Pars-plana vitrectomy combined with retinectomy in severe open-globe injuries: A systematic review and meta-analysis

Abstract

Background:

This review summarized prophylactic retinectomy technique and its effect on anatomic and functional outcomes in severe open globe injuries (OGIs).

Methods:

A comprehensive search in PubMed (MEDLINE), Embase, Scopus, and EuropePMC databases was performed up until 8 January 2020. Enrolled studies include case series, studies involving pars plana vitrectomy (PPV) combined with retinectomy in severe penetrating injuries with or without IOFB, perforating injuries, and globe ruptures. Primary outcome was best-corrected visual acuity (BCVA) ⩾20/200 at the end of the study. Secondary outcomes were the rate of proliferative retinopathy (PVR), globe survival rate and retinal reattachment rate.

Results:

A total of seven studies, involving 275 eyes with severe OGIs, is included in this study. Meta-analysis indicates that final BCVA ⩾20/200 was achieved in 61% (95% CI 49%–73%). Meta-regression analysis showed that improvement was inversely affected by the presence of pre-operative direct macular injury (p = 0.001) and corneal scar (p = 0.015). The proportion of pre-operative BCVA <20/200 was statistically insignificant to the final BCVA ⩾20/200 (p = 0.569). One study showed that the rate is higher in the retinectomy group than the non-retinectomy group (54% vs 11%). Meta-analysis showed that anatomical success can be achieved in 85% (95% CI 78%–91%) of the patients. Meta-regression analysis indicates that the anatomical success did not vary with age (p = 0.653), retinal detachment (p = 0.525), corneal scar (p = 0.596), and lens involvement (p = 0.450).

Conclusion:

Early PPV combined with retinectomy was associated with acceptable visual improvement and anatomical success.

Keywords

Retinectomy eye injuries open-globe injuries proliferative vitreoretinopathy vitrectomy

Get full access to this article

View all access options for this article.

References

Feng

. Epidemiology of ocular trauma. In: Yan H (ed.) Anatomy and examination in ocular trauma. Singapore: Springer, 2019, pp.105–122.

Kuhn

Morris

Witherspoon

, et al. Birmingham Eye Trauma Terminology system (BETT). J Fr Ophtalmol 2004; 27(2): 206–210.

Chen

SM.

Trauma of the globe: state of art in global and in China. Chin J Traumatol 2016; 19(6): 317–318.

Tök

Tok

Eraslan

, et al. Prognostic factors influencing final visual acuity in open globe injuries. J Trauma 2011; 71(6): 1794–1800.

Ozturk

Cetin Dora

Ayhan

, et al. Etiology and visual prognosis in open globe injuries: results of a tertiary referral center in Turkey. Sci Rep 2019; 9(1): 17977.

Kuhn

Morris

Witherspoon

, et al. Epidemiology of blinding trauma in the United States eye injury registry. Ophthalmic Epidemiol 2006; 13(3): 209–216.

Colyer

Weber

Weichel

, et al. Delayed intraocular foreign body removal without endophthalmitis during operations iraqi freedom and enduring freedom. Ophthalmology 2007; 114(8): 1439–1447.

Kruger

Nguyen

Ramos-Lopez

, et al. Proliferative vitreoretinopathy after trauma. Int Ophthalmol Clin 2002; 42(3): 129–143.

Morescalchi

Duse

Gambicorti

, et al. Proliferative vitreoretinopathy after eye injuries: an overexpression of growth factors and cytokines leading to a retinal keloid. Mediators Inflamm 2013; 2013: 269787.

10.

Kuhn

Mester

Morris

A proactive treatment approach for eyes with perforating injury. Klin Monbl Augenheilkd 2004; 221(8): 622–628.

11.

Kuhn

Morris

Witherspoon

, et al. Blunt-force injuries involving the posterior segment. Retin Phys 2007; 4(6): 20–24.

12.

Ung

Stryjewski

Eliott

Indications, findings, and outcomes of pars plana vitrectomy after open globe injury. Ophthalmol Retina 2020; 4(2): 216–223.

13.

Weichel

Bower

Colyer

MH.

Chorioretinectomy for perforating or severe intraocular foreign body injuries. Graefes Arch Clin Exp Ophthalmol 2010; 248(3): 319–330.

14.

Yang

Liu

, et al. Prophylactic chorioretinectomy for traumatic retinal incarceration [In Chinese]. Int J Ophthalmol 2011; 11(5): 875–877.

15.

Kuhn

Schrader

Prophylactic chorioretinectomy for eye injuries with high proliferative-vitreoretinopathy risk. Clin Anat 2018; 31(1): 28–38.

16.

Ozdek

Hasanreisoglu

Yuksel

Chorioretinectomy for perforating eye injuries. Eye 2013; 27(6): 722–727.

17.

