Outcomes of pars plana vitrectomy following ocular trauma at varying surgical time points

Abstract

Background The optimal timing of pars plana vitrectomy (PPV) following ocular trauma is an ongoing debate. Early vitrectomy post-trauma enables the rapid assessment of retinal disease by removing the scaffold that fosters proliferative vitreoretinopathy. On the other hand, late vitrectomy is less challenging as there is a lower risk of bleeding and posterior vitreous detachment induction is easier. The purpose of this work is to report the functional and anatomical outcomes following ocular traumatic injuries in a United States-based cohort, emphasizing the time of intervention. Methods This was a retrospective case series of 110 patients with traumatic ocular injuries who underwent PPV between 2008 to 2020. Patients were grouped into four timing categories: same day (0 days), early (1–7 days), delayed (8–14 days), and late (> 14 days). Multivariable regression models controlling for confounding were implemented to assess the impact of vitrectomy timing on anatomical and functional outcomes. Visual acuity (VA) at baseline and after surgery, proliferative vitreoretinopathy (PVR), and enucleation for each vitrectomy timing category were recorded. Results Patient demographics and severity of ocular trauma were comparable across timing categories. Final VA in LogMAR was found to have a stepwise worsening as the time of ocular trauma to vitrectomy was increased (p < 0.05). For every one-step increase in the vitrectomy timing category, there was an adjusted 0.24 (CI 0.04–0.44) increase in final VA. No patient in the same day vitrectomy group had an enucleation or PVR, while patients who had late vitrectomies had the largest number of both enucleations and PVR (44.4% and 52.0%, respectively). In adjusted analysis, there was 3.11 increased odds (CI 1.03–9.42) of developing PVR for a one-step increase in vitrectomy timing (p < 0.05). Conclusion Vitrectomy on the same day of injury has the best final VA, and the lowest incidence rates of PVR and enucleation in comparison to other timing categories, regardless of etiology.

The Optimal Timing for Vitrectomy Following Open-Globe Injuries

“…Of note, same-day vitrectomy included a large proportion of IOFB injuries (75%), while the fourth group with delayed vitrectomy had a larger proportion of blunt force injuries (72%). 4 This is relevant as prior studies have suggested that penetrating injuries with IOFBs have a better visual prognosis than ruptured globes from blunt trauma. 3 Nevertheless, their results show a stepwise worsening of visual outcomes and higher PVR among groups based on the timing of surgery, with the largest number of enucleations and PVR in the late vitrectomy category.…”

“…They found that vitrectomy on the same day of injury led to the best final VA and lowest incidence of PVR. 4 While they report that the OTS score among groups was not significantly different, they acknowledge that the mechanism of injury was different among the timing of intervention. Of note, same-day vitrectomy included a large proportion of IOFB injuries (75%), while the fourth group with delayed vitrectomy had a larger proportion of blunt force injuries (72%).…”

“…3 Nevertheless, their results show a stepwise worsening of visual outcomes and higher PVR among groups based on the timing of surgery, with the largest number of enucleations and PVR in the late vitrectomy category. 4 To assist with the determination of when to perform a vitrectomy, Han et al 8 developed the vitrectomy timing individualization system for ocular trauma, which aims to suggest the timing of vitrectomy by weighing factors associated with the formation of PVR. The study enrolled 305 patients evaluated for ocular trauma at a single site requiring vitrectomy.…”

“…2 Other benefits include the earlier assessment and treatment of retinal pathology (retinal breaks, detachments, traumatic macular holes), faster visual rehabilitation in cases of vitreous hemorrhage, and reducing the risk of endophthalmitis. 1,4,5 While many centers have gained significant experience in managing ocular trauma with posterior segment involvement, the debate regarding the timing of vitrectomy is still ongoing. Given the large heterogeneity among ocular trauma cases in terms of the mechanism and extent of injury, as well as the timing of initial presentation, it is challenging to extrapolate from retrospective studies whether early versus delayed intervention gives an optimal outcome.…”

“…Proponents of early intervention argue that vitrectomy within 7 days following injury is beneficial because it minimizes the risk of development of proliferative vitreoretinopathy (PVR) by removing the vitreous scaffold, blood, and stimulating cytokines from the vitreous cavity 2 . Other benefits include the earlier assessment and treatment of retinal pathology (retinal breaks, detachments, traumatic macular holes), faster visual rehabilitation in cases of vitreous hemorrhage, and reducing the risk of endophthalmitis 1,4,5 …”