Visual outcomes of vitreoretinal surgery in eyes with severe open-globe injury presenting with no-light-perception...

Severe ocular trauma causing no light perception (NLP) typically carries a dismal prognosis, and implies no further therapeutic intervention. We have identified a cohort of patients with verified NLP following open-globe injury who have recovered vision of light perception (LP) or better. We evaluated the outcomes of vitreoretinal surgery performed on eyes that were NLP post open-globe injury.

Retrospective review of outcomes of secondary vitreoretinal surgery performed at Massachusetts Eye and Ear Infirmary from 1 January 2001 to 31 December 2006 on all cases of open-globe repair (OGR) that had NLP prior to OGR or on the first post-operative day.

A total of 648 cases of OGR were performed in the study period. Eighty-eight patients had NLP prior to OGR or on the first post-operative day after OGR. Twenty-three patients from the above group (26.1%) spontaneously recovered a vision of light perception (LP) or better. Eight of the 23 patients had a secondary vitreoretinal surgery. All eyes that did not undergo vitreoretinal surgery returned to NLP or became phthisical within 7 months. Among the eight eyes that underwent surgery, five had improvement, with vision ranging from hand motion to 20/70. Prognostic indicators for successful surgical outcome were hand motion or better vision prior to vitreoretinal surgery, recovery of vision within 5 days of OGR, and vitreoretinal intervention within 5 weeks of the initial open-globe injury.

Patients with severe open-globe injury and NLP occasionally recover LP or better vision. These patients may regain useful vision after vitreoretinal surgery if prompt referral and intervention is attempted and if the spontaneous visual recovery occurs within the first week after OGR.