Chorioretinectomy for perforating or severe intraocular foreign body injuries
To report the outcomes of chorioretinectomy versus non-chorioretinectomy in combat ocular injuries where a foreign body penetrated the choroid or perforated the globe. Retrospective, comparative, consecutive interventional case series of 32 perforating or severe intraocular foreign body combat ocular trauma injuries sustained by United States military soldiers and treated at a single institution from March 2003 to March 2009. Final best-corrected visual acuity (BCVA) in 19 non-chorioretinectomy-treated eyes was compared to 13 chorioretinectomy-treated eyes. The chorioretinectomy group was repaired with a 20 gauge three-port pars plana vitrectomy (PPV) by removing the choroid and/or retina at the impact or perforation site of the foreign body following evacuation from a combat zone. The main outcome measures were best-corrected visual acuity and rates of globe survival, retina reattachment and proliferative vitreoretinopathy. Thirty-two eyes of 31 patients with a mean age of 29 +/- 9 years (range, 19-53 years) were followed for a median of 463 +/- 226 days (range, 59-1022 days). The mean time of injury to the operating room in the chorioretinectomy group was 12.6 +/- 9.8 days, compared to that of the non-chorioretinectomy group of 22.1 +/- 16.4 days (P = 0.05) Final BCVA > or =20/200 occurred in seven of 13 (54%) of the chorioretinectomy group, compared to two of 19 (11%) in the non-chorioretinectomy group (P = 0.04). Globe survival rates were higher in the chorioretinectomy group [11 of 13 (85%) vs 9 of 19 (45%); P = 0.06], as well as the final retinal reattachment rate [8 of 13 (62%) vs 8 of 19 (42%); P = 0.47]. The proliferative vitreoretinopathy rate was eight of 13 (62%) in the chorioretinectomy group, compared to 14 of 19 (74%) in the non-chorioretinectomy group (P = 0.70). Graft failure occurred in five of six eyes (83%) of non-chorioretinectomy cases, requiring temporary keratoprosthesis and penetrating keratoplasty. Chorioretinectomy is a surgical option that may improve final BCVA and increase globe survival rates when a foreign body penetrates the choroid or perforates the globe.
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[Show abstract] [Hide abstract] ABSTRACT: Management of ocular trauma is both challenging and controversial. Using current available evidence in literature and author experience this review aims to highlight critical issues in management of ocular and orbital trauma. This review provides a working framework from initial presentation, investigations, management principles, complications and prognosis to outcome and controversies involved in management. The review will focus on the concept of atraumatic repair of traumatized globe and will also give guidelines about strategic planning in ocular trauma management. Clinicians are occasionally faced with dilemmas and challenges in management of severely traumatized eyes with limited or no visual potential in view of life-time risk of sympathetic ophthalmia and the authors aim to address the controversy surrounding it.
- "This involves removal of all retina tissue incarcerated into the perforation site using the vitrector, with diathermy destruction of the retina/choroid in a 1-mm ring around the exit wound/ impact site. In subsequent follow-up study by authors' better visual outcomes, lesser PVR rates have been reported [64,65]. "
[Show abstract] [Hide abstract] ABSTRACT: Background Ocular trauma is a major cause of vision loss, especially in the young patients, and is the leading cause of unilateral blind in China.Objective The aims of this report are to analyze ciliary and choroidal lesion characteristics and outcomes of a group of patients with ruptured globe injuries and discuss finding a more effective treatment protocol. Here we report our experience treating ruptured globe injuries.Methods Seventy-five patients (75 eyes) with a diagnosis of ruptured globe injuries were selected from 264 patients with open globe injuries at the Shierming Eye Hospital of Shandong Province between January 2009 and December 2011. General information and clinical characteristics such as ciliary and choroidal lesion features were reviewed.ResultsOf the 75 patients, 85.3% were men, and the average age of the patients was 37.2 years (range, 6–63 years). The right eye was injured in 52.0%; enucleation was performed in 9 patients. There was no light perception, in the final corrected visual acuity in another 3 patients. The ratio of better visual acuity (better than 0.1) increased from 0 preoperatively to 16.0% postoperatively. Among the 75 patients with ruptured globe injuries, 13 had ciliary injury and 47 (62.7%) had choroidal injuries. Both ciliary and choroidal injuries were detected in 15 patients. Retinal tissue incarceration during sclera suturing was usually the vital point leading to unfavorable results.Conclusions Ruptured globe injury usually results in severe visual acuity damage. Active treatment could help to restore visual acuity in patients to some degree. Some effective treatment protocols for ruptured globe injuries could be followed. Some unsuitable procedures in primary treatment should be avoided to achieve a better prognosis.
- "For some patients with anterior chamber hyphema, anterior chamber irrigation after injection of viscoelastics could prevent blood staining of the cornea. A complete vitrectomy is performed via a pars plana incision, avoiding the injury site.5 If there is ciliary body injury, detachment, or hyphema, it is difficult to determine the injection tube location. "