Timing and Outcomes of Vitreoretinal Surgery after Traumatic Retinal Detachment

The Role of Adjunctive Triamcinolone Acetonide in Post-traumatic Vitreoretinal Surgery: Current Insights and Future Perspectives

Post-traumatic vitreoretinal surgery is pivotal for repairing damage to the retina and vitreous body, commonly resulting from blunt or penetrating ocular trauma. Incorporating adjunctive pharmacological agents, particularly triamcinolone acetonide (TA), has gained considerable prominence in optimizing surgical outcomes. TA, a potent corticosteroid, is applied intraoperatively to improve the visualization of vitreous structures and epiretinal membranes, enabling surgeons to perform more precise maneuvers. Furthermore, its anti-inflammatory properties are instrumental in reducing postoperative complications such as macular edema and proliferative vitreoretinopathy (PVR), conditions that could hinder recovery and compromise visual acuity. TA use during vitrectomy enhances surgical precision and contributes to a smoother postoperative recovery. However, concerns surrounding potential side effects, such as steroid-induced ocular hypertension and cataract formation, necessitate careful patient selection and close monitoring throughout its use. Looking ahead, innovations in sustained-release formulations and combination therapies may further augment TA efficacy while reducing associated risks. This review provides current insights into TA application in post-traumatic vitreoretinal surgeries and highlights emerging trends poised to enhance its therapeutic role.

Visual outcomes and prognostic factors of early pars plana vitrectomy for open globe injury

OBJECTIVES

To identify the clinical features and outcomes of early vitrectomy in patients with open globe injury (OGI) and the prognostic factors for visual outcome.

METHODS

This retrospective observational case series included 390 eyes in 389 patients diagnosed with OGI receiving vitrectomy within four days after injury. Preoperative parameters included the injury types, wound locations, consequent tissue damages, initial visual acuity (VA), and ocular trauma score. Postoperative outcome measures included surgical procedures, retinal (re)attachment, complications, and final VA. The logistic analysis evaluated the prognostic factors for visual outcome.

RESULTS

Intraocular foreign bodies (59.2%) and penetrating injuries (28.7%) were the most common injury types. Among the 165 eyes with retinal detachment (RD), 121 (73.3%) had retinal reattachment during early primary vitrectomy, and 32 (19.4%) were repaired during a second or subsequent surgery. Thirteen eyes (3.3%) were enucleated. The final VA improved from the initial level in 207 eyes (55.2%), remained unchanged in 123 (32.8%), and decreased in 45 (12.0%). Multivariable regression revealed that the injury zone, initial VA, RD, and endophthalmitis were associated with poor visual outcomes (P < 0.05).

CONCLUSIONS

Higher zone injury, low initial VA, RD, and endophthalmitis are predictors of poor visual outcome in eyes undergoing early vitrectomy for OGI.

Incidence and Risk Factors Affecting the Recurrence of Primary Retinal Detachment in a Tertiary Hospital in Spain

(1) Objective: To determine the incidence, visual outcomes and risk factors associated with the recurrence of primary retinal detachment (RD) in a tertiary hospital. (2) Methods: A retrospective observational study was conducted, and data were collected on all eyes diagnosed with primary RD between January 2017 and December 2020. A detailed database was generated with data on anatomic and visual outcomes, and surgical technique information, for all the cases. (3) Results: 570 eyes with primary RD were included. Mean annual incidence of primary RD was 21.8 cases per 100,000 inhabitants. Mean follow-up time was 465 (±410.5) days. Mean time to redetachment was 114.4 (±215.8) days, with the median being 35 days. Statistically significant variables related to a higher risk of recurrence were: male sex (p = 0.04), type of tamponade (p = 0.01), surgeon (p = 0.035), inferonasal (p = 0.002) and inferotemporal (p = 0.032) involvement, complex RD (p < 0.001) and ocular comorbidity (p < 0.001). More satisfactory final visual acuity (VA) in patients not suffering redetachment was associated with shorter duration of central vision loss. (4) Conclusions: Sex, type of tamponade, inferior detachment, RD complexity, surgeon and ocular comorbidity were identified as prognostic factors for recurrence. Worse final postoperative VA was found in patients referring central vision loss for more than 4 days before surgery.

