Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts; Harvard Medical School, Harvard University, Boston, Massachusetts.
Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts; Harvard Medical School, Harvard University, Boston, Massachusetts; Department of Ophthalmology, Boston Children's Hospital, Boston, Massachusetts; Picower Institute for Learning and Memory, Massachusetts Institute of Technology, Cambridge, Massachusetts.
Ophthalmology. 2023 Apr;130(4):379-386. doi: 10.1016/j.ophtha.2022.10.027. Epub 2022 Nov 1.
Open globe injuries (OGIs) are categorized by zone, with zone 3 (Z3) comprising wounds > 5 mm beyond the limbus. Outcomes of Z3 OGIs are highly heterogeneous. Open globe injuries with far posterior Z3 (pZ3) wounds were hypothesized to have worse visual and anatomic outcomes.
Single-center retrospective cohort study.
A total of 258 eyes with Z3 OGIs.
A retrospective review of Z3 OGIs treated at a tertiary center over 12 years. Wounds ≥ 10 mm posterior to the limbus were defined as pZ3. Outcomes were compared between pZ3 and anterior Z3 (aZ3) eyes.
Visual acuity on a logarithm of the minimum angle of resolution (logMAR) scale. Secondary outcomes included anatomic outcomes, development of retinal detachment and proliferative vitreoretinopathy, and the number of secondary surgeries.
A total of 258 Z3 OGI eyes with > 30 days follow-up were assessed; 161 (62%) were pZ3. At 3-month follow-up, pZ3 OGIs were more likely to exhibit no light perception (pZ3: 38%; aZ3: 17%; P < 0.003), lack count fingers vision (pZ3: 72%; aZ3: 43%; P < 0.002), and fail to read a letter on the eye chart (pZ3: 83%; aZ3: 64%; P < 0.001). The visual acuity distribution at 3 months was significantly worse for pZ3 compared with aZ3 injuries (P < 0.004). Similar results were found at final follow-up. Multiple linear regression showed that pZ3 location was independently associated with worse visual acuity (β = 0.29, 95% confidence interval [CI], 0.09-0.50, P < 0.006) in addition to presenting acuity, age, vitreous hemorrhage, uveal prolapse, and afferent pupillary defect. Far posterior wounds injuries were more likely to develop retinal detachments (pZ3: 87%; aZ3: 71%; P < 0.01) and proliferative vitreoretinopathy (pZ3 66%; aZ3 47%; P < 0.03). Patients with pZ3 OGIs were significantly more likely to reach poor anatomic outcome (phthisis, enucleation, need for keratoprosthesis) compared with patients with aZ3 OGI (pZ3: 56%; aZ3: 40%; P < 0.03).
Posterior OGI extension independently portends worse visual and anatomic outcomes. The effect on visual outcome was durable and clinically relevant compared with established predictors of OGI outcomes. Application of these findings improves the prognostic precision and will guide future research efforts to optimize surgical decision-making in severe OGI cases.
FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.
眼球开放性损伤（OGI）按区域分类，其中区域 3（Z3）包括超过 5 毫米巩膜缘的伤口。Z3 OGI 的结果高度异质。假设远后区 Z3（pZ3）伤口的开放性眼球损伤的视觉和解剖结果更差。
单中心回顾性队列研究。
共 258 只 Z3 OGI 眼。
回顾性分析在三级中心治疗的 Z3 OGI 超过 12 年的情况。≥10 毫米后巩膜缘的伤口定义为 pZ3。比较 pZ3 和前区 Z3（aZ3）眼的结果。
最小角分辨率（logMAR）对数视力。次要结果包括解剖结果、视网膜脱离和增生性玻璃体视网膜病变的发展，以及二次手术的数量。
共评估了 258 只 Z3 OGI 眼，随访时间超过 30 天；其中 161 只（62%）为 pZ3。在 3 个月随访时，pZ3 OGI 更可能表现为无光感（pZ3：38%；aZ3：17%；P < 0.003）、无法数指（pZ3：72%；aZ3：43%；P < 0.002）和无法在视力表上读字母（pZ3：83%；aZ3：64%；P < 0.001）。与 aZ3 损伤相比，pZ3 在 3 个月时的视力分布明显更差（P < 0.004）。最终随访时也发现了类似的结果。多元线性回归显示，除了现有的视力、年龄、玻璃体积血、葡萄膜膨出和传入瞳孔缺陷外，pZ3 位置与较差的视力（β=0.29，95%置信区间[CI]，0.09-0.50，P < 0.006）独立相关。远后区伤口更可能发生视网膜脱离（pZ3：87%；aZ3：71%；P < 0.01）和增生性玻璃体视网膜病变（pZ3 66%；aZ3 47%；P < 0.03）。与 aZ3 OGI 相比，pZ3 OGI 患者更有可能达到不良解剖结果（眼球萎缩、眼球摘除、需要角膜移植）（pZ3：56%；aZ3：40%；P < 0.03）。
后部 OGI 延伸独立预示着更差的视觉和解剖结果。与 OGI 结果的既定预测因素相比，对视觉结果的影响是持久的且具有临床相关性。这些发现的应用提高了预后的准确性，并将指导未来的研究工作，以优化严重 OGI 病例的手术决策。
