HARVARD DEPARTMENT OF OPHTHALMOLOGY
Category : Clinical Research Candidate : Karen Wai Poster #: C15
Recovery of Vision in Open Globe Injury Patients with Initial No Light Perception Vision
Karen M . Wai , Noha A . Sherif , Kevin Makhoul , Racquel Bitar , Marisa G . Tieger MD , Grayson W . Armstrong MD MPH
Purpose : The recovery of vision in open globe injuries ( OGI ) presenting with no light perception ( NLP ) vision is poorly understood , and patients presenting with NLP vision often undergo primary enucleation or evisceration to mitigate the risk of sympathetic ophthalmia . We conducted a retrospective chart review to identify patient characteristics , OGI features , and surgical events that may predict the recovery of any vision in patients initially presenting with NLP and inform clinical considerations for management .
Methods : The Massachusetts Eye and Ear ( MEE ) OGI Database was used to identify patients with NLP vision at presentation from January 1999 to March 2022 with at least one week of follow up . The medical records of these patients were analyzed to identify demographic characteristics ; zone of injury ; time from injury to surgical repair ; presence of retinal detachment , vitreous hemorrhage ( VH ), intraocular foreign body ( IOFB ), vitrectomy , hyphema , amongst 17 other features ; and visual acuity ( VA ) at last follow-up appointment . Logistic regression was used to analyze the relationship between regained vision at most recent follow-up visit and the above dependent variables ( Python 3.10.1 ).
Results : A total of 152 OGI cases with NLP at presentation that met inclusion criteria were identified . Of these , the majority were zone 3 injuries ( 68.4 %). The average time of OGI to repair was 0.85 days , and the average length of follow up in our study was 3.5 years . Of patients with initial NLP vision with OGI included in our study , 29 cases ( 19.1 %) regained better than NLP vision at most recent follow-up . Regained vision ranged from VAs of 20 / 100 ( 3.4 %) to LP ( 58.62 %). Vitrectomy was positively associated with regained vision ( B = 3.1 , p < 0.001 ) while zone 3 injury was negatively associated with regained vision ( B = -1.94 , p = 0.05 ). Previous intraocular surgery approached statistical significance for a negative association with regained vision ( B = -1.36 , p = 0.08 )
Conclusions : While OGIs cause severe ocular morbidity , a significant proportion of OGIs with initial NLP vision regained some vision during follow-up care . Vitrectomy was positively associated with return of vision , while zone 3 injuries were negatively associated . These findings argue for primary closure of OGIs given potential for return of vision rather than primary enucleation , even in the presence of NLP vision at presentation .