Surgical outcomes and prognostic factors in traumatic retinal detachment following closed-globe injuries

PURPOSE

To evaluate the anatomical and functional results of retinal detachment (RD) surgery following closed-globe injuries (CGI).

METHODS

Patients treated with vitreoretinal surgeries due to RD following CGI from 2014 to 2020 were retrospectively reviewed. Data included demographics, mechanism of injury, preoperative evaluation, and surgical intervention. Outcome measurements included anatomic success, best corrected visual acuity (BCVA), and possible prognostic factors.

RESULTS

A total of 67 eyes from 64 patients (49 males; mean age 52.84 years) were included. The most common causes of the CGI were work-related injury (22.4%) and traffic accidents (23.9%). The primary and final anatomic success rates were 80.6% (54/67) and 89.6% (60/67), respectively. In the multivariable analysis of the logistic regression models, the poor prognostic factor was proliferative vitreoretinopathy (PVR) (P = 0.009) for primary anatomic success. The median preoperative and final BCVA were logMAR 0.7 (IQR, 0.3-1.6) and logMAR 0.5 (IQR, 0.1-1.1), respectively (P = 0.077). Poorly presenting BCVA (counting fingers or worse) and giant tear were associated with poor visual outcomes.

CONCLUSION

Work-related injuries and traffic accidents are the prevalent causes of RD following CGI. The anatomic outcomes were favorable, but visual outcomes varied. Poor prognostic factors included PVR and poorly presenting BCVA, highlighting the importance of a careful initial evaluation.

TRAUMATIC RETINAL DETACHMENT CAUSED BY NERF GUN SHOT IN A PEDIATRIC PATIENT

PURPOSE

To present a case of retinal detachment caused by a Nerf-gun shot in a pediatric patient.

METHODS

Single case report.

RESULTS

A 16-year-old white man presented with a nasal visual field deficit and floaters in his left eye for 1 month after being shot with a foam-ball Nerf gun by a friend. Fundus examination revealed a midperipheral retinal dialysis extending from 1 to 4:30 clock hours with a macula-on retinal detachment and superficial proliferative vitreoretinopathy. He underwent successful 25-gauge pars plana vitrectomy with membrane peel, retinectomy, injection of perfluoron, endolaser, and use of 1,000 centistoke silicone oil for tamponade.

CONCLUSION

This is the first reported case of traumatic retinal detachment secondary to a Nerf-gun shot.

Proliferative Vitreoretinopathy After Combat Ocular Trauma in Operation Iraqi Freedom and Operation Enduring Freedom: 2001-2011

BACKGROUND AND OBJECTIVE

To determine the risk factors associated with developing proliferative vitreoretinopathy (PVR) from combat ocular injuries in U.S. service members.

PATIENTS AND METHODS

Retrospective review of associated risk factors and outcomes of PVR within the Walter Reed Ocular Trauma Database. Ocular injuries in U.S. service members wounded during Operation Enduring Freedom and Operation Iraqi Freedom from 2001 to 2011 were assessed, and of these all cases of PVR were studied. Principal outcome measures were the risk factors associated with PVR development and rate of final visual acuity (VA) less than 20/200.

RESULTS

Eight hundred ninety eyes of 651 U.S. service members were evaluated. A total of 76 eyes (8.5%) of 66 patients developed PVR. Five patients had bilateral PVR. Nineteen patients had bilateral eye injuries. Sixty-one eyes (80.2%) had a final VA less than 20/200. PVR was found to be a significant risk factor for a poor final VA (P < .001). Retinal detachment (RD) was found in 52 eyes (68.4%) of patients. In patients with a RD, intraocular foreign bodies (IOFBs) (P < .001), unsuccessful repair (P = .002), and macular hemorrhage (P = .04) were significant risk factors for the development of PVR. Time to initial retina surgery was not found to be a risk factor for PVR development (P = .5). Time to initial retina surgery was available in 41 patients and the time to surgery on average was 22.56 days (range: 3 to 87 days).

CONCLUSIONS

PVR occurs frequently in combat trauma and is a significant cause of poor final VA. In patients with PVR and RD, injuries caused by an IOFB, macular hemorrhage, or unsuccessful repair were significant risk factors for the development of PVR. [Ophthalmic Surg Lasers Imaging Retina. 2020;51:556-563.].