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

Abstract

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

Methods: 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.

Results: 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.

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

Keywords: corneal opacity; endoscopy-assisted vitrectomy; penetrating keratoplasty; retinal detachment; severe ocular trauma.

Figure 1. Case 19 with a penetrating injury of the right eye

A: Aphakia and aniridia 1mo after Stage-I surgery. The conjunctival congestion, irregular corneal wound, corneal suture, and corneal neovascularisation were located in the temporal region and superior limbus region. B: Image from endoscopy-assisted vitrectomy showed the inferior retina; the vitreous cutter was cutting the dense vitreous haemorrhage. Vitreous blood clots, detached retina, and retina puckers associated with the membrane were observed. C: Image from endoscopy-assisted vitrectomy showed the posterior fundus 12mo after Stage-II surgery. The posterior retina was flat with scattered retinal laser spots and white sheets of preretinal membrane (the red arrow). The optic nerve (the white arrow) was normal, and the macula was covered by the preretinal white membrane.

Figure 2. Case 20 with penetrating injury of right eye

A: Aphakia after Stage-I surgery. An irregular corneal wound, corneal edema, and corneal suture were located along the interpalpebral zone with conjunctival haemorrhage and conjunctival oedema. B: Image from endoscopy-assisted vitrectomy showed the fundus in the superior peripheral retina with retinal detachment, retinal break, vitreous opacity, and vitreous haemorrhage. The vitreous cutter incised the vitreous opacity. C: Image from the endoscopy-assisted retinal laser photocoagulation showed the fundus in the nasal-superior peripheral retina. D: Aphakia and aniridia 3mo after Stage-I surgery with corneal suture and leukoma. E: 6mo after penetrating keratoplasty, the corneal graft was transparent. F: Image from endoscopy-assisted vitrectomy showed the fundus after all operations. The retina was flat, and the macula can be seen with scattered retinal scarring, retinal pigmentation, and retinal laser spots. The white arrow indicated the optic nerve, and the red arrow showed the crest of the scleral buckling.