The role of pars plana vitrectomy in eyes with no light perception after severe open globe injury and the determination of prognostic factors.

BACKGROUND

This study aimed to identify prognostic factors in patients undergoing pars plana vitrectomy (PPV) following open globe injury (OGI) and to evaluate surgical outcomes of PPV in eyes with no light perception (NLP) at presentation after OGI.

METHODS

We retrospectively reviewed the medical records of patients who underwent primary repair for severe ocular trauma, subsequently required PPV due to posterior segment damage, and had a minimum follow-up of 6 months. Patients were divided into two groups based on initial best-corrected visual acuity (BCVA): Group 1, no light perception (NLP); and Group 2, light perception (LP) or better. Clinical characteristics, as well as final anatomical and visual outcomes, were compared between the groups. Additionally, the role of PPV was specifically evaluated in eyes that were most severely affected by trauma and presented with NLP after primary repair.

RESULTS

A total of 47 eyes from 47 patients were included. Twelve eyes had NLP after primary repair for OGI. Among these, five eyes remained NLP, two (16.7%) improved to light perception (LP), three (25.0%) to hand motion, one (8.3%) to counting fingers, and one (8.3%) achieved a visual acuity of 20/60 at final follow-up. Final anatomical success was achieved in 39 of 47 eyes (82.9%). Visual improvement was observed in 91.4% of eyes (32/35) with preoperative visual acuity of at least LP, and in 58.3% of eyes (7/12) with NLP prior to vitrectomy. No eyes required enucleation. Retinal detachment (p<0.001), retinectomy (p=0.01), silicone oil use (p=0.001), and the need for a second vitrectomy (p=0.019) were associated with poor prognosis.

CONCLUSION

In patients with loss of LP secondary to severe ocular trauma, PPV can achieve high rates of anatomical success, with a significant proportion regaining ambulatory vision when appropriate surgical techniques are employed.