Open Globe Management

Alessandro A. Castellarin, MD; Dante J. Pieramici, MD

Disclosures

Compr Ophthalmol Update. 2007;8(5):111-124. 

In This Article

Perforating Injuries: Role of Primary Pars Plana Vitrectomy

The incidence of perforating injuries varies widely depending on study criteria. Missile and gunshot wounds are the cause of these injuries in three-fourths of eyes. These injuries usually carry a worse prognosis than IOFBs and penetrating trauma, as the inciting agent enters the front and exits out of the posterior pole. Contracting membranes may be present as early as 6 hours after injury. Vitreous hemorrhage, vitreous incarceration, along with the injury of the lens and the ciliary body seem to accelerate the process.[33] Fibrosis and the amount of new collagen increases dramatically between 14 and 30 days, leading to anteroposterior traction. Before vitrectomy was available, most of the eyes with perforating trauma became phthisical or required enucleation.

Vitrectomy surgery has improved the prognosis of perforating injuries, and a meta-analysis of published reports on eyes undergoing vitrectomy showed anatomical success in 69% and a visual acuity of ≥5/ 200 in 56% of the eyes.[34,35] The timing of vitrectomy for perforating injuries remains controversial, and can be early (within 2 days), delayed (7-14 days), or late (after 30 days). Early vitrectomy may present technical difficulties due to poor visibility, lack of posterior hyaloidal separation, bleeding, and re-opening of the exit wound. Late vitrectomy is usually not recommended, but delayed vitrectomy may eliminate some of the difficulties associated with early surgery and allows spontaneous closure of the posterior exit wound.

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