When to treat with vitrectomy and the outcomes of open-globe injured eyes_Chinese Journal of Ocular Fundus Diseases

Authors：

Zhu Xinlei ,  Yan Hua

Department of Ophthalmology, Tianjin Medical University General Hospital, Tianjin 300052, China;

Corresponding author：

Yan Hua, Email: phuayan2000@163.com

Keywords：

Eye injuries/surgery; Vitrectomy; Review

DOI：

10.3760/cma.j.issn.1005-1015.2018.02.022

Video：

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Open-globe injuries (OGI) result in complicated and diverse conditions with different mechanisms and anatomical locations, which lead to completely different outcomes based on when to perform pars plana vitrectomy (PPV) after trauma. The PPV operation time points are generally divided into early (0 - 3 days), delayed (4 - 14 days), and late (> 2 weeks). There are still some controversies about the PPV time points after OGI. Injuries with intraocular foreign bodies or high risk of infection usually need early surgery to reduce the occurrence of endophthalmitis. However corneal edema and vitreous hemorrhage can increase the difficulties for early diagnosis and surgery. If there is choroidal hemorrhage or severe trauma in the back part of the eye, delayed intervention can allow the blood clots to be liquefied and removed easily. But there is higher incidence of postoperative complications. Late surgery can reduce the difficulty of PPV, but the increased incidence of proliferative vitreoretinopathy may lead to severe retinal traction, tears and postoperative scar formation.

Citation： Zhu Xinlei, Yan Hua. When to treat with vitrectomy and the outcomes of open-globe injured eyes. Chinese Journal of Ocular Fundus Diseases, 2018, 34(2): 184-186. doi: 10.3760/cma.j.issn.1005-1015.2018.02.022 Copy

