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Perforating open globe injuries- epidemiology, diagnosis and management

Session Details

Session Title: Quick Fire Free Paper 1

Session Date/Time: Thursday 11/09/2014 | 08:00-10:00

Paper Time: 09:20

Venue: Boulevard D

First Author: : R.Troyanovsky RUSSIA

Co Author(s): :    B. Monakhov   A. Baranov   S. Solonina   O. Sinyavskiy   A. Golovin   N. Malinovskaya

Abstract Details

Purpose:

To analyse epidemiology, peculiarities and errors of diagnostics and results of surgical treatment of perforating open globe injuries in adults and children

Setting:

Perforating injuries maintain leading position among eye trauma peace and war time and amount to 5% of all open globe injuries in adults and children. Decreasing of this rate demonstrates the clinical peculiarities of damage, complexity and errors of diagnostics

Methods:

24 eyes with perforating open-globe injuries were analyzed among 331 patients aged 6-35 y. o. (379 eyes) with penetrating eye’s trauma. In children damages were caused by bullet pneumatic weapon (5 cases), knife, homemade dart or large fishhook (3 cases). In adults injuries were caused by fragments of artillery min, shells, grenades or bullets (9 eyes) or antipersonnel and antitank mines (6 eyes) and shot (1 case). Visual acuity before operation was: no light perception in 2 eyes, light perception in 14 eyes, hand moving in 6 eyes, 0,005 - 0,09 in 2 eyes. The first operation was performed in 4 days after trauma in 22 eyes including in 1 day in 16 cases and in 2 another cases in 14 days. Early operations contained lensvitrectomy in 12 from 22 eyes (54,5%) and wound closure in 10 eyes with stitching of output wound in 4 cases. In 2 cases delayed operations were radical vitrectomies. Recurring operations took place in 11 cases when first operations were not perfect: lensvitrectomy with intraocular lens implantation (3), cerclage and buckling (8), silicone tamponade (3)

Results:

The perforating open-globe injuries were revealed in 7,25% patients (6,3% eyes). Repeated operations in cases of severe damage of posterior eye’s pole (after stitching of output wound) and the marked opacity of the cornea were made for elimination of pathological tissue fixation and improvement of relief retina in 45,8% (11 eyes) in 8-15 days after first operation. The final visual acuity was: no light perception in 4 eyes, light perception – in 6 eyes, 0,01-0,09 – in 3 eyes, 0,1 – 1,0 – in 11 eyes. Phthisis of the eye took place in 5 patients. In 3 cases errors of diagnostics led to delayed operation and deterioration of functional results of treatment

Conclusions:

The late diagnosis of perforating open globe injuries or diagnostic errors remains the main cause of not radical first operation. Delayed first or repeated operation more advisable in severe injury in 3-14 days. In cases of not radical first operation repeated operation should be made in 7-14 days. Restoration of the anatomical integrity of the eye and prevention of pathological tissue fixation are the main factors in prophylaxis of vitreoretinal tractional syndrome and proliferative vitreoretinopathy

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