Cesare Forlini, MD (Ravenna, Italy), Paolo Rossini, MD (Ravenna, Italy), Stefano Dolce, MD (Ravenna, Italy), William Gualtieri, MD (Ravenna, Italy), Antonio Aversano, MD (Ravenna, Italy)

PURPOSE:

The management of severe globe injuries depends on several factors that do not tolerate prefixed schemes or dogmas. The “close-as-you-go” technique consists in the restoration of the globe integrity suturing both cornea and sclera surfaces step by step as the wound opens. This in order to preserve the structure and avoid the globe collapse. When, where and why to stop? There are no precise limits.

METHODS:

We present a bulbar rupture with large and irregular scleral tear and collapsed globe. After reconstructing the sclera with “close-as-you-go” technique we started via pars plana infusion and removed the haemorrhage in the anterior chamber. The reconstruction went on with retinotomy and removal of vitreous and subretinal haematoma. F6H8/silicone oil tamponade
was injected.

RESULTS:

After 40 days the removal of the double tamponade: centrale retina was preserved, but peripheral PVR required the the surgeon to perform limited retinotomies and retinectomies with new silicone oil tamponade. After six month the retina is flat.

CONCLUSION:

The surgeon’s experience and capabilities play a decisive role in this kind of surgery. However, designing a strategy that may the allow the surgeon to proceed in the different surgical steps improve the prognosis in complex cases, avoiding the patient to undergo different surgeries.