1.	颜华.我国眼外伤救治现状与面临的挑战[J]. 中华眼科杂志, 2015, 51(8): 561-564. DOI: 10.3760/cma.j.issn.0412-4081.2015.08.001.Yan H. The challenge and present condition of management of ocular trauma in China[J]. Chinese Journal of Ophthalmology, 2015, 51(8): 561-564. DOI: 10.3760/cma.j.issn.0412-4081.2015.08.001.
2.	Kuhn F. The timing of reconstruction in severe mechanical trauma[J]. Ophthalmic Res, 2014, 51(2): 67-72. DOI: 10.1159/000351635.
3.	Coleman DJ. Early vitrectomy in the management of the severely traumatized eye[J]. Am J Ophthalmol, 1982, 93(5): 543-551.
4.	de Juan E Jr, Sternberg P Jr, Michels RG. Timing of vitrectomy after penetrating ocular injuries[J]. Ophthalmology, 1984, 91(9): 1072-1074.
5.	Ryan SJ, Allen AW. Pars planavitrectomy in ocular trauma[J]. Am J Ophthalmol, 1979, 88(3 Pt 1): 483-491.
6.	Dalma-Weiszhausz J, Quiroz-Mercado H, Morales-Cantón V, et al. Vitrectomy for ocular trauma: a question of timing[J]. Eur J Ophthalmol, 1996, 6(4): 460-463.
7.	Mieler WF, Mittra RA. The role and timing of pars planavitrectomy in penetrating ocular trauma[J]. Arch Ophthalmol, 1997, 115(9): 1191-1192.
8.	Cleary PE, Ryan SJ. Vitrectomy in penetrating eye injury: results of a controlled trial of vitrectomy in an experimental posterior penetrating eye injury in the rhesus monkey[J]. Arch Ophthalmol, 1981, 99(2): 287-292.
9.	Nashed A, Saikia P, Herrmann WA, et al. The outcome of early surgical repair with vitrectomy and silicone oil in open-globe injuries with retinal detachment[J]. Am J Ophthalmol, 2011, 151(3): 522-528. DOI: 10.1016/j.ajo.2010.08.041.
10.	Bajaire B, Oudovitchenko E, Morales E. Vitreoretinal surgery of the posterior segment for explosive trauma in terrorist warfare[J]. Graefe's Arch Clin Exp Ophthalmol, 2006, 244(8): 991-995. DOI: 10.1007/s00417-005-0186-1.
11.	Ferreira N, Monteiro S, Meireles A, et al. Outcome of vitrectomy and chorioretinectomy in perforating eye injuries[J]. Ophthalmic Res, 2015, 53(4): 200-206. DOI: 10.1159/000371494.
12.	Agrawal R, Shah M, Mireskandari K, et al. Controversies in ocular trauma classification and management: review[J]. Int Ophthalmol, 2013, 33(4): 435-445. DOI: 10.1007/s10792-012-9698-y.
13.	Aylward GW. Vitreous management in penetrating trauma: primary repair and secondary intervention[J]. Eye(Lond), 2008, 22(10): 1366-1369. DOI: 10.1038/eye.2008.74.
14.	Mansouri MR, Tabatabaei SA, Soleimani M, et al. Ocular trauma treated with pars planavitrectomy: early outcome report[J]. Int J Ophthalmol, 2016, 9(5): 738-742. DOI: 10.18240/ijo.2016.05.18.
15.	Globocnik Petrovic M, Lumi X, DrnovsekOlup B.Prognostic factors in open eye injury managed with vitrectomy: retrospective study[J]. Croat Med J, 2004, 45(3): 299-303.
16.	Colyer MH, Weber ED, Weichel ED, et al. Delayed intraocular foreign body removal without endophthalmitis during Operations Iraqi Freedom and Enduring Freedom[J]. Ophthalmology, 2007, 114(8): 1439-1447. DOI: 10.1016/j.ophtha.2006.10.052.
17.	Falavarjani KG, Hashemi M, Modarres M, et al. Vitrectomy for posterior segment intraocular foreign bodies, visual and anatomical outcomes[J]. Middle East Afr J Ophthalmol, 2013, 20(3): 244-247. DOI: 10.4103/0974-9233.114803.
