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Julia P. Shulman, Shameema Sikder, Majid Moshirfar, Roger Harrie, Mary Elizabeth Hartnett; Success of Early Limited Core Vitrectomy in Double Penetrating Globe Injuries. Invest. Ophthalmol. Vis. Sci. 2011;52(14):5625.
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To present a surgical approach for preventing tractional retinal detachment following double penetrating or perforating globe injuries in eyes with extensive corneal trauma without using a keratoprosthesis.
An IRB approved, retrospective chart review of 3 patients from the Moran Eye Center, all of whom underwent corneal laceration repair by an anterior segment surgeon and were referred to the retina service for management of posterior segment pathology.
Patients’ ages were 9 months, 3 years and 21 years. Two were males and one female. Two patients had perforating knife injuries; the infant suffered trauma from a weed wacker cord hitting and perforating the globe. The lens was involved in all three cases. Because of poor visibility, only limited core vitrectomies without removal of the posterior hyaloid were performed within 6 days of the initial ruptured globe repair. A keratoprosthesis was not done in any of the cases because of the concern of graft rejection, particularly in the pediatric patients. One patient developed retinal traction that was observed with serial ultrasounds for 2 months, prior to repeat vitrectomy, endolaser and gas. All patients remain attached at postoperative follow up of 6 months.
A near complete pars plana vitrectomy, to relieve vitreo-retinal traction and remove the posterior hyaloid within 14 days of a double penetrating globe injury has been the standard of care to reduce the risk of tractional retinal detachment. In this series, however, retinal attachment was maintained even though only limited core vitrectomies were performed and the posterior hyaloid was not removed due to poor visualization of the posterior segment. A limited vitrectomy alone, done early, may be useful to stabilize the eye and prevent vitreo-retinal traction, in eyes with extensive corneal trauma limiting visibility to the posterior segment. Further study is warranted to assess long-term outcomes with this approach that may provide better corneal recovery particularly in pediatric patients.
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