Severe Eye Injuries: The Trouble with Being Late


The “when” is just as an important question in the surgical intervention for eyes with posterior segment injury as is the “what”. Identifying the ideal timing (staging) of vitreoretinal surgery is thus crucial as the most optimal management strategy is selected. Delaying posterior segment surgery beyond two weeks, which is unfortunately too often seen in the real world, risks the development of irreversible retinal damage. Performing it concomitant to wound repair (primary comprehensive reconstruction) is able to treat and typically also prevent many retinal complications and has therefore huge advantages, but may risk major intraoperative hemorrhage. Performing vitrectomy as a secondary procedure but within 4 days is an excellent compromise: it still allows timely treatment of damage that has already occurred and prevent complications that usually follow these severe injuries. Early vitreoretinal surgery in eyes with posterior segment injury in the hands of an experienced surgeon who has proper logistical support (well-equipped operating room and adequate, knowledgeable support staff) is especially crucial in cases of high risk for endophthalmitis or proliferative vitreoretinopathy. Conversely, no surgeon should start an operation that he cannot complete (“don’t start what you can’t finish”).



Ferenc Kuhn
Saint Johns, United States
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Cell Phone: +19044636428
Work Phone: +19044636428