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Endoscope-assisted pars plana vitrectomy in severe ocular trauma
Khalid Al Sabti1, Seemant Raizada
1Vitreo Retinal Unit, Al Bahar Eye Hospital, Kuwait City, Kuwait.
The British Journal of Ophthalmology
|September 7, 2012
Summary
Ophthalmic endoscope-assisted pars plana vitrectomy (PPV) successfully restored vision in severe ocular trauma cases with media haze. This technique is crucial when standard PPV is not feasible, preventing vision loss from proliferative vitreoretinopathy.
Area of Science:
- Ophthalmology
- Surgical Innovation
- Trauma Care
Background:
- Severe ocular trauma often presents with media haze or anterior segment disorganization, complicating standard pars plana vitrectomy (PPV).
- Limited visibility due to corneal opacity or vitreous hemorrhage can preclude the use of wide-angle viewing systems.
- Delayed surgical intervention in such cases increases the risk of proliferative vitreoretinopathy and irreversible vision loss.
Purpose of the Study:
- To evaluate the efficacy of pars plana vitrectomy (PPV) assisted by an ophthalmic endoscope (OE) in managing severe ocular trauma.
- To assess the feasibility of OE-assisted PPV in cases unsuitable for conventional wide-angle viewing systems due to media opacity or anterior segment issues.
- To determine the anatomical and functional outcomes of OE-assisted PPV in complex traumatic eye injuries.
Main Methods:
- A prospective, non-comparative, interventional case series was conducted.
- Fifty patients with severe ocular trauma were included.
- Outcomes measured included postoperative retinal status, visual function, intraocular pressure, and inflammation control in endophthalmitis cases.
Main Results:
- Of 50 cases, 43 had open globe injuries (32 without IOFB, 11 with IOFB) and 7 had post-traumatic endophthalmitis.
- Anatomical success and visual improvement were observed in a significant majority of cases.
- Specifically, 83.7% of open globe injury eyes showed visual improvement, and 5 out of 7 endophthalmitis eyes improved.
Conclusions:
- Ophthalmic endoscope (OE) facilitates clear visualization for pars plana vitrectomy (PPV) in challenging ocular trauma cases.
- OE-assisted PPV is a valuable technique when media haze or anterior segment disorganization prevents standard PPV.
- This approach can prevent delays in surgery, thereby mitigating the risk of severe complications like proliferative vitreoretinopathy.
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