Clinical efficacy of early vitrectomy in patients with severe blunt ocular trauma

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Abstract

BACKGROUND: Eye injury is an actual problem, occupying a leading position among the main causes of blindness and low vision, accounting for 22.8% in the structure of primary visual disability, of which 53% of cases are due to closed eye injury. Despite the development and widespread introduction into practice of methods of high-tech care for patients of this profile, there are a number of complications that poorly respond to treatment, ultimately leading to the loss of visual function of the injured eye.

AIM: Evaluation of the effectiveness of early vitrectomy in patients with severe blunt ocular trauma, based on clinical results obtained during treatment and postoperative follow-up.

MATERIALS AND METHODS: The study included 34 patients (34 eyes) with contusion-type eye injury. The mean age of patients was 39 years, among them 30 were men (88.24%) and 4 (11.76%) women. Patients were divided into 2 groups. Group 1 included 11 patients (10 men, 1 woman) with an open-type eye injury — with a subconjunctival scleral rupture; upon admission, visual acuity varied from incorrect light projection to 0.01. In group 2, there were 23 patients (20 men, 3 women) with severe closed eye injury, upon admission to the hospital, visual acuity ranged from incorrect light projection to 0.06. In all cases, patients underwent subtotal three-port vitrectomy at an early date (up to 3 days) after injury.

RESULTS: On the 1st day after surgery, there was an improvement in visual acuity in all patients. The follow-up period for patients was 6 months. All included patients had a stable anatomical result, no cases of subatrophy were noted, satisfactory functional results were achieved - visual acuity varied from 0.02 to 0.8. After 6 months, 32 out of 34 eyes (94.12%) showed no signs of proliferative vitreoretinopathy. In 2 patients (18.18%) from group 1, the development of proliferative vitreoretinopathy under silicone oil was revealed. Epiretinal membrane was diagnosed in 2 patients (8.7%) from group 2 and in 1 patient (9.09%) from group 1.

CONCLUSIONS: Obtained clinical results of treatment of patients with severe blunt ocular trauma indicate the expediency of vitrectomy in early stages after injury, which is an effective treatment method. Long-term results demonstrate stable functional results for 6 months. Vitrectomy performed early after injury serves for prevention of proliferative vitreoretinopathy, but does not completely exclude its development. Performing surgery early after injury increases the prospects for preserving visual functions of the eye and is a positive prognostic factor.

About the authors

Serafima N. Subbotina

Central City Clinical Hospital No. 23

Author for correspondence.
Email: shmaksn@yandex.ru
ORCID iD: 0000-0001-9284-6502

ophthalmosurgeon

Russian Federation, Yekaterinburg

Sergey S. Shamkin

Central City Clinical Hospital №23

Email: sergeyshamkin87@yandex.ru
ORCID iD: 0000-0002-3504-8886

ophthalmosurgeon

Russian Federation, Yekaterinburg

Armen B. Stepanyants

Ural State Medical University

Email: stepanyants@okb1.ru

Dr. Sci. (Med.), professor, Ophthalmology Department

Russian Federation, Yekaterinburg

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Supplementary files

Supplementary Files
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2. Fig. 1. Traumatic injuries of intraocular structures in group 1 patients

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3. Fig. 2. Traumatic injuries of intraocular structures in group 2 patients

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4. Fig. 3. Visual acuity of patients at discharge

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5. Fig. 4. Visual acuity of patients 1 month after discharge

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