Open globe trauma – visual outcomes after primary vitrectomy
Reviewed by Sofia Rokerya

This retrospective study aimed to evaluate the impact of early vitrectomy on visual outcomes in eyes with open globe ocular trauma. One hundred and eighty eyes from a cohort of 166 patients who underwent primary vitrectomy between 2017 and 2023 were analysed. Data collected included the Birmingham Eye Trauma Terminology for injury assessment, the ocular trauma score (OTS) for clinical findings, and visual acuity measured on the logMAR scale. The median age was 43.0 years, and 84.4% were male. The most frequent occupation was students, followed by self-employed workers. Most cases involved only one eye, with a slight predominance of the left eye, although 7.7% presented with bilateral trauma. The most common cause of trauma was domestic accidents (31.1%), followed by workplace accidents. The most frequent mechanisms were blunt trauma (43.3%) and sharp blunt trauma (38.3%). Of 180 eyes, 120 had penetrating trauma and 44 of these cases involved an intraocular foreign body (IOFB). Gender, age, trauma context and baseline visual acuity were comparable between groups. The most frequent injuries at the first admission were corneal wounds (65.5%) and corneal oedema (56.5%). Nearly half of the eyes had vitreous haemorrhage (45.5%), scleral wounds (45.0%), or retinal detachments (43.8%). Epithelial defects were observed in 26% of cases, while choroidal detachments and retinal tears occurred in 9.4% and 13.8%, respectively. Other associated findings include traumatic cataract (35%), hyphema (28.8%), uveitis (26.6%), eyelid wounds (20.5%), lens dislocation/subluxation (18.8%), iris sphincter rupture (16.1%), and iridodialysis (15%). Less than 7% of cases had lacrimal pathway involvement, orbital fractures, angle recession, peripheral or macular contusions, subretinal or retrovitreal haemorrhages, globe avulsion, extraocular muscle involvement and endophthalmitis. Importantly, IOFB was present in 24.4% of eyes, while endophthalmitis was rare (2.2%). 44.44% of eyes underwent vitrectomy within 4 days, and 55.56% after 4 days, although students and those with work-related trauma tended to have surgery more frequently after 4 days. Of the total eyes, 103 (57.2%) corresponded to OTS 1, 45 to OTS 2, 22 to OTS 3, and less than 10% to OTS 4. No statistically significant association between OTS categories 1–3 and surgical timing (χ2=1.12, p=0.57) was found. Most cases had an OTS of 1 and underwent pars plana vitrectomy (PPV) and phacoemulsification (PHACO). OTS 2 cases underwent PPV with PHACO and air tamponade, while OTS 3–4 cases involved additional tamponades. The study concluded that 1 month after surgery, approximately 44% of eyes showed improved visual acuity, 42% remained stable, and 14% experienced a decline in vision. OTS 2 eyes with early surgery showed significantly better visual outcomes (p=0.003). There were no statistically significant differences in complications related to the time of surgery. Limitations: The number of eyes within OTS categories 4 and 5 was small to allow for meaningful subgroup analysis. For eyes with OTS category 3, the study may have been underpowered to detect significant differences in visual outcomes between early and late intervention; therefore, these negative findings should be interpreted with caution. Follow-up period was short, as beyond the first month, patients were monitored at other healthcare facilities. Strengths: Completeness of clinical records, which minimised the potential for selection bias, and the comparability of the OTS groups.

Visual outcomes after primary vitrectomy in open globe trauma.
Pérez-Pérez SM, Zuluga GE, Arias VC, et al.
OPHTHALMOLOGICA
2026;249:158–66.