A proactive treatment approach for eyes with perforating injury

Perforating injuries continue to have a poor prognosis with less than two-thirds of eyes having at least ambulatory final vision, due to proliferation originating from the exit wound.

We developed a new, proactive treatment method, which is applicable in most eyes with perforating trauma. The strategy involves limited, indirect ophthalmoscopic vitrectomy during the primary repair; heavy topical corticosteroid therapy postoperatively; and complete vitrectomy on day 3, including prophylactic retinectomy around the exit wound, evacuation of subretinal blood, laser retinopexy, and silicone oil implantation.

In the five consecutive eyes in which the proactive treatment approach was used, no "enscarceration" of the retina into the exit wound, proliferative vitreoretinopathy, retinal detachment, or retinal folding has occurred. The median visual acuity improved from count fingers to 0.6 in the three eyes without macular involvement.

Far-reaching conclusions must not be made based on such a small series, but the proactive treatment approach appears promising in preventing proliferation-related complications such as tractional retinal detachment or retinal fold development. A similar approach should be considered for eyes with deep impact trauma from intraocular foreign bodies and in eyes with retinal incarcerated retina in the rupture wound.