[Prognosis of traumatic eyes with no light perception undergone vitrectomy and analysis of risk factors].

ABSTRACT

OBJECTIVE: To evaluate the prognosis of traumatic eyes with no light perception post vitrectomy, and to analyze the risk factors influencing the final results. METHODS: Five hundred and ninety nine mechanically injured eyes in 577 patients undergone vitrectomy were registered from 1999 - 2004. Thirty-eight eyes in this group showed no light perception in initial visual examination. Thirty-two eyes (84.2%) had open-globe injury, the other 6 eyes (15.8%) had closed-globe injury. Excluded the enucleated eyes, the others were followed up for at least 6 months, averaged 7.2 months. All registered data were filled in predesigned forms. Each parameter was evaluated strictly according to the standards of the protocol. The risk factors of poor prognosis and traumatic no light perception were analyzed by logistic regression. RESULTS: Fourteen eyes (36.8%) achieved anatomic and functional success. Three eyes (7.9%) attained anatomic success. Nine eyes (23.7%) were enucleated. Hypotony occurred in 4 eyes. Seven eyes were maintained by silicone oil. Atrophy of eyeball occurred in 1 eye. Twenty-one eyes (55.3%) achieved a final visual acuity of light perception or better, including 0.2 in 3 eyes, 0.02 in 2 eyes, count finger in 3 eyes, hand move in 3 eyes, light perception in 10 eyes. Eight eyes (21.1%) remained no light perception. The logistic regression analysis identified the significant risk factors predictive of poor prognosis, including traumatic no light perception, presence of a relative afferent pupillary defect (RAPD), massive suprachoroid hemorrhage (MSCH), panretinal detachment with closed-funnel, ciliary body injury, preoperative atrophy of eyeball, prolapse of iris and aniridia, extrusion of crystalline lens, length of scleral wound greater than 10 mm and ruptured injury. These factors were also the risk factors of traumatic no light perception, excluded traumatic no light perception, prolapse of iris and aniridia. More than one risk factor usually co-exists in each eye. CONCLUSIONS: The eyes with traumatic no light perception have poor prognosis. However, 45% of them can achieve functional and anatomic success undergone vitrectomy. Eyes with no light perception are related to the combination of various risk factors. MSCH, severe retinal injury and extensive ciliary body injury are the main risk factors for poor prognosis.