Artikel
Importance of timing of vitrectomy for opening eye (globe) injury – An analysis on correlation of proliferative vitroretinopathy (PVR), retinal detachment and timing of vitrectomy
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Veröffentlicht: | 18. Juni 2008 |
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Purpose: To investigate the effect of PVR, retinal detachment (RD), and timing of vitrectomy (TV) on the prognosis of opening eye injury.
Methods: A series of 357 eyes from 347 patients sustained opening injury and underwent vitrectomy. All subtypes of opening injuries were included. Time duration from injury to vitrectomy ranged from less than 14 days up to more than 30 days. Referring to the independent predictive risk factors presented by logistic regression, we analyzed the effect of PVR and RD occurring preoperatively and delayed vitrectomy on the prognosis.
Results: The 224 eyes (62.75%) gained best corrected visual acuity (BCVA);20/800 at last follow-up, a noticeable increase over 115 eyes (32.21%) with preoperative BCVA on matched level (p=0.000). No light perception occurred to 37 eyes. Anatomical unfavorable outcome occurred in 79 eyes (22.10%) including 17 enucleated eyes and 22 atrophic eyes. 12 eyes with low pressure tended to be atrophic and 28 eyes became cilicon oil-dependent. Either PVR and RD occurring preoperatively or vitrectomy performed 14 days after injury would significantly deteriorate the unfavorable outcome (p values were 0.000, 0.000, 0.042 respectively). Incidence of PVR significantly increased in the eyes with RD initially occurring after injury (p=0.000) and with delayed vitrectomy (p=0.000). More RDs (73.20%) were identified(p=0.047) in the eyes undergoing vitrectomy;30 days than within 30 days (63.24%).Anatomically, RD complicated with PVR(36.41%) showed worse outcome than without PVR (6.58%, p=0.000). VA less than 20/800 in last follow-up was more in the eyes with PVR (50.26%) than without PVR (6.58%, p=0.000). Univariate logistic analysis showed that no light perception, closed-funnel RD, PVR and expulsive choroidal hemorrhage were independent risk factors.
Conclusion: Opening eye injury threatens both ocular structures and visual function. Preoperative occurrence of PVR and RD were risk factors to unfavorable outcome. RD complicated with PVR deteriorated unfavorable prognosis. Delayed vitrectomy was a critical risk factor to occurrence of PVR. Timing of vitrectomy in openly injured eyes is closely related to prognosis.