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SOPHIE COFFIN, Boris Rysanek, Eric Denion; Prophylactic Chorioretinectomy : A New Weapon To Fight Proliferative Vitreoretinopathy In Open Globe Injuries ?. Invest. Ophthalmol. Vis. Sci. 2012;53(14):4965.
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Among the multiple forms of proliferative vitreoretinopathy, some are specific to open globe injuries. Proliferation around the posterior wound (perforating trauma) or around the posterior impact site (intraocular foreign body with deep impact, reaching at least the choroid) is one of these forms. It may result in centripetal traction on the neighbouring retina, leading to retinal folds and then sometimes to tractional retinal detachment.
Retrospective case series of 3 perforating trauma cases and 6 intraocular foreign body cases with deep posterior impact. A prophylactic chorioretinectomy (PCR) was performed by burning away the retina and the choroid 1 mm around the exit wound (perforating injuries) or at the impact site and 1 milimeter around it (intraocular foreign bodies), using the endodiathermy probe. In one of the three perforating cases, the PCR was done with the vitrectomy probe. A green laser retinopexy was then done, followed by a gas (7 patients) or a silicone oil tamponnade (2 patients). The main outcomes were best-corrected visual acuity and rates of globe survival, retinal reattachment and proliferative vitreoretinopathy.
9 eyes of 9 patients with a mean age of 44 years (range, 28-54 years) were followed for a median of 12 months (range, 4-28 months). Final best corrected visual acuity superior or equal to 20/40 occured in 78% of the patients. No phtisis bulbi occured. No proliferative vitreoretinopathy was noted at the chorioretinectomy site (no "scar-PVR"). Two patients had a proliferative vitreoretinopathy away from the chorioretinectomy site ("extra-scar PVR"). Only one patient had a vitreoretinal star fold next to the chorioretinectomy site, with a favorable outcome 5 months after peeling during silicone oil removal.
Prophylactic chorioretinectomy creates a zone of bare sclera area around the exit wound (perforating trauma) or the impact site (intraocular foreign body). First and foremost, it seems that the scar fibroblasts are unable to go through such an area and cannot therefore reach the neighbouring healthy retina. Secondarily, with this technique, no retinal pigment epithelium (whose role in promoting PVR is well-known) is left bare. Tractionnal folds / retinal detachment may thus be prevented. Although promising, this technique should probably be compared to a series of exit wounds (perforating injuries) or impact sites (intraocular foreign body) left alone.
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