Effect of Time to Operative Repair Within Twenty-Four Hours on Visual Acuity Outcomes for Open Globe Injuries

Abstract Background/Objectives Convention is to perform open globe injury (OGI) repair within 24 hours to minimize risk of endophthalmitis. However, there is limited data assessing how time to operative repair (OR) within 24 hours impacts postoperative visual acuity (VA). Subjects/Methods Manual retrospective chart review of 633 eyes at Massachusetts Eye and Ear (MEE) with a diagnosis of OGI between 2012–2022. Inclusion criteria were primary repair ≤ 24 hours after injury and ≥ one month up. Multivariate regression analysis was conducted with postoperative VA as primary outcome. Results Of the subjects, 489 (77.3%) were male and 496 (78.4%) were white. Demographics of OGI wounds included 320 (50.6%) rupture and 313 (49.4%) laceration; 126 (19.9%) with rAPD, 189 (29.9%) zone 3 injuries, 449 (71.2%) uveal prolapse, and 110 (17.4%) intraocular foreign body. Final postoperative LogMAR VAs consisted of 31% with a VA < 1.7, 9% with a VA of 1.9, 18% with a VA of 2.3, 27% with a VA of 2.7, and 11% with a VA of 3.0. Multivariate analysis showed no significant correlation between time to OR and postoperative VA (p = 0.800) [95%CI:-0.01,0.01]. Older age (p < 0.001) [95%CI:0.00,0.01], worse presenting VA (p < 0.001) [95%CI:0.17,0.32], rAPD (p < 0.001) [95%CI:0.65,1.0], mechanism of rupture (p < 0.001) [95%CI:0.19,0.54], higher zone of injury (p < 0.001) [95%CI:0.25,0.45], and uveal prolapse (p = 0.003) [95%CI:0.09,0.42] were significantly associated with worse final VA. Conclusions Time to repair of OGIs within 24 hours does not influence final VA. Optimization of surgical and patient factors may contribute more significantly to final VA than prioritizing more rapid time to OR.