Simultaneous Bilateral Open-Globe Repair and Vitreoretinal Surgery for Explosive-Related Ocular Injury

Abstract

Purpose: To report an approach to explosive injuries with simultaneous, co-surgeon bilateral ruptured globe repair and pars plana vitrectomy for bilateral intraocular foreign bodies (IOFBs). Methods: A case and its findings were analyzed. Results: A 31-year-old man had bilateral vision loss after an air compressor malfunction that caused a high-pressure explosion to his face. An examination showed bilateral open-globe injuries and IOFBs, necessitating urgent repair. Given the risk for endophthalmitis and the need for expeditious repair, open-globe repair surgery was performed in both eyes simultaneously by co-surgeons followed by pars plana lensectomy, vitrectomy with IOFB removal, and silicone oil placement. The final visual acuity after bilateral scleral-fixated intraocular lens implantation was 20/20 OD and 20/25 OS. Conclusions: This case of bilateral open-globe injuries and IOFBs required expeditious repair with bilateral, simultaneous surgery that ultimately resulted in excellent visual outcomes. Simultaneous surgery may be an option for bilateral ocular trauma.

Keywords: bilateral surgery; intraocular foreign body; ocular trauma; vitrectomy; vitreoretinal surgery.

Figure 1.

A preoperative computed tomography (CT) scan shows bilateral metallic foreign bodies. A brain CT scan without contrast obtained before surgery indicates the presence of numerous metallic foreign bodies in and around the orbits bilaterally (arrowheads). Axial (A and B), coronal (C and D), and sagittal (E and F) slices are shown at 2 depths (slice widths, 5.0 mm). Abbreviations: L, left; OD, right eye; OS, left eye; P, posterior; R, right.

Figure 2.

Surgical setup and timeline. (A) The surgeons were seated temporally at each eye. A separate tray was placed for each eye. The scrub technician was available to assist Surgeon 1 with Tray 1, while Surgeon 2 obtained instruments directly from Tray 2. The microscope was away from the surgical field during the globe repairs while the surgeons wore surgical loupes with headlamps. (B) Timeline (in hours) for simultaneous surgical repair. Abbreviation: PPV, pars plana vitrectomy.

Figure 3.

Postoperative clinical fundus images. (A) Ultra-widefield image of the right eye 10 months after the initial surgery shows a healthy optic nerve and macula and an attached retina with laser scars superotemporally. (B) Ultra-widefield image of the left eye 10 months after the initial surgery shows a healthy optic nerve and macula and an attached retina with laser scars temporally.