gms | German Medical Science

102. Jahrestagung der DOG

Deutsche Ophthalmologische Gesellschaft e. V.

23. bis 26.09.2004, Berlin

Treatment of severe ocular trauma: limits of evidence-based ophthalmology

Meeting Abstract

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  • corresponding author W. F. Schrader - Universitäts-Augenklinik, Würzburg
  • F. Kuhn - University of Pecs, Hungary and University of Birmingham at Alabama, Birmingham, U.S.A.

Evidenzbasierte Medizin - Anspruch und Wirklichkeit. 102. Jahrestagung der Deutschen Ophthalmologischen Gesellschaft. Berlin, 23.-26.09.2004. Düsseldorf, Köln: German Medical Science; 2004. Doc04dogDO.17.01

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Veröffentlicht: 22. September 2004

© 2004 Schrader et al.
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In Germany, the number of open globe injuries is decreasing. The incidence in USA and central Europe is reported to be 3/100 000. The cases per center are too low to evaluate new therapeutic modalities in prospective randomized studies. In addition, the cases are too heterogenous to sample them for multicenter studies. New therapeutic modalities can theoretically only be validated in large nationwide trauma registers, but only retrospectively. However, the therapeutic regimen is so far not reported detailed enough in these registers.


As in all areas of medicine, the treatment of ocular trauma should be reevaluated from time to time. Conventional timing suggests secondary pars plana vitrectomy (PPV) after an intervall of 7-10 days following posterior segment trauma. After globe rupture and following perforation severe PVR detachment is already seen at the time of secondary surgery. The authors therefore tried to perform vitrectomy already within the first 3 days. All traction has to be removed, which also requires retinectomies.


In small series performed by the authors the functional results were quite encouraging. In 10 of 12 cases with PPV even at the time of primary wound closure a sufficient anatomic reconstruction could be achieved, with visual acuity of at least 20/100 in 5 cases.


Based on a new approach to act rather than to react on alterations secondary to severe posterior segment trauma the functional results of these injuries may be further improved.