18.	Sandinha MT, Newman W, Wong D, et al. Outcomes of delayed vitrectomy in open-globe injuries in young patients[J]. Retina, 2011, 31(8): 1541-1544. DOI: 10.1097/IAE.0b013e31820840ef.
19.	Feng K, Wang CG, Hu YT, et al. Clinical features and prognosis of eyeball rupture: eye injury vitrectomy study[J]. Clin Exp Ophthalmol, 2015, 43(7): 629-636. DOI: 10.1111/ceo.12534.
20.	赵明贵, 张士红.急性开放性眼外伤患者早期玻璃体手术治疗的时机及临床效果[J/OL]. 中华卫生应急电子杂志, 2016, 2(1): 17-20. http://med.wanfangdata.com.cn/Paper/Detail/PeriodicalPaper_zhwsyjdzzz201601006. DOI: 10.3877/cma.j.issn.2095-9133.2016.01.006.Zhao MG, Zhang SH. Opportunity of early vitreous surgery and its clinical efficacy in patients with open emergency ocular trauma[J/OL]. Chinese Journal of Hygiene Rescue(Electronic Edition), 2016, 2(1)17-20.http://med.wanfangdata.com.cn/Paper/Detail/PeriodicalPaper_zhwsyjdzzz201601006.DOI:10.3877/cma.j.issn.2095-9133.2016.01.006.
21.	陆骏麒. 开放性眼外伤患者玻璃体手术的时机选择[J]. 国际眼科杂志, 2016, 16(9): 1765-1767. DOI: 10.3980/j.issn.1672-5123.2016.9.46.Lu JQ. Opportunity of vitreous surgery in patients with open ocular trauma[J]. Int Eye Sci, 2016: 1765-1767. DOI: 10.3980/j.issn.1672-5123.2016.9.46.
22.	张效房, 杨进献.眼外伤学[M].郑州: 河南医科大学出版社, 1997: 32-36.Zhang XF, Yang JX. Ocular trauma[M]. Zhengzhou: Henan Medical University Publishing House, 1997: 32-36.
23.	Meier P, Wiedemann P.Massive suprachoroidal hemorrhage: secondary treatment and outcome[J]. Graefe's Arch ClinExpOphthalmol, 2000, 238: 28-32.
24.	Martin DF, Meredith TA, Topping TM, et al. Perforating (through-and-through) injuries of the globe: surgical results with vitrectomy[J]. Arch Ophthalmol, 1991, 109(7): 951-956.
25.	Spalding SC, Sternberg P Jr.Controversies in the management of posterior segment ocular trauma[J]. Retina, 1990, 10 Suppl 1: S76-82.
26.	Colyer MH, Chun DW, Bower KS, et al. Perforating globe injuries during operation Iraqi Freedom[J]. Ophthalmology, 2008, 115(11): 2087-2093. DOI: 10.1016/j.ophtha.2008.05.013.
27.	Feng K, Hu Y, Wang C, et al. Risk factors, anatomical, and visual outcomes of injured eyes with proliferative vitreoretinopathy: eye injury vitrectomy study[J]. Retina, 2013, 33(8): 1512-1518. DOI: 10.1097/IAE.0b013e3182852469.
28.	Abrams GW, Topping TM, Machemer R. Vitrectomy for injury: the effect on intraocular proliferation following perforation of the posterior segment of the rabbit eye[J]. Arch Ophthalmo, 1979, 97(4): 743-748.
29.	Tolentino FI, Liu HS, Freeman HM, et al. Vitrectomy in penetrating ocular trauma: an experimental study using rabbits[J]. Ann Ophthalmol, 1979, 11(11): 1763-1771.
30.	Williams DF, Mieler WF, Abrams GW, et al. Results and prognostic factors in penetrating ocular injuries with retained intraocular foreign bodies[J]. Ophthalmology, 1988, 95(7): 911-916.
31.	Thach AB, Ward TP, Dick JS, et al. Intraocular foreign body injuries during Operation Iraqi Freedom[J]. Ophthalmology, 2005, 112(10): 1829-1833. DOI: 10.1016/j.ophtha.2005.04.024.
32.	Wani VB, Al-Ajmi M, Thalib L, et al. Vitrectomy for posterior segment intraocular foreign bodies: visual results and prognostic factors[J]. Retina, 2003, 23(5): 654-660.

