Surgical Techniques in the Management of Perforating Injuries of the Globe

Yoshihiro Yonekawa, MD; James Chodosh, MD, MPH; Dean Eliott, MD

Disclosures

Int Ophthalmol Clin. 2013;53(4):127-137. 

In This Article

Prognosis

Small studies in the 1980s showed a trend toward benefit in managing perforating ocular injuries with vitrectomy.[10–12] The largest series is from Martin et al[1] who reviewed 51 eyes with perforating injuries. Vitrectomy was performed 7 to 14 days after the primary repair, and prophylactic encircling bands were placed in select cases. Visual acuity of 20/100 or better was achieved in 32% (20/200 or worse in 68%). Sixty-two percent of eyes with knife or nail injuries achieved final visual acuities of 20/50 or better, compared with 16% of those with missile injuries (P<0.02). Preoperative visual acuities did not correlate with final visual acuities, and there were no differences in subsequent retinal detachment rates between those with prophylactic encircling bands and those without.

A meta-analysis of 15 reports found that anatomic success in treating perforating injuries was 69%, and 5/200 or better vision was attained in 56% of eyes.[2] Risk factors for poor visual outcomes included injuries by projectile objects such as shotgun pellets, poor presenting visual acuity, dense vitreous hemorrhage, preoperative retinal detachment, direct macular/optic nerve injury, multiple exit wounds, absence of spontaneous PVD before vitrectomy, and inability to remove all vitreous adhesions from the exit wound.

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