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Open Globe Injury Repairs in the American Academy of Ophthalmology IRIS® Registry 2014-2018: Incidence, Risk Factors, and Visual Outcomes.

Ophthalmology 2023 March 15
PURPOSE: To estimate incidence and evaluate demographic risk factors and visual acuity (VA) outcomes of open globe injuries requiring surgical repair in the IRIS® Registry (Intelligent Research in Sight).

DESIGN: Retrospective cohort study.

SUBJECTS, PARTICIPANTS, AND/OR CONTROLS: Patients with open globe injury repairs (OGR) were identified by Current Procedural Terminology codes (65275, 65280, 65285, 65286, 65235, 65260, 65265) from 2014 to 2018 in the IRIS Registry.

METHODS INTERVENTION OR TESTING: Logistic regression models adjusting for age, sex, race, ethnicity, US region, concurrent and subsequent surgeries, and baseline VA.

MAIN OUTCOME MEASURES: Outcomes included annual and 5-year incidence rates per 100,000 persons and factors associated with OGR, VA < 20/40, and VA ≤ 20/200 at final follow up (3 to 12 months post OGR).

RESULTS: A total of 13,766 OGR's were identified during the study period, and 5-year incidence was 28.0/100,000. Annual incidence ranged from 11.1 to 12.7/100,000. OGR was associated with ages 21-40 years (yrs) compared to younger than 21 yrs (OR, 1.6 [95% CI: 1.5-1.7]); males compared to females (OR, 2.8 [CI: 2.7-2.9]); Black vs. White race (OR, 1.3 [CI, 1.2-1.4]); Hispanic vs. Non-Hispanic ethnicity (OR, 1.7 [CI, 1.6-1.8]); living in the South (OR, 1.4 [CI, 1.3-1.5]) and West (OR, 1.3 [CI, 1.2-1.4]) (vs Midwest) regions and inversely associated with Asian vs. White race (OR, 0.6 [CI, 0.6-0.7]). VA outcomes were analyzed in a subset of 2,966 patients with VA observations before the injury and at follow-up. Vision impairment (VA < 20/40) at final follow up was associated with VA ≤ 20/200 at presentation (20/200 better than 20/40 - OR, 11.1 [CI, 8.0-15.7]); older age e.g. 80+ yrs (vs < 21 yrs) (OR, 5.8 [CI, 3.2-10.7]); and Black race (vs White) (OR, 1.8 [CI, 1.3-2.6]). Risk factors were similar for VA ≤ 20/200 post OGR. Among the 1,063 OGR patients presenting with VA 20/200 or worse, VA did not improve to better than 20/200 at follow up in 35% (1,063/2,996) of patients.

CONCLUSIONS: Our findings bring to light racial disparities in risk of OGR and poor visual outcomes that warrant further exploration.

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