Posterior Segment Trauma: Types of Injuries, Result of Vitreo-retinal Surgery and Prophylactic Broad Encircling Scleral Buckle
Sukhuma Warrasak MD*, Ataya Euswas MD*, Supawat Hongsakorn MD*
Affiliation : * Department of Ophthalmology, Ramathibodi Hospital, Mahidol University
Objectives : To evaluate the result of pars plana vitrectomy (PPV) and prophylactic broad encirling scleral
buckle in posterior segment trauma and to define factors that lead to functional failure.
Design : Retrospective, noncomparative, interventional case series.
Intervention: Prophylactic broad encircling scleral buckle, PPV, SF6/C3F8 or silicone oil implantation if
required.
Results : Ninety-two patients (94 eyes) with open globe ocular injuries involving posterior segment, were
treated between January 1988 and December 2004.The mean age was 33.1 years Common sources of injuries
were industrial and automobile accidents. After a follow up period of at least 6 months, 62 of 94 eyes (65.96%)
achieved visual acuity of 20/400 or better and 6 eyes (6.38%) lost vision to no light perception. Eyes that had
sharp perforating injuries with retained IOFB had better visual outcome than the others. Twenty-three of 38
eyes (60.53 %) that had sharp perforating injuries with retained IOFBs achieved a visual acuity of 20/70 or
better. Eyes with traumatic retinal detachment had a reattachment rate of 78.18 % and a functional success
rate of 56.36%.The detachment rate in vitrectomized eyes with prophylactic broad encircling scleral buckle
was 3.19 %. Main reasons for functional failure (V.A.<20/400) were macular damage, retinal detachment with
PVR and optic nerve injury. Endophthalmitis occurred in 6.25%.
Conclusion : Sharp perforating ocular injuries have the best visual prognosis among all types of injuries.Pars
plana vtrectomy and prophylactic broad encircling scleral buckle, can salvage and prevent subsequent
retinal detachment in these severely traumatized eyes.
Keywords : Vitreoretina surgery, Posterior segment trauma, Open globe injury, Intraocular foreign body, Prophylactic broad encircling scleral buckle
