Early versus Delayed Vitrectomy for Open Globe Injuries: A Systematic Review and Meta-Analysis

Area of Science:

• Ophthalmology
• Trauma Surgery

Background:

• Open globe injuries (OGIs) are a primary cause of monocular blindness globally.
• Prompt management is essential to prevent complications like proliferative vitreoretinopathy (PVR) and endophthalmitis.
• Current OGI management involves wound closure followed by vitrectomy, but optimal timing is debated.

Purpose of the Study:

• To compare the effectiveness of early versus delayed vitrectomy in managing OGIs.
• To evaluate the impact of vitrectomy timing on visual outcomes and anatomical success.
• To determine the optimal surgical timing for maximizing patient prognosis after OGI.

Main Methods:

• A meta-analysis adhering to PRISMA guidelines was performed.
• Searched Medline, Embase, Scopus, Cochrane, and ClinicalTrials.gov databases (up to October 23, 2023).
• Included clinical studies comparing early (within 7 days) and delayed (8-14 days) vitrectomy for OGIs, assessing RCTs and non-RCTs.

Main Results:

• Eleven studies involving 235 early and 211 delayed intervention patients were analyzed.
• Early vitrectomy showed higher retinal reattachment rates (91% vs. 76%) and better visual acuity (≥5/200 odds 2.4x greater).
• Delayed surgery was associated with a significantly higher incidence of PVR (41% vs. 9%) and increased need for repeat surgeries.

Conclusions:

• Early vitrectomy demonstrates superior outcomes in OGI management.
• Prompt surgical intervention leads to improved visual acuity and retinal reattachment.
• Delayed vitrectomy increases the risk of PVR and necessitates more complex surgical management.