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MM Thakker; Results of retinal detachment surgery in zones I, II, and III open globe injuries . Invest. Ophthalmol. Vis. Sci. 2002;43(13):4499.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose: In open globe trauma, it has been shown that the anatomical zone of injury (zone I v. II & III) as well as the mechanism (penetrating v. rupture) are predictive factors for the development of retinal detachments within the first 3 months after injury. Using the recently developed Ocular Trauma Classification System of open globe injuries, we attempted to determine if zone of injury as well as mechanism were predictive of the anatomical success rate of retinal detachment surgery at 5-7 months follow-up. Methods: The records of 288 consecutive patients with open globe injuries treated at the Massachusetts Eye and Ear Infirmary from 1997-2001 were reviewed. Results: Of the 288 records that were reviewed, 56 patients (19.4%)experienced retinal detachments during the first 3 months after injury. The rate of anatomical reattachment at 5-7 months after primary retinal surgery in all open globe injuries was 48%. Zone I injuries had a similar rate of retinal reattachment at 5-7 months when compared to zones II and III injuries. Penetrating injuries, however, had a significantly higher retinal reattachment rate when compared to ruptures at 5-7 months after surgery (56.5% v. 30.4%, p<0.05). Retinal detachments involving the macula in all open globes had a significantly lower reattachment rate at 5-7 months post-surgery when compared to retinal detachments not involving the macula (23.8% v. 88.2%, p<0.001). In all open globe injuries, there was a 27% incidence of redetachment of the retina within 5-7 months of retinal surgery. The most common cause of a redetachment of the retina was proliferative vitreoretinopathy, which occurred in 70% of these patients. There were similar rates of redetachment in zone I open globe injuries when compared to zones II & III trauma. Patients who underwent additional retinal surgery for a redetached retina had a 54% rate of anatomic reattachment at 3-5 months following the additional procedure. The primary surgical procedures performed (i.e. scleral buckles, vitrectomies, etc.) in patients who experienced redetachments were similar to those performed in patients who did not require additional procedures. Conclusions: Retinal detachment surgery in patients with penetrating open globe injuries has a higher anatomical success rate than in patients with ruptures. In open globe trauma, the anatomical success rate of retinal detachment surgery is similar regardless of the zone of injury. The major cause for redetachments of the retina in open globe trauma is proliferative vitreoretinopathy.
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