Although previous research suggests open globe injuries should be repaired within 12 to 24 hours to reduce the risk of endophthalmitis, the condition is uncommon when clinicians prescribe a systemic antibiotic as prophylaxis. Nonetheless, after open globe repair, the proportion of eyes requiring enucleation/evisceration is higher in eyes with endophthalmitis than without endophthalmitis, warranting careful attention.1
To better understand the best time to repair an open globe injury to optimize visual outcomes, a team of British researchers looked at all open globe injuries at the Birmingham Midland Eye Centre between January 2014 and March 2016. They found that these injuries should be repaired promptly, as the longer the repair is put off, the higher the risk of negative visual outcomes.2
In this retrospective, comparative case series, the researchers examined the presenting features, mechanisms of injury, visual acuities and demographic data of 52 repaired open globe injuries. The team notes that the mean time to primary repair was one day after injury, with repairs ranging from five hours to seven days after injuries. They found that final visual acuities at six to 12 months were related to presenting visual acuities, ocular trauma scores and the time between injuries and primary repairs. Patients experienced a reduced predicted visual acuity for every 24 hours of delay.2
“Presenting visual acuity remains the strongest predictor of outcome; however, delay to primary repair also reduced final visual acuity, and any significant delay from injury to repair is likely to negatively impact final visual outcome,” the study concluded.
1. Zhang Y, Zhang MN, Jiang CH, et al. Endophthalmitis following open globe injury. Br J Ophthalmol. 2010;94(1):111-4.
2. Blanch RJ, Bishop J, Javidi H, et al. Effect of time to primary repair on final visual outcome after open globe injury. Clin Sci. January 12, 2019. [Epub ahead of print].