Prophylactic chorioretinectomy in deadly weapon-related open globe injuries

To evaluate the anatomical and functional outcomes of pars plana vitrectomy (PPV) combined with prophylactic chorioretinectomy (CR) in patients with deadly weapon-related open globe injuries (DWOGIs).

Medical records of patients who underwent PPV and prophylactic CR for open globe injuries (OGIs) caused by deadly weapons between November 2016 and October 2024 were retrospectively reviewed. Demographic characteristics, injury type, cause of injury, zone of injury, intraocular foreign body (IOFB) exit/impact site, best-corrected visual acuity (BCVA), proliferative vitreoretinopathy (PVR) rates, anatomical success, and globe survival were evaluated.

Of a total of 283 OGIs, 41 eyes from 35 patients who underwent PPV with prophylactic CR for deadly weapon-related trauma were included in the analysis. The mean age was 30.9+-9.4 years, and 88.6% of the patients were male. Perforating injuries were observed in 38 eyes (92.7%), and penetrating injuries associated with an IOFB in 3 eyes (7.3%). The causes of injury included improvised explosive devices in 20 eyes (48.8%), hand grenades in 11 eyes (26.8%), landmines in 8 eyes (19.5%), and rocket-propelled grenades in 2 eyes (4.9%). The IOFB exit/impact site was located in the posterior pole in 38 eyes (92.7%), of which 22 (53.6%) were outside the vascular arcades, 12 (29.3%) within the vascular arcades, and 4 (9.7%) adjacent to the optic disc. The mean initial BCVA was 2.62+-0.98 logMAR, with 90.2% of eyes presenting between light perception and counting fingers. PPV was performed at a mean of 5.9+-2.7 days after primary repair. Of these eyes, 43.9% had retinal detachment. The mean number of PPV procedures was 2.6+-1.1. C3F8 gas endotamponade was used in 51.2% of cases. At a mean follow-up of 32.8+-16.6 months, the final BCVA improved significantly to 1.18+-1.20 logMAR (p<0.001), with 68.3% achieving ≥20/200 vision. At final follow-up, the rates of PVR, anatomical success, and globe survival were 14.6% (6/41), 85.4% (35/41), and 87.8% (36/41), respectively.

Pars plana vitrectomy combined with prophylactic CR appears to be an effective treatment option for DWOGIs, offering prevention of PVR development and achieving high anatomical success, favorable globe survival, and meaningful visual improvement despite severe ocular trauma.