrong
Purpose : Open globe injuries ( OGIs ) are categorized by zone of injury , with Zone 3 ( Z3 ) defined as ≥5mm posterior to the corneal limbus . Heterogeneity in outcomes of Z3 OGIs precludes precise prognostication and surgical management decisions . We hypothesized that Z3 OGIs with far posterior wounds would have worse visual and anatomic outcomes .
Methods : We performed a retrospective review of Z3 OGIs with at least 30 days of follow-up treated at a tertiary care center over a 10-year period . Far posterior OGIs ( pZ3 ) were defined as those with wounds extending ≥10mm posterior from the corneal limbus . Secondary surgeries , visual outcomes , and anatomic outcomes were compared between pZ3 and anterior Z3 ( aZ3 ) eyes at presentation , the 3 months and the latest available timepoints after injury . Chi-square and Mann-Whitney U tests were used to compare pZ3 and aZ3 outcomes .
Results : Of 300 eyes , 258 met inclusion criteria . Of these , 62 % were classified as pZ3 . At final follow-up , pZ3 eyes were more likely to be no light perception ( NLP ) ( pZ3 : 49 %, aZ3 : 33 %), hand motion ( HM ) or worse ( pZ3 : 75 %, aZ3 : 57 %) or < 20 / 400 Snellen acuity ( pZ3 : 84 %, aZ3 : 65 %) ( p ≤0.02 ). The effect of zonal group on HM and < 20 / 400 acuity persisted even when excluding patients presenting NLP ( p ≤0.05 ). These relationships were also seen at 3 month follow-up for NLP , HM , and 20 / 400 visual acuities ( all p < 0.01 ) Compared to presentation , pZ3 eyes were less likely to have acuity improve ( pZ3 : 33 %, aZ3 : 44 %) and more likely to have worsened acuity ( pZ3 : 19 %, aZ3 : 11 %) ( p < 0.02 ). pZ3 eyes were more likely to become phthisical or be eviscerated / enucleated ( pZ3 : 56 %, aZ3 40 %, p < 0.02 ). pZ3 and aZ3 eyes underwent means (± SD ) of 1.5 ± 1.6 and 1.4 ± 1.5 secondary procedures , respectively ( p > 0.76 ).
Conclusions : Eyes with OGIs extending ≥10 mm posterior to the corneal limbus have poorer visual and anatomic outcomes compared to those limited to the more anterior Z3 . While the potential for recovery in posterior OGIs necessitates careful assessment and emergent repair in all cases , further zonal categorization within zone 3 injuries may help improve prognostic precision and refine surgical approaches .