Early versus Delayed Timing of Primary Repair after Open-Globe Injury: A Systematic Review and Meta-analysis.

Area of Science:

• Ophthalmology
• Trauma Surgery
• Evidence-Based Medicine

Background:

• Optimal timing for primary repair of open-globe injuries remains unclear, with significant variability in practice across trauma centers.
• Endophthalmitis is a severe complication that can lead to vision loss following open-globe injuries.

Purpose of the Study:

• To systematically review the literature on the timing of primary repair for open-globe injuries.
• To assess the association between timing of repair and outcomes such as endophthalmitis and visual acuity.

Main Methods:

• Systematic literature review adhering to PRISMA guidelines.
• Included prospective and retrospective nonrandomized studies with at least 1 month follow-up.
• Assessed visual acuity and endophthalmitis rates; certainty of evidence using GRADE.

Main Results:

• Fifteen studies (8497 eyes) were included, primarily penetrating and intraocular foreign body injuries.
• Repair within 24 hours was associated with a 0.30 odds of endophthalmitis compared to later repair (OR, 0.39; P = 0.01).
• No significant difference in visual acuity was found based on repair timing; evidence certainty was low.

Conclusions:

• Current evidence, though limited by retrospective data, suggests early primary repair (<24 hours) for open-globe injuries may decrease endophthalmitis risk.
• Further research with higher certainty evidence is needed to establish optimal surgical timing.
• Timely surgical intervention is crucial for managing open-globe injuries and preventing vision-threatening complications.