Ferreira

Monteiro

Meireles

, et al. Outcome of vitrectomy and chorioretinectomy in perforating eye injuries. Ophthalmic Res 2015; 53(4): 200–206.

18.

Monteiro

Meireles

Prophylactic chorioretinectomy in open ocular trauma: a series of 36 eyes. Ophthalmologica 2018; 240(1): 55–60.

19.

Colyer

Chun

Bower

, et al. Perforating globe injuries during operation Iraqi freedom. Ophthalmology 2008; 115(11): 2087–2093.

20.

Knyazer

Levy

Rosen

, et al. Prognostic factors in posterior open globe injuries (zone-III injuries). Clin Exp Ophthalmol 2008; 36(9): 836–841.

21.

Petrovič

Lumi

Olup

BD.

Prognostic factors in open eye injury managed with vitrectomy: retrospective study. Croat Med J 2004; 45(3): 299–303.

22.

Jin

Chen

, et al. Traumatic proliferative retinopathy: clinical and histopathological observations. Retina 2017; 37(7): 1236–1245.

23.

Zivojnovic

Silicone oil in vitreoretinal surgery. Chap 5. In: Surgical techniques. Dordrecht: Marinus Nijhoff, 1987, pp.45–103.

24.

Martin

Meredith

Topping

, et al. Perforating (through-and-through) injuries of the globe: surgical results with vitrectomy. Arch Ophthalmol 1991; 109: 951–956.

25.

Ozdek

Hasanreisoglu

. Current concepts and management of severely traumatized tissues in the inner coatings (the posterior segment: the ciliary body, the choroid, and the retina) of the globe: mechanical injuries, perforating injury. In: Sobaci

(ed.) Current concepts and management of eye injuries. London: Springer, 2016, pp.107–118.

26.

Erdurman

Hurmeric

Gokce

, et al. Ocular injuries from improvised explosive devices. Eye 2011; 25(11): 1491–1498.

27.

Kuhn

Pieramici

Ocular trauma - principles and practice. New York, NY: Thieme, 2002.

28.

Wei

Zhou

, et al. Retinectomy vs vitrectomy combined with scleral buckling in repair of posterior segment open-globe injuries with retinal incarceration. Eye 2016; 30(5): 726–730.

29.

Xia

Bauza

Soni

, et al. Surgical management and outcome of open globe injuries with posterior segment complications: a 10-year review. Semin Ophthalmol 2018; 33(3): 351–356.

30.

Beshay

Keay

Dunn

, et al. The epidemiology of open globe injuries presenting to a tertiary referral eye hospital in Australia. Injury 2017; 48(7): 1348–1354.

31.

Kuhn

Maisiak

Mann

, et al. The ocular trauma score (OTS). Ophthalmol Clin North Am 2002; 15(2): 163–165.

32.

Kalayci

Tahtabasi

Bomb explosion: ocular effects of primary, secondary and tertiary mechanisms. Clin Ophthalmol 2020;14:1145–1151.

33.

Islam

Ishaq

Yaqub

, et al. Predictive value of ocular trauma score in open globe combat eye injuries. J Ayub Med Coll Abbottabad 2016; 28(3): 484–488.

34.

Feng

Wang

, et al. Risk factors, anatomical, and visual outcomes of injured eyes with proliferative vitreoretinopathy: eye injury vitrectomy study. Retina 2013; 33: 1512–1518.

35.

Nicoara

Irimescu

Calinici

, et al. Outcome and prognostic factors for traumatic endophthalmitis over a 5-year period. J Ophthalmol 2014; 2014: 1–7.

36.

Agrawal

Teoh

Pre-operative variables affecting final vision outcome with a critical review of ocular trauma classification for posterior open globe (zone III) injury. Indian J Ophthalmol 2013; 61(10): 541–545.

37.

Dehghani

Rezaei

Salam

, et al. Post traumatic endophthalmitis: incidence and risk factors. Glob J Health Sci 2014; 6(6): 68–72.

38.

Kuhn

The timing of reconstruction in severe mechanical trauma. Ophthalmic Res 2014; 51(2): 67–72.

39.

Kuhn

Teixeira

Pelayes

DE.

Late versus prophylactic chorioretinectomy for the prevention of trauma-related proliferative vitreoretinopathy. Ophthalmic Res 2012; 48(Suppl. 1): 32–37.

40.

Abdullatif

Macky

Abdullatif

, et al. Intravitreal decorin preventing proliferative vitreoretinopathy in perforating injuries: a pilot study. Graefes Arch Clin Exp Ophthalmol 2018; 256(12): 2473–2481.

41.

Assi

Khoueir

Helou

, et al. Intraocular application of Mitomycin C to prevent proliferative vitreoretinopathy in perforating and severe intraocular foreign body injuries. Eye 2019; 33(8): 1261–1270.