The first experience in the treatment of large penetrating wounds of the sclera using expanded primary microsurgical treatment

Abstract

BACKGROUND: According to the literature, the absence of pattern vision in the outcome of open wounds of the eyeball is observed in 2530% of cases, and in the presence of large wounds with multiple injuries of intraocular structures, it is 6180%. AIM: to present the results of expanded microsurgical treatment of large penetrating corneoscleral and scleral wounds involving the zone III, to evaluate the results of the given algorithm for severe penetrating injury care. MATERIALS AND METHODS: Presented are the results of treatment of 24 patients with large penetrating corneoscleral and scleral wounds, massive hemophthalmos, and other injuries. All patients underwent primary microsurgical treatment according to a modified, expanded algorithm, which, in addition to suturing the fibrous capsule of the eye, included subtotal vitrectomy, primary treatment of retinal and choroidal wounds, the use of autologous conditioned plasma (P-PRP) , tamponade with silicone oil or a gas-air mixture. RESULTS: Evaluation of treatment results was carried out on day 3, after 1 and 6 months. Special attention was paid to the identification of signs of proliferative vitreoretinopathy as most important in terms of prognosis. After 6 months, visual acuity above 0.1 was noted in 10 patients, 0.020.09 in 12, absence of pattern vision in 2. Signs of development and progression of PVR during 6 months were noted in 7 patients (29.2%), of which repeated surgeries were performed in 5 cases. CONCLUSIONS: The new advanced algorithm of primary microsurgical treatment allows to improve functional results in severe cases of penetrating eye injury.