The Timing of Reconstruction in Severe Mechanical Trauma

Abstract

Serious ocular trauma involving the posterior segment remains rather common and, despite many technological advances in recent years, continues to represent a significant management challenge to the ophthalmologist. One of these challenges is to identify the most optimal timing for the ultimate reconstruction, namely vitrectomy. While it is fairly obvious that suture-closure of the wound of open-globe injuries should be done as soon as possible, it is less clear whether vitrectomy should be performed in the same surgical session (primary comprehensive reconstruction) or be deferred (staged approach), and if so for how long. In this review, 4 options for staging are offered: early (days 2-4); delayed (days 5-7); late (days 8-14), and very late (past 2 weeks). The earlier the vitrectomy, the higher the risk of intraoperative complications. Conversely, the later the vitrectomy, the higher the incidence and severity of postoperative complications, of which proliferative vitreoretinopathy is the most damaging.

Surgical Management of Traumatic Retinal Detachment with Primary Vitrectomy in Adult Patients

“…He concluded that the earlier the vitrectomy, the higher the risk of intraoperative complications, bleeding, wound leakage, and bad visualization. Conversely, the later the vitrectomy, the higher the incidence and severity of postoperative complications, mainly PVR [22, 23]. However, other authors investigated longer time [24] (mean 49 days) and they concluded that a delayed approach is compatible with good visual prognosis in relatively young patients.…”

Rupture of the Globe: What to Do, What not to Do

“…Sparing the patient a second operation, together with the possibly that a detached retina may be reattached sooner, favours a one-stage intervention [12].…”

“…Overall, there are thus good reasons for a two-stage approach [12,13], and the two-stage approach has some clear advantages: If the cornea is involved, the exploratory inspection during the ini-tial surgery may not be optimal for retinal surgery treatment. This may fundamentally jeopardise the success of a retinal surgery intervention, may however also lead to more subtle changes such as a traumatic macular hole being overlooked.…”

A 2014 és 2018 között osztályos ellátást igénylő szemsérülések klasszifikációja a Markusovszky Egyetemi Oktatókórházban

“…Nyitott szemgolyósérülések esetén minden esetben az érkezést követő lehető legkorábbi primer sebzárás történt az endophthalmitis és az expulzív vérzés kivédése céljából. A sebzárás halasztása (24 óra; például éjszaka helyett munkaidőben történő ellátás) a szakirodalmi adatok szerint növeli az endophthalmitis kockázatát [14][15][16]. Az esetek 70%-ában primer átfogó rekonstrukció történt, vagyis a páciens nem szorult több beavatkozásra.…”