Is it Possible to Treat Serious Penetrating Injury Successfully?

Overview

The number of serious devastating eye injuries caused by violent crimes ortransport accidents is growing. The patients are mostly young men and thepreserving of the eye, especially its function is often difficult.From June 2000 to March 2003, 4 eyes of 3 men (aged 16 –⁠ 23 years) with extraordinaryserious devastating penetrating injuries were treated in the Departmentof Ophthalmology in Pilsen. One eye was enucleated because of serious lacerationof the whole globe and eyelids at the initial treatment. In three eyes, a pars planavitrectomy (PPV) with inner silicone tamponade was performed after the initialtreatment of the penetrating and eventually exiting site. In all vitrectomized eyesa pars plana lensectomy (PPL) was performed, at the time of PPV in one eye, andin two eyes subsequently. When the eyes were stabilized, and the retina wasattached, the silicone oil was removed in two eyes.The visual acuity before the surgery decreased to uncertain light projection, andin two eyes of one patient, we were not able to detect the visual acuity because ofthe unconsciousness of the patient. The follow-up period was 3months to 2 years;all three eyes are aphakic, and the central visual acuity improved in two eyes to6/6-9 (20/20-30 or 1.0 –⁠ 0.66) with the aphakic correction or with the contact lens,in one eye with the silicone eye remained the visual acuity is 6/60 (20/200 or 0.1).Even as the prognosis in such patients is unfavorable, in some cases good functional resultsmaybe obtained.Thebasic precondition for successful reconstructionof the seriously injured eye is meticulous primary treatment. For salvage of visualfunctions, there are often necessary repeated surgeries on the anterior as well asposterior segment of the eye. Their good timing and adequate technique mayrapidly decrease the risk of complications after the injury and/or after the surgeryrespectively.

Key words:
perforating injury, pars plana vitrectomy, visual function