Comparison of endoscopic-assisted and temporary keratoprosthesis-assisted vitrectomy in combat ocular trauma: experience at a tertiary eye center in Turkey

Abstract

Objective This study was performed to compare the functional and anatomical results of endoscopic-assisted and temporary keratoprosthesis (TKP)-assisted vitrectomy in patients with combat ocular trauma (COT). Methods The medical records of 14 severely injured eyes of 12 patients who underwent endoscopy or TKP implantation in combination with vitreoretinal surgery from 2007 to 2015 were retrospectively evaluated. The patients' ocular history and functional and anatomic anterior and posterior segment results were analyzed. Results Eight eyes (57%) underwent TKP-assisted vitrectomy and six eyes (43%) underwent endoscopic vitrectomy. The most common cause of COT was detonation of improvised explosive devices (72%), and the most common type of injury was an intraocular foreign body (50%). The median time from trauma to surgery and the median surgical time were significantly shorter in the endoscopy than TKP group. The postoperative functional and anatomical results were not significantly different between the two groups. Conclusions TKP-assisted vitrectomy should be performed in eyes requiring extensive bimanual surgery. In such cases, a corneal graft must be preserved for the TKP at the end of the surgery. Endoscopy shortens the surgical time and can reduce the complication rate.

Keywords: Combat ocular trauma; anatomical outcome; complications; endoscopy; functional outcome; temporary keratoprosthesis; vitrectomy.

Figure 1.

A 29-year-old patient. He had an open globe injury in his right eye due to detonation of an improvised explosive device. Only primary suture closure was performed for this eye at the primary center. His visual acuity was hand movements at presentation. The patient had a right eye perforating injury affecting zone 1, and his ocular trauma score was 45. He had a centrally opaque cornea (a). No view of the posterior segment was possible. Tractional retinal detachment was present, and he underwent endoscopic vitrectomy (b).

Figure 2.

A 20-year-old patient with open globe injuries in his eyes after a mine explosion. At the primary center, only primary suture closure was performed for his right eye, and evisceration of his left eye was performed. His visual acuity was hand movements in his right eye at presentation. He had an opaque cornea (a). No view of the posterior segment was possible. Orbital ultrasound revealed an inferiorly located retinal detachment (b). The patient had a right eye penetrating injury affecting zone 3, and his ocular trauma score was 60. He underwent temporary keratoprosthesis implantation and vitrectomy. His vision was 20/200 at the first month. At the ninth month, his vision improved to 20/40 and he still had a clear corneal graft and attached retina (c, d).