We are grateful for the comments from Chen and associates regarding our article reporting traumatized eyes with no light perception (NLP) visual acuity after open-globe injury. This study was based on the Eye Injury Vitrectomy Study database, the purpose of which is to investigate the surgical interventions and outcomes of severe mechanical injured eyes.

Chen and associates pointed out that light perception is a subjective measure and is not a reliable test in the presence of severe media opacity. Thus, NLP is not the indicator for enucleation. Our previous study also demonstrated that the risk factors of having NLP after open-globe injury were not prognostic indicators for NLP visual outcome. Therefore, we should try our best to salvage the severe injured globes, and we do not recommend undertaking primary enucleation in the injured patients with initial NLP without exploratory surgery.

We agree with Chen and associates’ opinion that early removal of the proinflammatory mediators and repair of retinal detachment can reduce the risk of formation of extensive proliferative vitreoretinopathy. The reattachment of the detached retina will inhibit the process of inflammatory mediator release, which we call contact inhibition of tissues . Chen and associates administered intravitreal tissue plasminogen activator before vitreoretinal surgery to accelerate the liquefaction of vitreous and subretinal blood clots. We are very interested in their means and we believe that it may be a feasible method to avoid the development of proliferative vitreoretinopathy in severely injured globes. As part of our series studies, the further prospective study of the risk factors for the development of proliferative vitreoretinopathy is now in process.

According to our study, the timing of vitreoretinal surgery is an important factor for the outcomes of severely injured eyes. However, the randomized controlled trial cannot be used to identify the optimal surgical timing because of the ethical issues. We are now engaging in the Eye Injury Vitrectomy Study — a large cohort of injured eyes with different intervals of injury and vitrectomy. It will be a more practical way to investigate the rational timing of vitreoretinal surgery based on the Eye Injury Vitrectomy Study database.

Now, we are fully convinced that injured eyes with NLP vision can be saved and can achieve light perception or better vision by vitreoretinal surgery.