Endoscopy-guided vitreoretinal surgery following penetrating corneal injury: a case report

Abstract

Introduction: Severe ocular trauma requires emergency surgery, and a fresh corneal graft may not always be available. We describe a case of perforating eye injury with corneal opacity, suspected endophthalmitis, and an intraocular foreign body. The patient was successfully treated with a two-step procedure comprising endoscopy-guided vitrectomy followed by corneal transplantation. This surgical technique offers a good option to vitrectomy with simultaneous keratoplasty in emergency cases where no graft is immediately available and there is the possibility of infection due to the presence of a foreign body.

Case presentation: A 55-year-old Japanese woman was referred to our hospital with a perforating corneal and lens injury sustained with a muddy ferrous rod. Primary corneal sutures and lensectomy were performed immediately. Vitreoretinal surgery was required due to suspected endophthalmitis, vitreous hemorrhage, retinal detachment, dialysis and necrosis of the peripheral retina. Instead of conventional vitrectomy, endoscopy-guided vitreous surgery was performed with the Solid Fiber Catheter AS-611 (FiberTech, Tokyo, Japan) due to the presence of corneal opacity and the unavailability of a donor cornea. The retina was successfully attached with the aid of a silicon oil tamponade. Following removal of the silicon oil at 3 months after surgery, penetrating keratoplasty and intraocular lens implantation with ciliary sulcus suture fixation were performed. At 6 months after penetrating keratoplasty, the graft remained clear and visual acuity was 20/40.

Conclusion: Primary endoscopic surgery for vitreoretinal complications in eyes with perforating injury performed prior to penetrating keratoplasty appears to be advantageous in terms of avoiding damage to the corneal endothelium.

Keywords: emergency; foreign body; vitreoretinal surgery.

Figure 1

Photograph of anterior segment just prior to endoscopy-guided vitrectomy. Note severe corneal edema, hyphema, +++cells and fibrin exudates in anterior chamber, leading to tentative diagnosis of endophthalmitis with secondary glaucoma.

Figure 2

Intraoperative endoscopic view. Note clear view of necrotic retinal break treated with endophotocoagulation after removal of small foreign body in 5.30 o’clock position anterior to equator in peripheral retina.

Figure 3

Photograph of anterior segment at 8 months after keratoplasty and ciliary sulcus fixated intraocular lens implantation. Note that graft remained clear with HCL corrected visual acuity of 20/40.