Ocular reconstruction always worth trying in severely traumatized eyes
Click Here to Manage Email Alerts
FORT LAUDERDALE, Fla. — In eyes with severe injury, even when there is no light perception vision, there is no justification for primary enucleation.
“Unless the eye is completely destroyed, surgeons should never give up,” Ferenc Kuhn, MD, PhD, said at the Retina World Congress.
Many surgeons give up on these eyes because they believe there is irreversible damage, but statistics show that 57% of reconstructed eyes improve from no light perception to anywhere between light perception and reading vision (20/40). The risk for sympathetic ophthalmia is also an unacceptable justification for removing the eye because it is rare, and if it is recognized early and treated properly, two-thirds of eyes retain reading vision.
“And in any case, the decision whether to do enucleation/evisceration or not is up to the patient, not up to us,” Kuhn said.
Although no one would easily admit this, many surgeons do primary enucleation because reconstructing the eye is too much work.
“True, there is a lot of work to do in these eyes, but this not an acceptable reason for giving up on them,” Kuhn said.
Surgery should start with accurate closure of any corneal wound, followed by internal limiting membrane peeling. Primary comprehensive reconstruction can be performed at the same time or deferred, but it should never be deferred by more than 100 hours, he said.
To prevent proliferative vitreoretinopathy, the ciliary body must be cleared of any blood, fibrin and vitreous. The capsule should be removed entirely if the patient is young because capsule contraction would pull off the zonules. Complete vitrectomy must be performed not by horizontal sweeping, which would damage the retina, but by vertical digging on the nasal side in a small area until the retinal plane is reached. Prophylactic chorioretinectomy is then performed around the lesion using the full power of the endodiathermy probe to destroy the cells that would lead to proliferative vitreoretinopathy.
Collapse
Kuhn F. The severely traumatized eye: Never give up! Presented at: Retina World Congress; May 12-15, 2022; Fort Lauderdale, Fla.
Read more about
Click Here to Manage Email Alerts