Overnight vs. daytime surgical repair in open globe injuries and their association with long-term visual outcomes

To assess how demographic and clinical characteristics of open globe injuries (OGIs) influence surgical timing (daytime versus overnight) as well as evaluate associations between after-hours OGI surgical repair and visual outcomes.

Retrospective cohort study on patients with OGI undergoing surgery at Massachusetts Eye and Ear (MEE) between January 1, 2016 and January 1, 2022. Surgical and presentation timing was classified as daytime (7:00 AM-6:59 PM) or overnight (7:00 PM-6:59 AM), based on the time of presentation to emergency department and surgery start time. Primary outcomes were associations between demographic and clinical characteristics and surgical timing, and between surgical timing and postoperative best corrected visual acuity (BCVA) at 6 and 12 months.

584 patients (588 eyes, 542 adults, 73.9% male), with OGI were identified. Multivariable logistic regression revealed pediatric patients (< 18 years) compared to patients ≥ 65 years (reference group) had increased odds of overnight repair (OR = 5.33, 95% CI: 1.94-15.3), while overnight presentation reduced odds of overnight surgery (OR = 0.55, 95% CI: 0.34-0.89). Surgical timing was not significantly associated with postoperative BCVA. Worse 12-month BCVA correlated with female sex, poor baseline VA, and zone II/III injuries.

Pediatric patients had increased odds of receiving overnight OGI repair, while overnight presentation reduced this likelihood. Surgery timing did not affect long-term BCVA, whereas baseline vision, sex, and injury zone predicted worse outcomes.