gms | German Medical Science

Purpose: To present a comprehensive pole to pole surgical strategy in a case of closed trauma on eye with previous Perforating Keratoplastic for keratoconus. Patient was suffering: Two year corneal suture reopened, lens expulsion, post-traumatic aniridia, massive suprachoroidal haemorrhage documented by ultrasound.

Methods: The surgical technique: Infusion cannula into the Anterior Chamber, ab-externo choroidal haemorrhage drainage through multiple sclerotomies, uncontinous corneal surgical suture of the reopened cornea, trans limbal anterior clot vitrectomy, TA assisted PPV to remove vitreous haemorrhage, to clean vitreous base and ciliary processes with scleral indentation aid. PFCL injection to help the residual suprachoroidal haemorrhage drainage from the bottom, to take out as much blood as possible, this step must be repeated several times. Endolaser retinopexy around every retinal breaks. Exchange PFCL/Silicon oil. The suprachoroidal haemorrhage was completely drained.

Results: After 40 days, the eye looks quite, normal IOP, heavy silicon oil in the vitreous chamber, slightly corneal edema around the fresh wound. The patient was scheduled to have the silicon oil removed and a secondary IOL implanted.

Conclusions: In this case, trauma caused the ocular content to be expulsed through the only route possible the anterior one. It is important to act at the right time to prevent PVR and/or other complications.