Open Globe Management

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

Disclosures

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

In This Article

Open Globe Injuries with Vitreous Hemorrhage Without Retinal Detachment: Controversial Role of Primary Vitrectomy

There are no controlled clinical studies demonstrating a benefit over the natural history of vitreous surgery in this particular group of eyes, but there is an excellent rationale for the procedure based on extensive experimental evidence. Using an injury model with blood injection in the monkey, Cleary and Ryan, and then Gregor and Ryan, were able to show that pars plana vitrectomy (PPV) performed after trauma markedly decreased the incidence of traction retinal detachment.[31] Vitrectomy allows early removal of cytokines and other inflammatory mediators that will later recruit retinal pigment epithelium cells, fibroblasts, and glial cells responsible for PVR and tractional retinal detachment.[32] In addition, removing the vitreous eliminates the scaffold on which the proliferation progresses. Pharmacologic modification of these cytokines has potential as a method to aid in the management of these patients. To date, no definitive evidence exists supporting the use of any one agent. Many agents have been used, including steroids, antimetabolites, nonsteroidal antiinflammatory agents, and lowmolecular- weight heparin, among others. Identifying the specific cytokines upregulated following open globe injury would be a first step in preventing PVR.

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