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A.A. Yucel, K. Suner, O. Sanli, O. Kalkan, H. Erturk; Viscoelastic Protection of the Retina After Severe Penetrating Eye Injury With Vitreous Loss . Invest. Ophthalmol. Vis. Sci. 2003;44(13):1837.
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Purpose: Despite surgical reconstruction of the eyeball and subsequent vitreoretinal interventions, prognosis in severe penetrating injuries of the globe with vitreous loss is not satisfactory because of a high incidence of proliferative vitreoretinopathy (PVR) and phthisis bulbi (PB) . We injected sodium hyaluronate, a known viscoelastic with procoagulant and antifibrotic properties in the vitreous cavity of the affected eyes during primary repair to investigate its effects on intraocular fibrotic processes which appear immediately after the trauma. Methods: We introduced 1.0-2.0 ml of sodium hyaluronate (10 mg/ml) in the vitreous cavity of 18 eyes with penetrating trauma (group A) and compared the results with 26 eyes of similar injury in which viscoelastics were not used (group B). Our criteria of selection were eyes with: 1)Vitreous loss from corneal and/or scleral wounds, 2) One scleral penetration line not exceeding the anatomic equator (9-12mm), 3) Other scleral penetration lines within 5 mm from the limbus, 4) Penetrating trauma not directly affecting the macula or its vicinity, 5) A time interval of 4-12 hours between trauma and primary repair. The controlled injection of viscoelastic in a reconstructed eye was followed by the injection of small amounts of MES (multiple electrolyte solution) and air in the vitreous cavity (group A). In group B only MES and air were used to restore the vitreous cavity. Results: The mean age of the trauma patients was 29.11±15.14 years in group A and 27.92±15.78 years in group B. Mean follow-up time was 55.33±42.00 months in group A and 16.46±20.15 months in group B. The percentage of postoperative "useful" visual acuity (VA: 0.6 and more) was 44,4% (8 eyes) in group A and 7.6% (2 eyes) in group B. The difference between the two groups was highly significant (p<0.01 t=2.42). We categorized the eyes in both groups as functional (VA: 0.01 and up) and non-functional (VA: less than 0.01). The term non-functional referred to eyes with high grade PVR and/or eyes with phthisis bulbi. In group A the incidence of non-functional eyes was 38.8% (7 eyes) and 69.2% (18 eyes) in group B. The difference was significant (p<0.05 t=2.15). Conclusions: Sodium hyaluronate seems to be a worthwhile viscoelastic in the management of penetrating eye injuries with vitreous loss which procures protection of the retina and other intraocular structures with: 1- Better "useful" visual acuity results 2- More "functional"eyes with considerable inhibition of intraocular fibrosis 3) A small number of eyes with phthisis bulbi.
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