Although perforation is a rare complication of peribulbar anesthesia in normal eyes, the severity of complications in this study point to the importance of giving all patients, not only those with risk factors (eg, myopia, scar formation), detailed information about the possible risks and complications of peribulbar injections compared with those of other methods such as topical anesthesia and general anesthesia.

There is a relative constant incidence of 3.0 open globe injuries per 100,000 population. The circumstances of the injuries underwent major changes within the period of these observations.

With its incidence exceeding 60%, proliferative vitreoretinopathy (PVR) remains the most important pathology responsible for loss of vision, even the eyeball, after certain types of severe trauma. In this article, we present results obtained using our novel surgical technique, prophylactic chorioretinectomy (PCR), to prevent the development of PVR. Data on severely injured eyes at high risk for PVR [rupture, posterior laceration, deep-impact intraocular foreign body (IOFB) trauma, perforating injury] were collected prospectively. All eyes underwent vitrectomy (PPV) by PCR within 100 hr of the trauma. Eyes were excluded if they presented with endophthalmitis or if the reconstructive surgery was performed outside this time frame. Forty eyes of 40 consecutive patients were analyzed; full follow-up information was obtained for all of them. The injury was rupture in 27%, penetrating in 15%, (deep-impact) IOFB in 35%, and perforating in 23%. PPV-PCR was performed during primary (wound closure) surgery in 59% of cases. All eyes had at least minimal vitreous hemorrhage, and none had a true posterior vitreous detachment. At the time of PPV, 30% of the eyes had a retinal detachment. Sixteen percent developed PVR, but none from the site of the PCR procedure. In 20%, silicone oil remained in the eye at the last follow-up. The visual acuity improved in 93% of eyes and worsened in none; the improvement was mostly due to surgical clearing of the media opacity. In this subgroup of eyes with severe open-globe trauma, over 60% are expected to develop PVR. PPV/PCR performed within 100 hr reduced the PVR risk significantly, so currently it remains the best option for the surgeon. Clin.

Background: To compare the outcome of bevacizumab or triamcinolone acetate (TA) treatment in patients with macular edema (ME) after branch retinal vein occlusion (BRVO). Methods: In a retrospective assessment, 10 bevacizumab-treated patients and 10 TA-treated with ME after BRVO were pair-matched according to initial best-corrected visual acuity (BCVA) and central macular thickness (CMT) as measured by Stratus optical coherence tomography (OCT). BCVA and CMT were the main endpoints. Results: The initial BCVA was 0.2 ± 0.13 in bevacizumab-treated patients and 0.2 ± 0.16 in TA-treated patients, with a CMT of 497 ± 102 µm and 517 ± 88 µm, respectively. Following bevacizumab, the mean final BCVA increased by 2.8 ± 4 lines, and by 0.6 ± 3.5 lines in patients receiving TA. The mean final CMT was 238 ± 118 µm and 195 ± 243 µm in the respective treatment groups. Conclusions: Both treatments decreased the CMT, but only bevacizumab induced an improvement in BCVA from baseline, which was significant 8 weeks after treatment, but no longer significant after 13 months.

Globe rupture is one of the most severe open globe injuries, permanently impairing visual acuity or leading to blindness. The risk of globe rupture is increased after previous intraocular surgery (27-fold), in myopia, older age, females, and after sudden falls. The differentiation between an occult globe rupture and severe ocular contusion may be complicated by pronounced subconjunctival hemorrhage with conjunctival swelling. In case of doubt, a rupture of the eyeball should be ruled out after a severe blunt ocular trauma. Limbal and scleral exploration after 360 degrees peritomy leads to the correct diagnosis. Immediate and watertight wound closure is essential to avoid expulsive choroidal hemorrhage, persisting ocular hypotony or epithelial ingrowth. Delayed wound closure raises the risk of posttraumatic endophthalmitis. Early vitrectomy may prevent tractional retinal detachment in case of retinal injury with vitreal bleeding. Silicone oil instillation stabilizes the central retina after open globe injury; scleral buckling is controversial.