Eye Trauma Surgery

Time to Surgical Repair for Open Globe Injuries

During calendar year 2023, 100 open globe injuries requiring repair presented to the Eye Trauma Service. There were an additional three cases where an exploration was performed without repair. In two of these cases, no full thickness wound was identified for repair. In one case, the wound was deemed too posterior for effective repair. An additional case with late presentation to Mass Eye and Ear was managed by the Retina Service due to concerns for endophthalmitis. Of the 100 repaired injuries, 10 cases involving intraocular foreign bodies in the posterior segment were repaired by the Retina Service. Four dehisced penetrating keratoplasties and one corneal perforation were repaired by the Cornea Service. These were not included in the analysis but were also repaired within 24 hours of injury when possible. This left 85 patients that experienced open globe injuries requiring urgent surgical repair by the Eye Trauma Service.

Of these 85 patients, 81 (95.3%) were taken to the operating room (OR) within 24 hours of arrival at Mass Eye and Ear. Fifty-one of the 85 patients (60%) were taken to the operating room in under 12 hours. Four patients were taken to the operating room more than 24 hours after admission due to a delayed presentation to Mass Eye and Ear.

The mean time from presentation at the Emergency Department to arrival in the operating room was 11.23 hours (range: 0.47 to 70.88 hours). Multiple studies suggest the benefit of repairing open globe injuries within 12-24 hours after injury, particularly for the prevention of endophthalmitis.^1-2

Final Visual Acuity and Ocular Trauma Score

Patients who undergo open globe repair in the Mass Eye and Ear Trauma Service often do not return for follow-up within the four-to-six-month postoperative period in which we historically collected data on median visual acuity outcomes. This can be due to factors such as distant home location and patient’s perceived satisfactory recovery. Therefore, in 2018, we changed our outcomes methodology for eye trauma surgery. This analysis now consists of final visual acuity for all patients with a minimum of one week of follow-up as a function of their respective ocular trauma score (OTS).

OTS, a commonly used predictor in ocular trauma management, categorizes patients by the severity of open globe injury. This score accounts for the patient’s visual acuity at presentation and other preoperative findings, such as the mechanism of the open globe injury and the presence or absence of relative afferent pupillary defect. To calculate a patient’s score, all the raw points corresponding to the presenting variables are added; the final sum corresponds to the OTS. A higher ocular trauma score predicts a better visual outcome.¹

During the 2023 calendar year, 85 patients had an open globe injury repaired by the Mass Eye and Ear Trauma Service. Of these, 77 eyes had a recorded visual acuity at presentation and at least one week of follow-up at Mass Eye and Ear. The most recent visual acuity in the one-week to six-month window following surgery was recorded for each patient. Of the 38 eyes that presented with extensive injuries to the globe (OTS 1 or 2), 47.4% (18/38) had a final visual acuity of 20/400 or better. Of the remaining 39 patients that presented with ocular trauma scores 3 to 5, 66.7% (26/39) had final visual acuities ranging from 20/50 to 20/15.

*The tables below have been adapted from their original publication.¹

Distribution of Final Visual Acuity in 2023

Median Postoperative Vision

The numbers in white represent the number of patients for that OTS for their respective years.