Vitreous management in penetrating trauma: primary repair and secondary intervention

Abstract

Ocular trauma involving the vitreous produces a very wide range of pathology, the treatment of which can confuse. In the past, the prognosis for vision following such injuries was poor. Modern closed intraocular surgical techniques have transformed the management of penetrating trauma and allowed salvage of vision in many previously hopeless cases. However, many controversies remain, including the timing of surgical intervention, the use of encircling buckles, and the type of internal tamponade. This article will discuss those controversies, and make some practical recommendations for the management of penetrating and perforating trauma involving the vitreous.

The Timing of Reconstruction in Severe Mechanical Trauma

“…all intraocular injuries amenable to treatment are addressed immediately after the wound has been closed; fig. 2) can be performed [8]. The advantages of this approach are numerous: the risk of a subsequent development of endophthalmitis is eliminated; should an infection already have started, it can be properly dealt with; all tissue pathologies that do not represent irreversible damage may be treated (e.g.…”

Long-term results of 360A° scleral buckling and vitrectomy with silicone oil tamponade for management of gunshot-perforating ocular injury

“…These two factors have helped save many eyes that would have previously been enucleated. 1 Histological studies showed the important role of blood in creating a posterior vitreous detachment (PVD) after about a week of the injury. Proliferation of cells on the surface of the retina and vitreous subsequently leads to tractional retinal detachment, which usually occurs after 6 weeks.…”

“…The rationale of encirclement is to reduce the circumference of the vitreous base and thereby relieve traction on the peripheral retina. 1,10 The goal of our study is to examine how advanced microsurgical techniques can optimize the management of perforating ocular injuries.…”

“…1 A perforating injury refers to an ocular injury with an entry and exit wound. The term perforating injury has replaced double-penetrating injury because the latter term, while descriptively correct, is not adequately specific as it may also be used to describe wounds caused by two foreign bodies that enter but do not exit the globe.…”

Outcomes of Delayed Vitrectomy in Open-Globe Injuries in Young Patients

“…In this study, 6 despite a delay in the intervention of 21 days, spontaneous PVD at the time of surgery was present in only 24.5% of the patients. As stated in the review by Aylward,7 although the question of best timing for vitrectomy in penetrating trauma is likely to remain controversial for some time, a flexible approach is recommended.…”