Injury Involving the Entire Globe
Douglas Witherspoon Open globe injuries1 may cause substantial damage to the eye, making the situation akin to that of a polytraumatized person the condition of one pathology influences the condition and treatment of another (Fig. 2.2.14). The most serious of the potential scenarios is when the retina requires major surgery urgently but the cornea has become opaque and interferes with visibility. Such an injury represents one of the most challenging indications...
Info
It reveals for the surgeon when the incarcerated vitreous has been severed (see Chap. 2.5).2 Table 2.7.4 provides a summary of questions that need to be answered during the examination. 2.7.3 Specific Conditions 2.7.3.1 Dislocation The lens is either partially (subluxation) or completely (luxation) torn from the zonules in the latter case, it may be still inside the eye or extruded3. Both subluxation and luxation can occur anteriorly (AC) or posteriorly (vitreous cavity), and both can happen in...
Myths and Truths in Ocular Traumatology
* In this chapter, we provide a brief list of selected dogmas and their rebuttals. All physicians employ a few dogmas in their daily practice because this is what they were taught and may not have had the opportunity to challenge them. Patients also have beliefs that originate in the media, or come from the parents or the next-door neighbor. The interest of this book's author in ocular traumatology was established on his very first day of residency. A young man with a fresh IOFB presented to...
Vitrectomy Trauma Pearl
AIncludes all peripheral lesions (tear, necrotic hole, dialysis). All numbers are rounded aIncludes all peripheral lesions (tear, necrotic hole, dialysis). All numbers are rounded Not all eyes with contusion-related traumatic vitreous hemorrhage require vitrectomy, which has its own complications however, surgery is much easier, less risky, and more effective if secondary retinal complications are not yet present early vitrectomy can also prevent retinal complications. It therefore remains an...
Comprehensive Anterior Segment Reconstruction
Several structures of the AC and adjacent tissues may be damaged during the injury, and posttraumatic scarring may make the condition worse. The scar tissue can destroy the cornea and the angle, elevate the IOP, and seriously impede vision (Fig. 2.5.4). Reconstruction of such eyes requires a surgeon skilled in both anterior and posterior segment techniques, ranging from PK to vitrectomy. Chapters 2.1-2.15 and 2.18-2.20 describe various elements of the intervention, which must also be carefully...
Consequence of Chronic Hypotony Phthisis5
The difference between an eye in prephthisical vs phthisical stage is that in the latter, tissue disruption is evident the condition results from the cessation of aqueous production. If treatment of all known pathologies, including that of anterior PVR,6 has been exhausted and the eye starts to shrink, there are two options left besides eye removal (see below). 3 This is the clinician's observation there is no explanation for the phenomenon in the available literature. 4 Major iris damage is an...
Vitreous and Retina
In most cases the condition of the retina1 determines the outcome of an injury. In all cases of ocular (or systemic see Chap. 3.3) trauma when posterior segment involvement can be suspected, vitreoretinal consultation should be sought. The earlier such consultation takes place the better. Many vitreoretinal surgeons also prefer if they are the one who sutures the cor-neal scleral wound so that optimal conditions are established for vitrectomy, which may have be to performed in a very short...
Management
All vitreous must be thoroughly excised. If the prolapse is through a corneal wound, the surgeon is advised to also remove the vitreous from the AC (see Chap. 2.5). Although it is technically possible to thoroughly remove the prolapsed vitrectomy at the wound using Wechsler sponges9 and scissors, this is not without risk. The vitreous first needs to adhere to the sponge and then be lifted from the eye before it is cut. The traction exerted on the extruded vitreous is unavoidably transmitted to...
