McMaster David, Bapty James, Bush Lana, Serra Giuseppe, Kempapidis Theo, McClellan Scott F, Woreta Fasika A, Justin Grant A, Agrawal Rupesh, Hoskin Annette K, Cavuoto Kara, Leong James, Ascarza Andrés Rousselot, Cason John, Miller Kyle E, Caldwell Matthew C, Gensheimer William G, Williamson Tom H, Dhawahir-Scala Felipe, Shah Peter, Coombes Andrew, Sundar Gangadhara, Mazzoli Robert A, Woodcock Malcolm, Watson Stephanie L, Kuhn Ferenc, Colyer Marcus, Gomes Renata S M, Blanch Richard J
Imperial College London, London, United Kingdom.
Portsmouth Hospitals University NHS Trust, Portsmouth, United Kingdom.
Ophthalmology. 2025 Apr;132(4):431-441. doi: 10.1016/j.ophtha.2024.08.030. Epub 2024 Aug 31.
The timing of primary repair of open-globe injury is variable in major trauma centers worldwide, and consensus on optimal timing is lacking.
Surgery is the mainstay of open-globe injury management, and appropriate timing of surgical repair may minimize the risk of potentially blinding complications such as endophthalmitis, thereby optimizing visual outcomes.
A systematic literature review was performed following Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines (International Prospective Register of Systematic Reviews identifier, CRD42023442972). The Cochrane Central Register of Controlled Trials, MEDLINE, Embase, and ISRCTN registries and ClinicalTrials.gov were searched from inception through October 29, 2023. Prospective and retrospective nonrandomized studies of patients with open-globe injury with a minimum of 1 month of follow-up after primary repair were included. Primary outcomes included visual acuity at last follow-up and the proportion of patients with endophthalmitis. Certainty of the evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach.
Fifteen studies met inclusion criteria, reporting a total of 8497 eyes. The most common injury types were penetrating and intraocular foreign body (IOFB). Meta-analysis found that primary repair less than 24 hours after open-globe injury was associated with 0.30 odds of endophthalmitis compared with primary repair conducted more than 24 hours after trauma (odds ratio, 0.39; 95% confidence interval [CI], 0.19-0.79; I = 95%; P = 0.01). No significant difference was found in reported visual outcomes between patients whose open-globe injuries were repaired more than, compared with less than, 24 hours after trauma (odds ratio, 0.89; 95% CI, 0.61-1.29; I = 70%; P = 0.52). All included studies were retrospective and nonrandomized, demonstrating an overall low certainty of evidence on GRADE assessment.
Only retrospective data exist around the effect of timing of open-globe repair, resulting in low certainty of the available evidence. However, this review of current evidence, predominantly including penetrating and IOFB injuries, suggests that primary repair performed less than 24 hours after open-globe injury is associated with a reduced endophthalmitis rate compared with longer delays, consistent with delay to primary repair increasing endophthalmitis risk.
FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
在全球各大创伤中心，开放性眼球损伤一期修复的时机各不相同，目前缺乏关于最佳时机的共识。
手术是开放性眼球损伤治疗的主要手段，适当的手术修复时机可将诸如眼内炎等潜在致盲并发症的风险降至最低，从而优化视力预后。
按照系统评价和Meta分析的首选报告项目指南（国际前瞻性系统评价注册库标识符，CRD42023442972）进行系统文献综述。检索了Cochrane对照试验中央注册库、MEDLINE、Embase、ISRCTN注册库以及ClinicalTrials.gov，检索时间从创建至2023年10月29日。纳入了对开放性眼球损伤患者进行一期修复后至少随访1个月的前瞻性和回顾性非随机研究。主要结局包括末次随访时的视力以及发生眼内炎的患者比例。使用推荐分级、评估、制定与评价（GRADE）方法评估证据的确定性。
15项研究符合纳入标准，共报告了8497只眼。最常见的损伤类型为穿透伤和眼内异物（IOFB）。Meta分析发现，与开放性眼球损伤后超过24小时进行一期修复相比，损伤后24小时内进行一期修复发生眼内炎的几率为0.30（优势比，0.39；9%置信区间[CI]，0.19 - 0.79；I² = 95%；P = 0.01）。开放性眼球损伤在创伤后超过24小时与少于24小时进行修复的患者，在报告的视力预后方面未发现显著差异（优势比，0.89；95%CI，0.61 - 1.29；I² = 70%；P = 0.52）。所有纳入研究均为回顾性且非随机的，在GRADE评估中显示总体证据确定性较低。
关于开放性眼球修复时机的影响仅有回顾性数据，导致现有证据的确定性较低。然而，本次对当前证据的综述，主要包括穿透伤和眼内异物伤，表明与延迟时间更长相比，开放性眼球损伤后24小时内进行一期修复与眼内炎发生率降低相关，这与延迟一期修复会增加眼内炎风险一致。
在本文末尾的脚注和披露中可能会发现专有或商业披露信息。
