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Effect of time to primary repair on final visual outcome after open globe injury
  1. Richard J Blanch1,2,3,4,
  2. Jonathan Bishop4,
  3. Hedayat Javidi1,
  4. Philip Ian Murray1,2
  1. 1 Academic Unit of Ophthalmology, Birmingham and Midland Eye Centre, City Hospital, Birmingham, UK
  2. 2 Neuroscience and Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
  3. 3 Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, UK
  4. 4 National Institute for Health Research Surgical Reconstruction and Microbiology Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
  1. Correspondence to Richard J Blanch, Neuroscience and Ophthalmology, University of Birmingham, Birmingham B15 2TT, UK; R.J.Blanch{at}bham.ac.uk

Abstract

Background/Aim Historic data suggest that open globe injuries should be repaired within 12–24 hours to reduce the risk of endophthalmitis. However, endophthalmitis is uncommon when systemic antibiotic prophylaxis is given. It is not clear whether delayed primary repair impacts visual outcomes in other ways or what is the optimum time to repair. We aimed to examine the effect of time to primary repair on visual outcomes.

Methods This is a retrospective comparative case series including all open globe injuries presenting to the Birmingham Midland Eye Centre between 1 January 2014 and 15 March 2016. Presenting features, mechanism of injury, visual acuity at 6–12 months and demographic data were examined.

Results 56 open globe injuries were repaired, of which sufficient data for analysis were available on 52 cases. The mean time to primary repair was 1 day after injury (range 5 hours to 7 days). Final visual acuity at 6–12 months was related to the presenting visual acuity and the Ocular Trauma Score and to the time between injury and primary repair, with a reduction in predicted visual acuity of logarithm of the minimum angle of resolution of 0.37 for every 24 hours of delay (95% CI 0.14 to 0.6).

Discussion Open globe injuries should be repaired promptly. Presenting visual acuity remains the strongest predictor of outcome; however, delay to primary repair also reduced final visual acuity, and any significant delay from injury to repair is likely to negatively impact final visual outcome.

  • trauma
  • treatment surgery
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Footnotes

  • Contributors RJB and PIM conceived and designed the study. RJB and HJ acquired the data. RJB, HJ and JB analysed and interpreted the data. RJB drafted the final manuscript, and all authors revised it critically for important intellectual content and gave final approval of the version to be published. All authors agree to be accountable for all aspects of the work in ensuring that any questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study was approved by the Clinical Governance Department of the Sandwell and West Birmingham Hospitals NHS Trust.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data will be shared because these are clinical data, permission has not been granted for this level of data sharing, and with a small number of subjects and an uncommon condition there is a significant risk that subjects could be identifiable from aspects of the raw data.

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