Early versus delayed timing of primary repair after open-globe injury: a systematic review and meta-analysis
McMaster, David Bapty, James Bush, Lana Serra, Giuseppe Kempapidis, Theo McClellan, Scott F Woreta, Fasika A Justin, Grant A Agrawal, Rupesh Hoskin, Annette K
McMaster, David
Bapty, James
Bush, Lana
Serra, Giuseppe
Kempapidis, Theo
McClellan, Scott F
Woreta, Fasika A
Justin, Grant A
Agrawal, Rupesh
Hoskin, Annette K
Affiliation
Imperial College London; Portsmouth Hospitals University NHS Trust; University of Birmingham; University of Udine; Northumbria University; BRAVO VICTOR; Defense Health Agency; Johns Hopkins University; Uniformed Services University of the Health Sciences; Walter Reed National Military Medical Center; Tan Tock Seng Hospital; Singapore Eye Research Institute; Lee Kong Chian School of Medicine; Duke NUS Medical School; University of Sydney; University of Western Australia; University of Miami; Sydney Eye Hospital; Universidad del Salvador; Navy Medical Center Portsmouth; San Antonio Uniformed Services Health Education Consortium; White River Junction Veterans Administration Medical Center; Dartmouth-Hitchcock Medical Center; University of Surrey; St Thomas' Hospital; Manchester Royal Eye Hospital; Birmingham Institute for Glaucoma Research; University Hospitals Birmingham NHS Foundation Trust; Royal London Hospital; National University Hospital; Worcestershire Acute Hospitals NHS Trust; Helen Keller Foundation for Research and Education; University of Pécs Medical School; Royal Centre for Defence Medicine
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Publication date
2024-08-31
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Collections
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Abstract
Topic: The timing of primary repair of open-globe injury is variable in major trauma centers worldwide, and consensus on optimal timing is lacking.
Clinical relevance: 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.
Methods: 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.
Results: 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; I2 = 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; I2 = 70%; P = 0.52). All included studies were retrospective and nonrandomized, demonstrating an overall low certainty of evidence on GRADE assessment.
Discussion: 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.
Citation
McMaster D, Bapty J, Bush L, Serra G, Kempapidis T, McClellan SF, Woreta FA, Justin GA, Agrawal R, Hoskin AK, Cavuoto K, Leong J, Ascarza AR, Cason J, Miller KE, Caldwell MC, Gensheimer WG, Williamson TH, Dhawahir-Scala F, Shah P, Coombes A, Sundar G, Mazzoli RA, Woodcock M, Watson SL, Kuhn F, Colyer M, Gomes RSM, Blanch RJ. Early versus Delayed Timing of Primary Repair after Open-Globe Injury: A Systematic Review and Meta-analysis. Ophthalmology. 2025 Apr;132(4):431-441. doi: 10.1016/j.ophtha.2024.08.030. Epub 2024 Aug 31.
Type
Article