Outcome of Posterior Open Globe Injuries (Zone-III) At a Tertiary Referral Eye Care Centre in Singapore

Rupesh Agrawal

Purpose: The objective of this study was to evaluate the outcome of surgical repair of posterior open globe injuries at a tertiary referral eye care centre in Singapore.

Method: Retrospective review of medical records of patients with surgical repair of open globe injury over last ten years at a tertiary referral eye care centre in Singapore was conducted. Out of one hundred and seventy two eyes with open globe injury, twenty eight eyes (16.27%) with zone III injury1 were identified and reviewed further. Preoperative visual acuity, associated ophthalmic trauma, relative afferent pupillary defect and nature of surgery with final outcome was recorded.

Results: Twenty eight eyes had zone III open globe injury. Median age was 37.71 yrs (range: 19-74yrs) with male predilection (92.85%). Mean follow up was 11.92 months. Preoperative visual acuity was no light perception in 16 (57.14%) eyes. Final visual acuity remained no light perception in 14 eyes (50.00%). The factors contributing to poor postoperative vision were presence of relative afferent pupillary defect, poor preoperative visual acuity, extent of trauma and associated vitreoretinal trauma. None of the patients developed sympathetic ophthalmia or traumatic endopthalmitis.

Conclusion: Loss of light perception is the important determinant of final visual outcome in patients with zone III injury. Extensive scleral laceration, retinal detachment and lid injury are associated with poor final visual outcome. As there is low risk of sympathetic ophthalmia, surgeon should attempt to restore anatomical integrity of globe with guarded functional outcome in all zone III eyes with no light perception.