Is it Possible to Treat Serious Penetrating Injury Successfully?
Doležalová J.1, Rusňák Š.2, Říčařová R.2, Karel I.1
1Oční klinika, Praha 5 - Nové Butovice, vedoucí MUDr. J. Lešták, CSc. 2Oční klinika LF UK a FN, Plzeň, přednostka doc. MUDr. R. Říčařová, CSc. |
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Summary:
The number of serious devastating eye injuries caused by violent crimes or
transport accidents is growing. The patients are mostly young men and the
preserving of the eye, especially its function is often difficult.
From June 2000 to March 2003, 4 eyes of 3 men (aged 16 – 23 years) with extraordinary
serious devastating penetrating injuries were treated in the Department
of Ophthalmology in Pilsen. One eye was enucleated because of serious laceration
of the whole globe and eyelids at the initial treatment. In three eyes, a pars plana
vitrectomy (PPV) with inner silicone tamponade was performed after the initial
treatment of the penetrating and eventually exiting site. In all vitrectomized eyes
a pars plana lensectomy (PPL) was performed, at the time of PPV in one eye, and
in two eyes subsequently. When the eyes were stabilized, and the retina was
attached, the silicone oil was removed in two eyes.
The visual acuity before the surgery decreased to uncertain light projection, and
in two eyes of one patient, we were not able to detect the visual acuity because of
the unconsciousness of the patient. The follow-up period was 3months to 2 years;
all three eyes are aphakic, and the central visual acuity improved in two eyes to
6/6-9 (20/20-30 or 1.0 – 0.66) with the aphakic correction or with the contact lens,
in one eye with the silicone eye remained the visual acuity is 6/60 (20/200 or 0.1).
Even as the prognosis in such patients is unfavorable, in some cases good functional resultsmaybe obtained.Thebasic precondition for successful reconstruction
of the seriously injured eye is meticulous primary treatment. For salvage of visual
functions, there are often necessary repeated surgeries on the anterior as well as
posterior segment of the eye. Their good timing and adequate technique may
rapidly decrease the risk of complications after the injury and/or after the surgery
respectively.
Key words:
perforating injury, pars plana vitrectomy, visual function
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