Outcomes of Retinal Detachment after Open-Globe Injury, and Independent Validation of the Retinal Detachment after Open-Globe Injury Scoring System.

Abstract

To independently validate the Retinal Detachment after Open-Globe Injury (RD-OGI) scoring system as a clinical prediction model for estimating the risk of retinal detachment (RD) after open-globe injury (OGI), and to characterize outcomes of RD stratified by RD-OGI risk category. Retrospective, multi-institutional cohort study. A validation cohort of 236 eyes with OGI managed at 2 academic institutions from 2017 through 2021 was compared with the predictions of the RD-OGI score model and to the derivation cohort of 893 eyes with OGI used to develop it. RD-OGI scores were calculated, and patients were stratified into 3 risk groups (low, moderate, and high). The incidence of RD in the validation cohort was used to calculate performance metrics to evaluate predictive accuracy of the RD-OGI score. Area under the receiver operating characteristic curve (AUC), sensitivity, specificity, and accuracy of the RD-OGI score; anatomic success (retina attached or detached); and best-corrected visual acuity (BCVA) at last follow-up. In the validation cohort, 92 of 236 eyes (39%) demonstrated RD after OGI. The RD incidence predicted by the RD-OGI score was correlated strongly with actual RD incidence in the validation cohort (Spearman ρ = 0.92; P < 0.001). The RD-OGI score demonstrated high discrimination with the validation cohort (AUC, 0.84; 95% confidence interval [CI], 0.79-0.89). An RD-OGI score of 2.5 was found to have 73% accuracy, 93% sensitivity, and 60% specificity for predicting no RD (RD-OGI score < 2.5) versus RD (RD-OGI score ≥ 2.5). Median BCVA at last follow-up for successfully reattached eyes was comparable for high-risk eyes (approximately 20/380) and moderate-risk eyes (approximately 20/300; P > 0.99), but both were significantly worse compared with low-risk eyes (approximately 20/25; P = 0.010). The RD-OGI score reliably predicts the risk of developing RD after OGI. In eyes that develop RD, a higher RD-OGI score is correlated strongly with a greater risk for poor functional and anatomic outcomes. An RD-OGI score of 2.5 or more identifies eyes at substantial risk of RD and adverse outcomes and may serve as a useful cutoff for guiding referral to a vitreoretinal surgeon after primary globe closure. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.