Predictive factors of open globe injury in patients requiring vitrectomy Weeraya Pimolrat, Janejit Choovuthayakorn *, Nawat Watanachai, Direk Patikulsila, Paradee Kunavisarut, Voraporn Chaikitmongkol, Nimitr Ittipunkul Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Thailand Introduction Open globe injury remains a leading cause of acquired visual impairment despite a more thorough understanding of the pathological response following globe trauma. The ocular trauma score (OTS), published by Kuhn et al. in 2002, had been widely accepted as a model for estimating visual outcome after eye injury [1]. The initial predictors in OTS were endophthalmitis, retinal detachment (RD), initial visual acuity, rupture, perforating mechanisms of injury, and the presence of a relative afferent pupillary defect (RAPD). Subsequent studies have proposed additional prognostic variables, including age, wound length and location, iris prolapse, lens injury, hyphema, vitreous prolapse or haemorrhage, adnexal injury, causes of injury, and lag time between injury and surgery [2–9]. Previous studies have reported worse visual outcomes when open globe injury patients require vitreoretinal surgery, including pars plana vitrectomy (PPV) compared to patients not requiring surgery [3,10,11]. Pars plana vitrectomy is used in open globe injury to remove organised vitreous gel and repair traumatised intraocular structures, and recent advances of medical and microsurgical techniques for posterior segment surgery, including high speed cutter devices, high viscosity silicone oil, and endophotocoagulation, have resulted in ocular salvage with useful vision in severely injured eyes following PPV. These positive outcomes have even been seen in eyes presenting with no light perception [12,13]. Despite reports of good ocular outcomes following PPV for trauma, there is limited data regarding prognostic factors in open globe injury managed with PPV [12,14]. The purpose of this study is to assess factors associated with anatomical and functional outcomes in patients requiring PPV following ocular trauma. Materials and methods A retrospective chart review was performed on 415 open globe injury patients presenting at both the emergency department and outpatient eye clinic of a tertiary referral centre. Data was collected from January 1, 2006 to December 31, 2010. Open globe injury was defined as a full-thickness laceration of the sclera and/or cornea. To be included in this study, patients had to meet the following criteria: age of 10 years old or greater, have undergone PPV as treatment for ocular trauma, and have at least 6 months of follow up. The study protocol was approved by the local medical research ethics committee and adhered to the tenets of the Declaration of Helsinki. Injury, Int. J. Care Injured 45 (2014) 212–216 A R T I C L E I N F O Article history: Accepted 1 June 2013 Keywords: Open globe injury Trauma Vitrectomy Vitreoretinal surgery Prognosis A B S T R A C T Background: To determine the outcomes and predictive factors of patients with open globe injury requiring pars plana vitrectomy (PPV). Methods: The medical records of 114 patients age 10 years or older who had undergone PPV due to ocular trauma, with at least 6 months follow up, were retrospectively reviewed. Results: The mean age of the patients was 42 (SD14) years, with males accounting for 89% of the cases. Penetrating eye injury was the most common injury mechanism (43%) with most injuries occurring secondary to work related incidents (54%). After surgical interventions, 78% of the patients had visual improvement of one or more Snellen lines, while no light perception occurred in 10%. Anatomical attachment was achieved in 87% of eyes at the final follow up. Logistic regression analysis showed that the presence of a relative afferent pupillary defect (RAPD) was a significant predictive factor of visual outcome, while initial retinal detachment was a significant predictor of anatomical outcome. Conclusions: Pupillary reaction is an important presenting ocular sign in estimating the post-vitrectomy poor visual outcome for open globe injury. Vision was restored and improved in more than half of the patients in this study; however, long-term sequelae should be monitored. ß 2013 Elsevier Ltd. All rights reserved. * Corresponding author at: Department of Ophthalmology, Faculty of Medicine, 110 Intawaroros Road, Chiang Mai 50200, Thailand. Tel.: +66 53 945512/3; fax: +66 53 946121. E-mail address: janjitc@yahoo.com (J. Choovuthayakorn). Contents lists available at SciVerse ScienceDirect Injury jo ur n al ho m epag e: ww w.els evier .c om /lo cat e/inju r y 0020–1383/$ – see front matter ß 2013 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.injury.2013.06.003