gms | German Medical Science

Purpose: A 36-year-old man underwent trauma of right eye with screwdriver during an incident at home on 26^th October 2023. He presented with a BCVA of hand motion while his IOP was measured at 2 mmHg. Slit-lamp examination revealed a full thickness corneal wound with iris prolapse, damage and massive subconjunctival hemorrhage. The CT imaging of the orbits showed a deformation of the right eye, with no identifiable foreign objects detected.

Methods: Urgent closure of the corneal laceration was conducted using 12 sutures of 10/0 Nylon. The patient was administered cefazolin intravenously, along with local treatment involving levofloxacin and a combination of dexamethasone and chloramphenicol. On the first day postoperatively, the IOP in the right eye measured 6 mmHg, and light perception was noted. In the subsequent post-operative days, there was improved visibility of the anterior chamber, revealing the presence of hyphema and lens masses. Vitreous hemorrhage and choroidal detachment were detected during ultrasound examination. It was decided to perform second intervention. Pars plana vitrectomy with lensectomy and silicone oil tamponade was done. Hand motion visual acuity has been achieved, and the IOP has been increased to 8 mmHg.

Results: The patient remained under ambulatory care and attended scheduled follow-up visits regularly. Treatment recommendations included the application of dexamethasone-chloramphenicol eye drops and ointment. 1 month after trauma the patient’s BCVA measured 0.4 with a pinhole, and the IOP was recorded at 10 mmHg. On 5-months follow-up visit the patient’s BCVA was 0.5 and IOP was within normal limits (15 mmHg). During regular follow-up visits all sutures were gradually removed. Further vision prognosis depends on the healing process of the cornea, and the possibilities of scleral-fixed lens implantation will be decided.

Conclusion: In this reported case, urgent and successful closure of the corneal wound and subsequent pars plana vitrectomy with lensectomy and silicone oil injection preserved the structural integrity of the eye and enhanced the patient’s expected visual outcome. Presently, continued patient observation and planning for further intraocular lens implantation is necessary.