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Ramanath Bhandari, Shulamit Schwartz, Carmen Gonzalez, Regina Victoria, Naresh Mandava, Hugo Quiroz-Mercado; Pars Plana Vitrectomy with medium-term Perfluoro-N-Octane for severe ocular trauma and hemorrhage with or without retinal detachment. Invest. Ophthalmol. Vis. Sci. 2013;54(15):5758.
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To describe a retrospective series of patients post severe ocular trauma involving globe rupture and resultant vitreous hemorrhage and intra or subretinal hemorrhage treated with pars plana vitrectomy and post operative medium term tamponade with perfluoro-n-octane (PFO).
A chart review was conducted of patients with severe ocular trauma involving globe rupture and resultant vitreous hemorrhage with or without retinal detachment. All patients were treated with 23-gauge pars plana vitrectomy (PPV) and received a planned medium term tamponade with PFO. A second staged procedure was performed 10-17 days later with removal of the PFO and injection of 1000 centistoke Silicone Oil.
Four Eyes of four patients were included in the present study. Mean follow-up time was 9 months +/- 4.2 months. The average time between primary repair of ruptured globe and PPV was 12 days +/- 5 days. All patients had active hemorrhage during PPV that was controlled with PFO injection. Two patients also had submacular hemorrhage that resolved post PFO tamponade. One patient was found to have concurrent retinal detachment which was repaired with primary PPV alone. PFO was found to compartmentalize the hemorrhage during the medium term tamponade with a majority of the hemorrhage draining into the anterior chamber. In addition, during PFO tamponade, all patients had some degree of anterior segment inflammation and a transient rise in intraocular pressure(IOP) above 21mm Hg, but none required an intervention beyond topical agents to control IOP. BCVA improved from light perception in all patients prior to procedure to count finger vision or better in 75% of patients post procedure.
Medium-term PFO tamponade was found to be efficacious in the treatment of active hemorrhage during secondary repair with PPV post globe rupture with or without retinal detachment. A larger randomized prospective trial is required to evaluate this treatment against PPV alone.
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