Clinical course and outcomes of corneal blood staining in open-globe injury: Eye Injury Vitrectomy Study.

PURPOSE: To describe the clinical course and outcomes of corneal blood staining in open-globe injuries (OGIs) after vitrectomy without routine immediate allograft penetrating keratoplasty (PKP).

METHODS

This study included 42 eyes of 42 patients with corneal blood staining secondary to OGIs. Clinical data were retrospectively collected from the Eye Injury Vitrectomy Study (EIVS). All eyes underwent anterior chamber washout at the start of pars plana vitrectomy (PPV). When visualization remained inadequate, temporary keratoprosthesis (TKP)-assisted PPV was performed, followed by replacement of the trephined autologous cornea (TKP + PPV + RTC). Postoperative outcomes, including corneal transparency, best-corrected visual acuity (BCVA), intraocular pressure (IOP), and need for subsequent PKP, were assessed.

RESULTS

Median age was 36.5 years; globe rupture accounted for 95.2%. Preoperative hypotony (IOP ≤ 10 mmHg) was present in 90.5%, with severe posterior segment injury in all eyes. Eight eyes achieved sufficient corneal clarity after washout alone; the remaining 34 required TKP + PPV + RTC. During follow-up, varying degrees of spontaneous clearance occurred in most eyes, forming a peripheral "window" that enabled fundus assessment. At the final follow-up, BCVA improved from median 4.00 logMAR preoperatively to 2.80 logMAR (p = 0.002), and median IOP rose from 5.00 to 10.00 mmHg (p = 0.002). Five eyes developed phthisis bulbi, four eyes achieved complete silicone oil removal, and only 1 eye underwent allograft PKP.

CONCLUSIONS

The strategy of anterior chamber washout first, followed by TKP + PPV + RTC when necessary, provides timely posterior segment access while preserving the globe and conserving corneal tissue in severe OGIs complicated by corneal blood staining. These findings support selective, rather than routine, PKP during follow-up.