gms | German Medical Science

Background: In spite of the progress in vitreoretinal surgery, the anatomical and functional results of severe ocular injuries involving the posterior segment are still discouraging. Perforating injuries and ruptures, that extend posterior to the muscle insertions, have the worst outcome. At the time of secondary intervention between day 7 and 14 post trauma it is not unlikely that severe PVR already occurred. The authors retrospectively analyzed 71 severe ocular ruptures and perforating injuries, and investigated the effect of the time for secondary intervention on the anatomical and funcitonal outcome.

Method: 71 eyes with ruptures or perforations (with entrance and exit wounds, with at least one wound behind the insertion of the rectus muscles) had been treated at the department of Ophthalmology at the University of Würzburg. 27 eyes had vitrectomy within 100hrs after trauma, and 29 eyes later than 100hrs. In 15 eyes vitrectomy was considered either as unnecessary or as useless. Anatomical and functional outcome was examined at 6 months after trauma.

Results: 9 of the 27 eyes with reconstructive vitrectomy within 100hrs after trauma (33%) had a visual acuity of 0.1 or better, 3 (11%) failed anatomically (amaurosis, phthisis or enucleation). Only 3 of 29 eyes (10%) with vitrectomy later than 100hrs after the trauma regained a visual acuity of 0.1 or better, 6 (21%) failed. 7 of 15 eyes (47%) of the eyes, in which vitrectomy was considered as unnecessary or useless, had a visual acuity of 0.1 or better, the same amount was found having no light perception or phthitical or being enucleated.

Conclusion: Early vitrectomy for severe ocular trauma within 100hrs enables a better functional and anatomical outcome than vitrectomy later than 100hrs. The concept to act rather than to react on alterations secondary to severe posterior segment trauma is now further being evaluated in a prospective multicenter multinational study conducted by the World Eye Injury Register.