[Surgery of perforating ocular injuries of the posterior segment by lead shot: two case studies]

Treatment of retinal detachment secondary to perforating ocular trauma (POT) is difficult due to the fragility of the sclera, the number, size, and location of the retinal wounds, the vitreoretinal incarceration into the scleral wound, and the high risk of vitreoretinal proliferation. We report our experience of pars plana vitrectomy to prevent secondary retinal detachment in two cases of POT of the posterior segment caused by lead shot.

Two males, about 20 years old, suffered from a perforating ocular injury caused by a single pellet. In both cases, the entrance wound was more than 5mm posterior to the corneoscleral limbus and the exit wound was located in the posterior pole. In both cases, initial visual acuity was limited to perception of hand motions and the Ocular Trauma Score (OTS) was 2. Both patients underwent two surgical procedures, the first procedure consisting only in entrance wound closure. The second procedure was delayed 17 days (case 1) and 10 days (case 2). It consisted in pars plana vitrectomy including careful shaving of the incarcerated vitreous into the wounds and detachment of the posterior hyaloid. Surgery was completed by cryopexy of the retina beneath the entrance wound and by focal scleral buckling between the entrance and the exit wound. Cryopexy was not done on the exit wound. Final visual acuity was 40/200 (case 1) and 30/200 (case 2) after 36 and 8 months, respectively. No retinal detachment was observed.

This report highlights the advantage of early pars plana vitrectomy to prevent retinal detachment in POT related to lead shot.