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W. F. Schrader, F. Kuhn, ISOT – EVRS Prospective Study Group; Prophylaxis of Proliferative Vitreoretinopathy by Early Vitrectomy in Severe Ocular Trauma: Design and Preliminary Results of a Multicenter Prospective Study. Invest. Ophthalmol. Vis. Sci. 2007;48(13):716.
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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. When performed at the day of injury, in 24 of 28 cases with ocular ruptures or perforations a sufficient anatomic reconstruction could be achieved in 20 of 28 cases, 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. Encouraged by these findings, the authors designed a prospective international trial on severe ocular ruptures and perforating injuries (with entrance and exit wounds, with at least one wound behind the insertion of the rectus muscles), 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 multicenter prospective study "Proactive Management of Eyes with Perforating/Rupture/IOFB Injuries".
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, so that all eyes were finally anatomically successfully recosntructed. The visusal acuity was 20/200 or better in 19/21 cases and 20/50 or better in 9/21 cases.
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. The prospective multicenter multinational study conducted by the World Eye Injury Register will be continued. The cases will be matched to standard care patients from the World eye injury register.
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