Background: Perforating injuries continue to have a poor prognosis with less t han two-thirds of eyes having at least ambulatory final vision, due to prolifer ation originating from the exit wound. Materials and Metho...Background: Perforating injuries continue to have a poor prognosis with less t han two-thirds of eyes having at least ambulatory final vision, due to prolifer ation originating from the exit wound. Materials and Methods: We developed a new , proactive treatment method, which is applicable in most eyes with perforating trauma. The strategy involves limited, indirect ophthalmoscopic vitrectomy durin g the primary repair; heavy topical corticosteroid therapy postoperatively; and complete vitrectomyon day 3, including prophylactic retinectomy around the exit wound, evacuation of subretinal blood, laser retinopexy, and silicone oil implan tation. Results: In the five consecutive eyes in which the proactive treatment a pproach was used, no"enscarceration" of the retina into the exit wound, prolife rative vitreoretinopathy, retinal detachment, or retinal folding has occurred. T he median visual acuity improved from count fingers to 0.6 in the three eyes wit hout macular involvement. Conclusions: Far-reaching conclusions must not be mad e based on such a small series, but the proactive treatment approach appears pro mising in preventing proliferation-related complications such as fractional ret inal detachment or retinal fold development. A similar approach should be consid ered for eyes with deep impact trauma from intraocular foreign bodies and in eye s with incarcerated retina in the rupture wound.展开更多
文摘Background: Perforating injuries continue to have a poor prognosis with less t han two-thirds of eyes having at least ambulatory final vision, due to prolifer ation originating from the exit wound. Materials and Methods: We developed a new , proactive treatment method, which is applicable in most eyes with perforating trauma. The strategy involves limited, indirect ophthalmoscopic vitrectomy durin g the primary repair; heavy topical corticosteroid therapy postoperatively; and complete vitrectomyon day 3, including prophylactic retinectomy around the exit wound, evacuation of subretinal blood, laser retinopexy, and silicone oil implan tation. Results: In the five consecutive eyes in which the proactive treatment a pproach was used, no"enscarceration" of the retina into the exit wound, prolife rative vitreoretinopathy, retinal detachment, or retinal folding has occurred. T he median visual acuity improved from count fingers to 0.6 in the three eyes wit hout macular involvement. Conclusions: Far-reaching conclusions must not be mad e based on such a small series, but the proactive treatment approach appears pro mising in preventing proliferation-related complications such as fractional ret inal detachment or retinal fold development. A similar approach should be consid ered for eyes with deep impact trauma from intraocular foreign bodies and in eye s with incarcerated retina in the rupture wound.
