Noha Khater, (Cairo, Egypt)

PURPOSE:

To evaluate the anatomical and visual outcome of pars plana vitrectomy for patients with open globe injuries involving the posterior segment.

METHODS:

24 eyes of 24 patients with open globe injuries involving the posterior segment were evaluated following the initial repair. All cases were properly examined by slit-lamp, indirect ophthalmoscope and fundus biomicroscopy when a fundus view was possible. Ct-scan and ultrasound were performed for the possibility of retained intraocular foreign bodies (IOFB). The patients were immediately scheduled for vitreoretinal surgery with anterior segment reconstruction if needed. Functional and anatomical outcomes; as postoperative visual acuity (VA), success of retinal reattachment and anterior segment condition were recorded for up to 12 months postoperative.

RESULTS:

All patients were males with a mean age of 23.4 years. Preoperative VA was poor owing to the severity of ocular trauma; 18 eyes (75%) had hand motion, 4 eyes (16.6%) had light perception and 2 eyes (8.3%) had 6/9 VA. 12 eyes (50%) had retained IOFBs. 12 eyes (50%) had a traumatic retinal detachment. Silicone oil was used in 14 eyes (58.3%) and long acting gas (SF6) in 2 eyes (8.3%). Intraocular lens implantation was only performed in 4 (20%) of the 20 eyes that had traumatic cataract removed, rest were deferred until stabilization of the retinal condition. A temporary keratoprothesis was applied intraoperatively for better retinal visualization in 4 eyes. At twelve months, the postoperative VA was <3/60 in 12 eyes (50%), 3/60-6/60 in 6 eyes (25%) and >6/60 in 6 eyes (25%). Intraocular pressure was >22mmHg in 5 eyes (20.8%) after surgery, all were controlled medically.

CONCLUSION:

Open globe injuries are commonly associated with posterior segment injuries that tend to be severe with an unfavorable outcome. Prompt and proper management by the retina service improves the visual and functional outcome after surgery. Prevention is the key to avoid such serious injuries by educating workers about protective eyewear and enforcing it by law.