Bulbusrekonstruktion bei ausgedehnten Verletzungen des Hinterabschnittes

Multimodal imaging of a micro-anatomical structure in the vitreous base

BACKGROUND

To describe an ultrastructure in the vitreous base (VB) and its micro-anatomical characteristics by multimodal imaging.

METHODS

Light and transmission electron microscopy of the VB were performed on specimens from post-trauma eyes and one healthy donor eye. Intra-operative fundus images associated with VB abnormalities were captured from 4 cases, including 2 retinal detachment (RD) with PVR eyes and 2 post-trauma eyes. Images during micro-anatomical observation of the three specimens were analyzed along with the fundus images obtained during vitrectomy.

RESULTS

Densely packed collagen fibers were observed by light microscopy between the pigment epithelium layer and uveal tissue within the ora serrata region in specimen 1 and the post-mortem healthy eye, respectively. A similar structure was also observed by transmission electron microscopy interior to the pigment epithelium layer and exposed to the vitreous cavity in specimen 2. The collagen fibers, which were termed ciliary body-choroid-retina (CB-C-R) connector, connects to the vitreous fibers interiorly, ciliary epithelium anteriorly, peripheral retina posteriorly, and uveal tissue exteriorly. The three different RD boundaries related to the posterior edge of the VB, ora serrata, and ciliary epithelium are demonstrated with the micro-anatomical characteristics of the CB-C-R connector.

CONCLUSION

The CB-C-R connector exists deep in the VB.

Traumatic choroidal injuries - classification, incidence, diagnosis and prognosis twenty-year results of Eye Injury Vitrectomy Study

PURPOSE

To characterize the classification, incidence, diagnosis and prognosis of traumatic choroidal injuries.

METHODS

Subjects were selected from the database of the Eye Injury Vitrectomy Study (EIVS) and were examined for occurrences of different categories of choroidal injuries. Standard photographs were collected. Anatomical and visual outcomes were assessed in patients with greater than 1 year of follow-up. Eyes that had no light perception (NLP) and/or phthisis bulbi were defined as having had unfavourable outcomes. The percentage of eyes with an unfavourable outcome was analysed for different types of choroidal injuries.

RESULTS

Nine categories of choroidal injuries with distinctive features were identified in the EIVS database. The incidence and the percentage of eyes with an unfavourable outcome in each injury category were as follows: suprachoroidal effusion, 21.2% (7.2%); suprachoroidal haemorrhage, 12.8% (11.2%); massive suprachoroidal haemorrhage, 4.0% (64.9%); choroidal avulsion, 4.2% (92.2%); traumatic chorioretinal rupture, 1.8% (13.3%); choroidal rupture, 4.8% (6.8%); choroidal loss, 1.6% (79.3%); choroidal hole, 1.1% (5.3%); and choroidal damage at the wound site, 39.2% (17.7%).

CONCLUSIONS

Ocular trauma can cause a variety of choroidal injuries that have distinctive features, some of which are associated with a high frequency of unfavourable prognoses.

Vitrectomy combined with silicone oil tamponade in the treatment of severely traumatized eyes with the visual acuity of no light perception

AIM

To evaluate the efficacy of surgical treatment of vitrectomy combined with silicone oil tamponade in the treatment of severely traumatized eyes with the visual acuity of no light perception (NLP).

METHODS

This was a retrospective uncontrolled interventional case-series of 19 patients of severely traumatized eyes with NLP who underwent vitrectomy surgery at the Affiliated Hospital of Medical College, Qingdao University (Qingdao, China) during a 3-year period. We recorded perioperative factors with the potential to influence functional outcome including duration from the injury to intervention; causes for ocular trauma; open globe or closed globe injury; grade of vitreous hemorrhage; grade of endophthalmitis; grade of retinal detachment; size and location of intraocular foreign body (IOFB); extent and position of retinal defect; grade of proliferative vitreoretinopathy (PVR); type of surgery; perioperative complications and tamponade agent. The follow-up time was from 3 to 18 months, and the mean time was 12 months.

RESULTS

After a mean follow-up period of 12 months (3-18 months) 10.53% (2/19) of eyes had visual acuity of between 20/60 and 20/400, 52.63% (10/19) had visual acuity less than 20/400 but more than NLP, and 36.84% (7/19) remained NLP. Visual acuity was improved from NLP to light perception (LP) or better in 63.16% (12/19) of eyes and the rate of complete retinal reattachment was 73.68% (14/19). Good visual acuity all resulted from those patients of blunt trauma with intact eyewall (closed globe injury). The perioperative factors of poor visual acuity prognosis included delayed intervention; open globe injury; endophthalmitis; severe retinal detachment; large IOFB; macular defect; a wide range of retinal defects and severe PVR.

CONCLUSION

The main reasons of NLP after ocular trauma are severe vitreous hemorrhage opacity; refractive media opacity; retinal detachment; retinal and uveal damages and defects, especially defects of the macula; PVR and endophthalmitis. NLP after ocular trauma in some cases does not mean permanent vision loss. Early intervention of vitrectomy combined with silicone oil tamponade and achieving retinal reattachment of the remaining retina, may make the severely traumatized eyes regain the VA of LP or better.