Analysis Of Visual Acuity Related Factors After Vitrectomy For Open Globe Injury

Purpose:To observe the clinical characteristics of complicated OGI in adults who were requiring vitrectomy and the efficacy of vitrectomy,and to analyze the related factors affecting the visual prognosis of complicated OGI in adults.Method:A retrospective study was performed on 104 adult patients(104 eyes)with OGI who underwent vitrectomy in the department of Ophthalmology in our hospital from October 2017 to June 2019.The clinical data and treatment records of the whole patients were recorded in detail,including age,gender,left/right eye,cause of injury,mechanism of injury,size of wound,location of injury,preoperative best corrected visual acuity(BCVA),whether there was crystal damage,vitreous hemorrhage(VH),retinal detachment(RD)or endophthalmitis.All patients underwent 23 G or 25 G minimally invasive vitrectomy.We also recorded all the subjects' ocular conditions during follow-up(1 week,1 month,3 month and 6 months after surgery,respectively)and the BCVA at the last follow-up.In order to investigate the efficacy of vitrectomy in the treatment of complicated OGI and analyze the factors influencing the visual prognosis of complicated OGI in adults.SPSS 25.0 statistical software was used for data analysis,chi-square test was used to analyze general data,MannWhitney U test,Kruskal-Wallis H test and multivariate logistic regression analysis were used to analyze prognostic factors related to the final BCVA.Result:1.Among the 104 adult patients with OGI in this study,there were 89 males and 15 females,with the ratio of men to women was about 6:1,including 49 cases of left eye and 55 cases of right eye.The average age of the patients was 42.77±13.26 years.Among them,16 cases(15.4%)were penetrating injuries,5 cases(4.8%)were perforating injuries,37 cases(35.6%)were rupture injuries and 46 cases(44.2%)were intraocular foreign body injuries.The most common cause of injury was broken by metal sharp tools such as iron filings and nails while working.There were 79 cases(76.0%)of total wound length no more than 10 mm,25 cases(24.0%)of total wound length more than 10 mm,49 cases(47.1%)of wound area I,18 cases(17.3%)of wound area II,8 cases(7.7%)of wound area III,10 cases(9.6%)of wound area I+II,13 cases(12.5%)of wound area II+III,and 6 cases(5.8%)of wound area I+II+III.Among the patients with open globe injuries,78 cases(75.0%)were complicated with crystal injury,83 cases(79.8%)with VH,32 cases(30.8%)with RD,and 18 cases(17.3%)with endophthalmitis.2.In this group,the average value of preoperative BCVA(log MAR)was 2.333±0.860.All patients were followed up for at least 6 months after surgery.Except 1 patient who underwent enucleation eventually due to atrophy of the eyeball,the average value of the postoperative BCVA(log MAR)at the last follow-up was 1.249±0.957.The postoperative visual acuity was significantly improved compared with the preoperative visual acuity(P < 0.001).According to univariate statistical analysis,the factors associated with visual prognosis in patients with complicated OGI included: mechanism of injury(P=0.045),size of wound(P=0.014),location of injury(P=0.008),preoperative BCVA(P=0.031),timing of vitrectomy(P=0.035),crystal damage(P=0.027),VH(P=0.007),RD(P < 0.001)and endophthalmitis(P < 0.001).According to multivariate logistic regression analysis,preoperative BCVA(P=0.040),size of wound(P=0.008),RD(P=0.001),and endophthalmitis(P=0.019)were the independent risk factors to the final visual acuity of adults with complicated OGI.Conclusion:1.Complicated OGI in adult who was requiring vitrectomy was more common in middle-aged men and occupational related ocular trauma was the most common cause of injuries.2.Vitrectomy can effectively treat the complicated OGI involving the posterior segment of the eye and the postoperative visual acuity was significantly improved after vitrectomy.3.Univariate analysis showed that mechanism of injury,size of wound,location of injury,preoperative BCVA,timing of vitrectomy,complicated with crystal injury,VH,RD and endophthalmitis were the related factors affecting the visual acuity after vitrectomy for OGI.4.Preoperative BCVA,size of wound,complicated with RD and endophthalmitis were independent risk factors affecting the visual acuity after vitrectomy for OGI.