Endoscopy-assisted vitrectomy for severe ocular penetrating trauma with corneal opacity

To assess the utility and efficiency of endoscopy-assisted vitrectomy (EAV) for the treatment of corneal opacity in severe ocular trauma.

Patients who underwent fundus examination using a preoperative slit lamp and intraoperative endoscopy, followed by EAV and additional surgery were retrospectively recruited. Silicone oil removal and penetrating keratoplasty were used in selected eyes at postoperative follow-ups. Outcome measurements included the best corrected visual acuity (BCVA), intraocular pressure (IOP), findings of endoscopic fundus examination, and postoperative complications.

Twenty-one eyes with severe ocular trauma and corneal opacity were followed up for 24-36mo. Retinal detachment (RD) and vitreous haemorrhage (VH) were identified in 16 eyes (76.2%), RD only in four eyes (19.0%), and VH combined with intraocular foreign body in one eye (4.8%). All eyes underwent at least three surgeries. Stage-I surgeries involved wound closure (100%), lens extraction (76.2%), and anterior vitrectomy (14.3%). Stage-II surgeries involved scleral buckling (28.6%), membrane peeling (47.6%), retinal laser photocoagulation (100%) and silicone oil tamponade (100%) using EAV. Stage-III surgeries were conducted using endoscopy including silicone oil removal (52.4%), retinal laser photocoagulation (52.4%) and penetrating keratoplasty (28.6%). Nearly all eyes showed improvements in BCVA and IOP. Although there were no severe complications, glaucoma was noted in one eye, chronic hypotony in another eye, and band keratopathy in three eyes.

EAV is an effective adjunct for restoring ocular anatomical structures and visual function in the case of corneal opacity after severe ocular trauma.