Visual Outcomes and Risk of Endophthalmitis in Open Globe Injuries without Intraocular Foreign Bodies with Delayed...

Area of Science:

• Ophthalmology
• Trauma Surgery

Background:

• Open globe injuries (OGIs) are severe ocular emergencies requiring prompt management.
• The optimal timing for surgical repair of OGIs to minimize complications like endophthalmitis and maximize visual outcomes remains a critical question.

Purpose of the Study:

• To compare the incidence of endophthalmitis and visual results in patients with open globe injuries (OGIs) who underwent surgical repair within 24 hours versus those repaired after 24 hours.
• To evaluate the impact of delayed repair (25-36 hours and >36 hours) on infection rates and visual acuity.

Main Methods:

• A retrospective review of 1382 patients with open globe injuries (OGIs) treated at a single institution was conducted.
• Patients were categorized based on the timing of surgical repair: within 24 hours, 25-36 hours, and greater than 36 hours.
• Rates of endophthalmitis and postoperative visual acuity (logMAR) at 180 days and 1 year were analyzed.

Main Results:

• Most OGIs (84%) were repaired within 24 hours; 9% were repaired between 25-36 hours, and 7% after 36 hours.
• Endophthalmitis was significantly associated with repair timing greater than 36 hours (P=0.049), but not with repair between 25-36 hours.
• Surgical timing did not significantly impact final visual acuity outcomes, although female sex was a risk factor for delayed repair (>36 hours).

Conclusions:

• While urgent repair of open globe injuries (OGIs) is generally recommended, repair within 25-36 hours did not show a statistically significant increase in endophthalmitis or worse visual outcomes compared to repair within 24 hours.
• Repair beyond 36 hours was associated with increased endophthalmitis rates.
• Delaying OGI repair beyond 24 hours may be considered in specific situations to optimize surgical conditions without compromising outcomes, provided it does not exceed 36 hours.