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

Multi-Stage Reconstructive Surgery of the Eyeball with No Light Perception After Severe Open Globe Injury

Purpose

To analyze the visual and anatomical outcomes of multi-stage reconstructive surgery of the eyeball with no light perception (NLP) in patients after severe open globe injury (OGI).

Patients and methods

In this retrospective consecutive case series study, medical records of patients with severe OGI with visual loss up to NLP, who were referred to our clinic between February 1, 2016, and March 30, 2021, were included. The analysis of epidemiologic data, type and severity of OGI, timing and type of surgical treatment, and anatomical and functional results was performed.

Results

Nine patients met our inclusion criteria. The mean age was 52 years (range 34-78 years). Mean follow-up was 24 months (range 1-56 months). Estimated mean best corrected visual acuity (BCVA) was 2.92 LogMAR immediate after trauma, 2.27 LogMAR before reconstructive anterior segment surgery and 2.42 LogMAR at last follow-up. The functional gain after the primary repair was highly significant (p 0.005), but a non-significant gain was seen at the last follow-up. Retina reattachment was achieved in most of the cases (6/7, 85.7%), but these remained silicone oil dependent (5/6, 83.33%). In all cases, it was possible to prevent primary enucleation.

Conclusion

The multi-stage reconstructive surgical approach allowed for saving the eyes and improved the functional and anatomical condition. Despite the severity of OGI and NLP, an early surgical intervention should be considered by experienced surgeons.

Comparison of B-Scan ultrasonography, ultra-widefield fundus imaging, and indirect ophthalmoscopy in detecting retinal breaks in cataractous eyes

BACKGROUND/OBJECTIVES

To evaluate the diagnostic performance of B-scan kinetic ultrasonography (USG), standard ultra-widefield (UWF) imaging, and indirect ophthalmoscopy (IDO) in retinal break detection in cataractous eyes.

SUBJECTS/METHODS

We consecutively enrolled 126 cataract patients (including 246 eyes) with no comorbidities that could decrease best corrected visual acuity (BCVA). Three index tests (USG, nonmydriatic UWF, and mydriatic IDO) were performed preoperatively to screen for retinal breaks. One week after cataract extraction, a dilated IDO examination was repeated for the definitive diagnosis of retinal break as the reference standard. The sensitivity, specificity, Youden index (YI), and predictive values of each index test were calculated according to postoperative ophthalmoscopic findings. A deep-learning nomogram was developed to quantify the risk of retinal break presence using patients' baseline data and findings reported from preoperative ophthalmic tests.

RESULTS

Fifty-two eyes (21%) were excluded from appropriate preoperative UWF imaging because of massive lens opacity. The BCVA cutoff point with maximum YI indicating UWF applicability was 0.6 logMAR (YI = 0.3; area under curve [AUC] = 0.7). Among all 246 eyes, preoperative IDO, USG, and UWF showed fair interobserver agreement (all κ > 0.2). According to postoperative IDO findings, the index tests with the highest sensitivity and specificity were USG (100%) and preoperative IDO (99%), respectively.

CONCLUSIONS

For cataractous eyes without vision-impairing comorbidities, a BCVA better than 0.6 logMAR (Snellen acuity, 20/80) allows for appropriate nonmydriatic standard UWF imaging. In a high-volume clinic equipped with skilled ophthalmic examiners, screening with USG followed by directed IDO allows the efficient identification of retinal breaks in cataractous eyes.

Multiple Approaches for Managing Complex Ophthalmic Blunt Trauma: A Case Report

Introduction

Ophthalmic trauma is defined as injuries affecting the ocular structures, including the globe, eyelid, lacrimal system, and surrounding orbital walls. Blunt trauma acts as the leading cause of injury and it may affect both the anterior and posterior parts of the globe. Prompt diagnosis, early management, and sustained follow-up are mandatory for an optimal outcome.

Purpose

This report presents a one-step surgery management process for an intricate case of blunt facial trauma with complex ophthalmic and nasal injury.

