Retinal detachment after open globe injury

Abstract

Purpose: To characterize the development of retinal detachment (RD) after open globe trauma.

Design: Case-control study.

Participants: A total of 892 patients comprising 893 open globe injuries (OGIs), of whom 255 were ultimately diagnosed with RD, with the remaining eyes serving as controls.

Methods: Retrospective chart review of patients with OGIs presenting to the Massachusetts Eye and Ear Infirmary between 1999 and 2011. Kaplan-Meier analysis was used to estimate the time to detachment, and multivariable logistic regression was used to define the clinical factors associated with RD after OGI.

Main outcome measures: Demographic and clinical characteristics at the time of presentation after OGI, date of RD diagnosis, and last date of follow-up.

Results: Primary repair of the open globe was typically undertaken within hours of presentation. A total of 255 eyes were ultimately diagnosed with RD after open globe trauma, yielding an incidence of 29% (95% confidence interval, 26-32). For eyes that developed RD, 27% (69/255) detached within 24 hours of primary open globe repair, 47% (119/255) detached within 1 week, and 72% (183/255) detached within 1 month. Multivariable regression analysis revealed the presence of vitreous hemorrhage (odds ratio [OR], 7.29; P < 0.001), higher zone of injury (OR, 2.51 per integer increase in zone number; OR, 1.00-6.30; P < 0.001), and poorer logarithm of the minimum angle of resolution (logMAR) visual acuity at the time of presentation after OGI (OR, 2.41 per integer increase in logMAR visual acuity; OR, 1.00-81.30; P < 0.001) to be associated with RD. A screening tool was created: the Retinal Detachment after Open Globe Injury score.

Conclusions: Retinal detachment is common after open globe trauma, although often not appearing until days to weeks after the initial traumatic event. Several clinical variables at the time of initial presentation can predict the future risk of detachment.