Outcomes of Retinal Detachment (RD) after Open Globe Injury (OGI) and Independent Validation of the RD-OGI Scoring System

Purpose: To independently validate the retinal detachment (RD) after open globe injury (OGI) score (RD-OGI Score) as a clinical prediction model for estimating the risk of RD after OGI, and to characterize outcomes of RD stratified by RD-OGI risk category.

Design: Retrospective, multi-institutional cohort study.

Subjects: A validation cohort of 236 eyes with OGI managed at two U.S. academic institutions from 2017-2021 was compared to the predictions of the RD-OGI Score model and to the derivation cohort of 893 eyes with OGI used to develop the RD-OGI Score model.

Methods: RD-OGI Scores were calculated and patients were stratified into three risk groups (low, moderate, and high) for analysis. The incidence of RD in the validation cohort was used to calculate standard performance metrics to evaluate predictive accuracy of the RD-OGI Score.

Main outcome measures: Area under the curve (AUC), sensitivity, specificity, and accuracy of the RD-OGI Score; anatomic success (retina attached or detached) and best corrected visual acuity (BCVA) at last follow-up.

Results: In the validation cohort, 92 of 236 eyes (39%) developed RD after OGI. The RD incidence predicted by the RD-OGI Score was strongly correlated with actual RD incidence in the validation cohort (Spearman ρ= 0.92, P<0.001). The RD-OGI Score demonstrated a high discriminativeness with the validation cohort (AUC= 0.84, 95% CI: 0.79-0.89). An RD-OGI Score of 2.5 was found to have 73% accuracy, 93% sensitivity, and 60% specificity for predicting no RD (RD-OGI <2.5) versus RD (RD-OGI ≥2.5). Median BCVA at last follow-up for successfully reattached eyes was comparable for high risk (∼20/380) and moderate risk (∼20/300) eyes (P>0.99), but both were significantly worse compared to low risk eyes (∼20/25 Snellen) (P=0.010).

Conclusions: The RD-OGI Score reliably predicts the risk of developing RD after OGI. In eyes that develop RD, a higher RD-OGI Score is strongly correlated with a greater risk for poor functional and anatomic outcomes. An RD-OGI Score ≥2.5 identifies eyes at substantial risk for RD and adverse outcomes and may serve as a useful cutoff for guiding referral to a vitreoretinal surgeon after primary globe closure.