First Author: A.Novolodsky RUSSIA
Co Author(s): V. Bury T. Iureva A. Shchuko 0 0 0 0 0 0 0 0 0
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To improve approaches of surgical treatment of patients after penetrating injury with traumatic damage of lens and intraocular foreign body.
Irkutsk Branch of Sv. Fyodorov Eye Microsurgery Federal State Institution, Russia
We observed 12 patients aged 8 to 32 years after penetrating trauma. Period after injury ranged from 1 month to 6 months. All patients had traumatic cataract and intraocular foreign body which localized in the posterior parts of the eyeball. 5 patients had evidence of metallosis, 3 patients of phacogenic uveitis. Visual acuity varied from 0.001 to 1.0. All patients underwent surgery with a differentiated approach depending on the particular pathological changes. Lensectomy was performed with aspirating cannula in the viscoelastic medium. Programmable posterior capsulorhexis in optical zone was made in cases of paracentral or equatorial lens damage. In case of the central damage of posterior lens capsule its maximum preservation was fulfilled. Total 25G vitrectomy was performed with foreign body localization. Mobilized foreign body was extracted with forceps through a defect in the posterior lens capsule of into the anterior chamber. Foreign body was removed from anterior chamber. The IOL was implanted in capsular bag sheets. If foreign body was located in preretinal area, surgery was ended by tamponade of vitreous cavity with gas-air mixture. In case of impacted foreign body the laser photocoagulation of foreign body bed was performed with subsequent tamponade of vitreous cavity with silicone oil.
This treatment allowed achieving improvement of ocular status in all patients due to reduced phacogenic uveitis and phenomena of metallosis, as well as improved visual function from 0.6 to 1.0 in the early and late periods. Follow-up was from 6 months to 1 year.
Differentiated approach to treatment of this group of patients allows to reduce surgical trauma, to stable fixation of the intraocular lens in the capsular bag, reducing the risk of retinal complications and proper rehabilitation.