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Y. I. Leiderman, M. T. Andreoli, C. M. Andreoli, S. Mukai; Open Globe Repair Following Blunt Ocular Trauma With Posterior Rupture. Invest. Ophthalmol. Vis. Sci. 2008;49(13):4668. doi: https://doi.org/.
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Open globe injury (OGI) with posterior rupture following blunt trauma is a devastating injury often necessitating additional surgical interventions following primary open globe repair (OGR). Some authorities consider attempts to restore useful vision following posterior rupture a futile endeavor, advocating instead for globe salvage via limited closure without subsequent surgical intervention. We reviewed the records of the Trauma Service at our institution to assess the utility of surgical intervention following posterior globe rupture arising from blunt ocular injury.
Institutional retrospective review of case records from The Massachusetts Eye and Ear Infirmary Trauma Service from January 2000 to August 2007. Inclusion parameters for posterior rupture were defined as zone III OGI in the setting of explicitly documented blunt trauma.
Of 692 OGI, we identified 38 eyes (16 right, 22 left) of 38 patients that sustained posterior globe rupture following blunt ocular trauma. The patient demographics were as follows: 35 men, 3 women; median age 44 years; range 18 to 91 years. The visual acuity (VA) in the affected eye at the time of presentation varied from 20/70 to no light perception (NLP). The median pre-operative VA was light perception (LP), distributed as follows: >20/400 (3) (8%); count fingers (CF) (3) (8%); hand motions (HM) (5) (13%); LP (21) (55%); NLP (6) (16%). Computed tomography (CT) of the orbits was reviewed in 12 patients and revealed OGI in 11 cases. Primary OGR was performed in all cases. Pars plana vitrectomy, alone or in conjunction with placement of an encircling band, was subsequently performed in 18 of 38 eyes (47%). The median final best-corrected VA in affected eyes was HM, and varied from 20/20 to NLP, distributed as follows: >20/400 (6) (16%), CF (2) (5%), HM (11) (29%), LP (7) (18%), NLP (12) (32%). The median duration of follow-up was 3 months. Secondary enucleation was ultimately performed in 9 eyes with NLP vision.
Posterior rupture following blunt ocular trauma is associated with severe visual loss; 50% of eyes in our cohort demonstrated ≤ LP vision following surgical intervention. These findings are consistent with previous studies assessing outcomes of zone III traumatic injury of any type and mechanism. We advocate for primary OGR when feasible following posterior rupture arising from blunt trauma given that 50% of patients in our cohort ultimately achieved HM vision or better. CT is a sensitive indicator of posterior rupture following blunt ocular trauma in cases where the diagnosis of posterior rupture is uncertain.
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