Impact of Surgeon Subspecialty Training on Surgical Outcomes in Open-Globe Injuries
Narrative Responses:
Purpose
To evaluate whether subspecialty training of the initial treating surgeon affects visual acuity and surgical outcomes in patients with open globe injuries.
Methods
This is a single institution, retrospective case series study. Charts of 282 adult patients with open globe injuries requiring surgical repair at the Wilmer Eye Institute between July 1, 2007 and July 1, 2012 were retrospectively reviewed. 193 eyes had at least 6 months of follow up. Clinical findings at presentation were recorded. Details of initial repair and follow up surgeries were analyzed. Differences in visual acuity and surgical outcomes were compared by subspecialty training of the initial surgeon.
Results
Eyes initially treated by a vitreoretinal (VR) surgeon were 2.3 times (p=0.003) more likely to improve by one OTS visual acuity category and 1.9 times (p=0.027) more likely to have at least one more follow-up surgery at 6 months compared to eyes treated by non-VR surgeons. Patients with more anterior injuries treated by a VR surgeon were more likely to improve by one OTS visual acuity category compared to those treated by non-VR surgeons (Zone I p=0.004, Zone II p=0.016). There was no difference in visual acuity outcomes for eyes with posterior injuries (Zone III p=0.515).
Conclusion
Traumatic open globe injuries require significant surgical rehabilitation. Eyes treated by a VR surgeon overall have improved visual outcomes than those treated by non-VR surgeons. These patients, however, undergo more follow up surgical rehabilitation.