Patients and Methods

A 45-year-old male with blunt force trauma of the left eye from a wooden block, suffered from naso-orbital-ethmoidal fractures, eyelid laceration with canalicular, close-globe injuries of traumatic cataract and vitreous hemorrhage with retinal detachment. A simultaneous one-step surgery was performed by a trauma team of ophthalmological and ENT surgeons during the height of the COVID-19 pandemic to lessen the risk of cross-transmission. After ruling out the possibility of open-globe rupture, traumatic cataract extraction, retinal detachment surgery, the repair of an eyelid laceration with canalicular involvement, and septorhinoplasty were performed on concomitantly.

Results

Anatomical success was achieved for the repair of the nasoorbitoethmoidal (NOE) type II fracture and close-globe injuries, including the anatomical reattachment of the retina. However, the functional outcome remained unsatisfactory. Visual acuity failed to show further improvement at a later follow-up. Traumatic optic neuropathy was, at the final follow-up, considered to be the cause of the suboptimal visual acuity.

Conclusion

A single-step multi-procedure for a complex ophthalmic blunt trauma, as demonstrated in this case, may be beneficial for reducing the complications that might arise due to treatment delay. The complex nature of the injury, however, creates the higher possibility for residual post-operative complications. Risks of residual functional impairment should be considered in such complex trauma prior to surgery, to determine the surgical prognostic value and provide appropriate consent to the patient.

Outcomes of 25-gauge vitrectomy with relaxing retinectomy for retinal detachment secondary to proliferative vitreoretinopathy

Purpose

The aim of this study is to evaluate visual and anatomic outcomes of 25-gauge vitrectomy with relaxing retinectomies for complex retinal detachment (RD) secondary to proliferative vitreoretinopathy (PVR).

Methods

A single-center, retrospective case series of 44 patients who had undergone a 25-gauge vitrectomy with a relaxing retinectomy for the treatment of combined RD and PVR was performed. Pre-operative characteristics, intraoperative techniques, and outcomes were analyzed. The rates of attachment, complications, and visual acuity were analyzed. Institutional Review Board/Ethics Committee approval was obtained and the described research adhered to the tenets of the Declaration of Helsinki.

Results

At the final follow-up, 27 eyes (61%) had attachment after one surgery, 41 eyes (93%) ultimately had attached retinas, 3 eyes (7%) had hypotony, 3 eyes had become phthisical (7%), and 24 eyes (56%) had improved visual acuity. After stratifying by visual outcomes, 20/400 or better BCVA was not associated with age (p=0.66), RD etiology (p=0.61), pre-operative hypotony (p=0.60), nor size of retinectomy (p=0.48). Patients achieving 20/400 vision or better were statistically more likely to be pseudophakic (p=0.024) and have silicone oil removal (p<0.0001).

Conclusions

The use of 25-gauge vitrectomy and relaxing retinectomy provides a high rate of reattachment and improved visual acuity.

Visual recovery following open globe injury with initial no light perception

Background

The purpose of this study was to analyze eyes presenting with no light perception (NLP) after open globe injury (OGI) to determine visual outcomes and prognostic indicators for visual recovery.

Methods

The records of consecutive patients with at least 6 months of follow-up presenting with OGI and NLP to a single institution between January 1, 2003 and December 31, 2013 were reviewed for demographics, ophthalmic history, context and characteristics of injury, ocular examination findings, surgical interventions, and follow-up visual acuity. Unpaired t-tests and Fisher’s Exact tests were used for statistical analysis.

Results

Twenty-five patients met our inclusion criteria. The mean age was 50.4±25.5 (range 8–91) years. Four patients (16%) regained vision (hand motion in three patients and light perception in one patient) while 21 patients (84%) remained with NLP or had a prosthesis at final follow-up. Fourteen eyes (56%) were enucleated; nine (36%) were secondary enucleations. Although the sample sizes were small, neither ocular trauma score nor wound size was found to predict visual recovery.

Conclusion

Four patients regained some vision after presenting with NLP due to OGI. These findings suggest that, in select cases, physicians should discuss the possibility of regaining some vision.