Abstract

SO.19.12

Innovative treatment for severe ocular trauma

Schrader W. F. 
Universitäts-Augenklinik Würzburg

Objective: In spite of the progress in vitreoretinal surgery, the anatomical and functional results of severe ocular injuries involving the posterior segment are still discouraging. Perforating injuries and ruptures, that extend posterior to the muscle insertions, have the worst outcome. At the time of secondary intervention between day 7 and 14 post trauma it is not unlikely that severe PVR already occurred. The author presents a series of 102 severe ocular ruptures and perforating injuries (with entrance and exit wounds, with at least one wound behind the insertion of the rectus muscles), where they decided to perform the posterior segment reconstruction already at the time of primary wound closure.
Methods: 28 cases with ruptures or perforations were selected for posterior segment reconstruction at the time of primary wound closure and compared to 74 cases with conventional treatment. Selection criteria was the availability of a vitreoretinal surgeon at the time of primary wound care and the operability of the patient for a 3 hour surgery.
Results: In 24 of 28 cases with ocular ruptures or perforations a sufficient anatomic reconstruction could be achieved, in 17 of 28 cases with visual acuity of at least 20/100, whereas after conventional vitrectomy 7 to 10 days postoperatively an anatomic reconstruction was achieved in only 49 of 74 cases, with a visual acuity of 20/100 or better in only 22 of 74 cases. In November 2004 we continued with a prospective trial, with a posterior segment reconstruction performed already within 100 hours following the trauma. The authors present the preliminary results of this ongoing study. 3 centers contributed 21 cases to these preliminary results of the ongoing trial. Follow-up was 2 to 6 months in 9 cases and more than 6 months in 12 cases. An anatomic reconstruction was successfully performed in 19 of 21 cases primarily. In 2 cases a PVR detachment occurred, but could be successfully treated. The visusal acuity was 20/200 or better in 19/21 cases and 20/50 or better in 9/21 cases.
Conclusions: Based on a new approach to act rather than to react on alterations secondary to severe posterior segment trauma the functional results of these injuries may be further improved. This idea is now further being evaluated with a slightly different regimen in a prospective multicenter multinational study conducted by the World Eye Injury Register. Among the cases, that were contributed within the first year of the study, anatomic and functional results seem to be better with this new approach than with the conventional technique. The prospective multicenter multinational study conducted by the World Eye Injury Register will be continued.

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