[Is it possible to sucessfully treat severe penetrating injuries?]

The number of serious devastating eye injuries caused by violent crimes or transport accidents is growing. The patients are mostly young men and the preserving of the eye, especially its function is often difficult. From June 2000 to March 2003, 4 eyes of 3 men (aged 16-23 years) with extraordinary serious devastating penetrating injuries were treated in the Department of Ophthalmology in Pilsen. One eye was enucleated because of serious laceration of the whole globe and eyelids at the initial treatment. In three eyes, a pars plana vitrectomy (PPV) with inner silicone tamponade was performed after the initial treatment of the penetrating and eventually exiting site. In all vitrectomized eyes a pars plana lensectomy (PPL) was performed, at the time of PPV in one eye, and in two eyes subsequently. When the eyes were stabilized, and the retina was attached, the silicone oil was removed in two eyes. The visual acuity before the surgery decreased to uncertain light projection, and in two eyes of one patient, we were not able to detect the visual acuity because of the unconsciousness of the patient. The follow-up period was 3 months to 2 years; all three eyes are aphakic, and the central visual acuity improved in two eyes to 6/6-9 (20/20-30 or 1.0-0.66) with the aphakic correction or with the contact lens, in one eye with the silicone eye remained the visual acuity is 6/60 (20/200 or 0.1). Even as the prognosis in such patients is unfavorable, in some cases good functional results may be obtained. The basic precondition for successful reconstruction of the seriously injured eye is meticulous primary treatment. For salvage of visual functions, there are often necessary repeated surgeries on the anterior as well as posterior segment of the eye. Their good timing and adequate technique may rapidly decrease the risk of complications after the injury and/or after the surgery respectively.