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

Purpose: To assess and compare the rate of endophthalmitis and visual outcomes in cases of open globe injuries (OGIs) without intraocular foreign bodies repaired within and greater than 24 hours from the time of injury.

Design: A retrospective review of 2002 cases of OGIs presenting to a single institution.

Participants: Patients with OGIs were admitted and managed according to a standardized protocol.

Methods: The impact of timing of repair was assessed among those undergoing OGI repair within (i) 24 hours, (ii) 25 to 36 hours, and (iii) greater than 36 hours from the time of injury.

Main outcome measures: Rates of endophthalmitis and postoperative visual acuity of logarithm of the minimum angle of resolution (logMAR) 1.3, logMAR 1.0, and logMAR 0.3 at 180 days and 1 year after open globe repair.

Results: A total of 1382 patients with OGIs met our inclusion criteria, of whom 75% were male with an average age of 41 years. Maximal zone of injury was zone I for 420 patients, zone II for 488 patients, and zone III for 474 patients. A total of 84% of all OGIs underwent repair within 24 hours from the time of injury, 9% from 25 to 36 hours, and 7% greater than 36 hours. Average preoperative visual acuity was hand motion. Risk factors associated with repair performed greater than 36 hours from the time of injury included female sex (P = 0.042). Endophthalmitis was associated with time to repair greater than 36 hours (P = 0.049) but not with 25 to 36 hours or zone of injury (P = 0.111). Time to repair had no significant impact on visual acuity outcomes.

Conclusions: Although repair of OGIs within 24 hours is the current standard of care, this study found no statistically significant difference in rates of endophthalmitis or visual outcomes in eyes undergoing repair within 24 hours of injury compared with repair extending to 25 to 36 hours. Endophthalmitis rates did increase after 36 hours. We recommend urgent repair of OGIs, but in certain circumstances, it may be reasonable to delay repair beyond 24 hours to optimize operating conditions.

Financial disclosure(s): Proprietary or commercial disclosure may be found after the references.