1. 颜华.我国眼外伤救治现状与面临的挑战[J]. 中华眼科杂志, 2015, 51(8): 561-564. DOI: 10.3760/cma.j.issn.0412-4081.2015.08.001.Yan H. The challenge and present condition of management of ocular trauma in China[J]. Chinese Journal of Ophthalmology, 2015, 51(8): 561-564. DOI: 10.3760/cma.j.issn.0412-4081.2015.08.001.
2. Kuhn F. The timing of reconstruction in severe mechanical trauma[J]. Ophthalmic Res, 2014, 51(2): 67-72. DOI: 10.1159/000351635.
3. Coleman DJ. Early vitrectomy in the management of the severely traumatized eye[J]. Am J Ophthalmol, 1982, 93(5): 543-551.
4. de Juan E Jr, Sternberg P Jr, Michels RG. Timing of vitrectomy after penetrating ocular injuries[J]. Ophthalmology, 1984, 91(9): 1072-1074.
5. Ryan SJ, Allen AW. Pars planavitrectomy in ocular trauma[J]. Am J Ophthalmol, 1979, 88(3 Pt 1): 483-491.
6. Dalma-Weiszhausz J, Quiroz-Mercado H, Morales-Cantón V, et al. Vitrectomy for ocular trauma: a question of timing[J]. Eur J Ophthalmol, 1996, 6(4): 460-463.
7. Mieler WF, Mittra RA. The role and timing of pars planavitrectomy in penetrating ocular trauma[J]. Arch Ophthalmol, 1997, 115(9): 1191-1192.
8. Cleary PE, Ryan SJ. Vitrectomy in penetrating eye injury: results of a controlled trial of vitrectomy in an experimental posterior penetrating eye injury in the rhesus monkey[J]. Arch Ophthalmol, 1981, 99(2): 287-292.
9. Nashed A, Saikia P, Herrmann WA, et al. The outcome of early surgical repair with vitrectomy and silicone oil in open-globe injuries with retinal detachment[J]. Am J Ophthalmol, 2011, 151(3): 522-528. DOI: 10.1016/j.ajo.2010.08.041.
10. Bajaire B, Oudovitchenko E, Morales E. Vitreoretinal surgery of the posterior segment for explosive trauma in terrorist warfare[J]. Graefe's Arch Clin Exp Ophthalmol, 2006, 244(8): 991-995. DOI: 10.1007/s00417-005-0186-1.
11. Ferreira N, Monteiro S, Meireles A, et al. Outcome of vitrectomy and chorioretinectomy in perforating eye injuries[J]. Ophthalmic Res, 2015, 53(4): 200-206. DOI: 10.1159/000371494.
12. Agrawal R, Shah M, Mireskandari K, et al. Controversies in ocular trauma classification and management: review[J]. Int Ophthalmol, 2013, 33(4): 435-445. DOI: 10.1007/s10792-012-9698-y.
13. Aylward GW. Vitreous management in penetrating trauma: primary repair and secondary intervention[J]. Eye(Lond), 2008, 22(10): 1366-1369. DOI: 10.1038/eye.2008.74.
14. Mansouri MR, Tabatabaei SA, Soleimani M, et al. Ocular trauma treated with pars planavitrectomy: early outcome report[J]. Int J Ophthalmol, 2016, 9(5): 738-742. DOI: 10.18240/ijo.2016.05.18.
15. Globocnik Petrovic M, Lumi X, DrnovsekOlup B.Prognostic factors in open eye injury managed with vitrectomy: retrospective study[J]. Croat Med J, 2004, 45(3): 299-303.
16. Colyer MH, Weber ED, Weichel ED, et al. Delayed intraocular foreign body removal without endophthalmitis during Operations Iraqi Freedom and Enduring Freedom[J]. Ophthalmology, 2007, 114(8): 1439-1447. DOI: 10.1016/j.ophtha.2006.10.052.
17. Falavarjani KG, Hashemi M, Modarres M, et al. Vitrectomy for posterior segment intraocular foreign bodies, visual and anatomical outcomes[J]. Middle East Afr J Ophthalmol, 2013, 20(3): 244-247. DOI: 10.4103/0974-9233.114803.
18. Sandinha MT, Newman W, Wong D, et al. Outcomes of delayed vitrectomy in open-globe injuries in young patients[J]. Retina, 2011, 31(8): 1541-1544. DOI: 10.1097/IAE.0b013e31820840ef.
19. Feng K, Wang CG, Hu YT, et al. Clinical features and prognosis of eyeball rupture: eye injury vitrectomy study[J]. Clin Exp Ophthalmol, 2015, 43(7): 629-636. DOI: 10.1111/ceo.12534.
20. 赵明贵, 张士红.急性开放性眼外伤患者早期玻璃体手术治疗的时机及临床效果[J/OL]. 中华卫生应急电子杂志, 2016, 2(1): 17-20. http://med.wanfangdata.com.cn/Paper/Detail/PeriodicalPaper_zhwsyjdzzz201601006. DOI: 10.3877/cma.j.issn.2095-9133.2016.01.006.Zhao MG, Zhang SH. Opportunity of early vitreous surgery and its clinical efficacy in patients with open emergency ocular trauma[J/OL]. Chinese Journal of Hygiene Rescue(Electronic Edition), 2016, 2(1)17-20.http://med.wanfangdata.com.cn/Paper/Detail/PeriodicalPaper_zhwsyjdzzz201601006.DOI:10.3877/cma.j.issn.2095-9133.2016.01.006.
21. 陆骏麒. 开放性眼外伤患者玻璃体手术的时机选择[J]. 国际眼科杂志, 2016, 16(9): 1765-1767. DOI: 10.3980/j.issn.1672-5123.2016.9.46.Lu JQ. Opportunity of vitreous surgery in patients with open ocular trauma[J]. Int Eye Sci, 2016: 1765-1767. DOI: 10.3980/j.issn.1672-5123.2016.9.46.
22. 张效房, 杨进献.眼外伤学[M].郑州: 河南医科大学出版社, 1997: 32-36.Zhang XF, Yang JX. Ocular trauma[M]. Zhengzhou: Henan Medical University Publishing House, 1997: 32-36.
23. Meier P, Wiedemann P.Massive suprachoroidal hemorrhage: secondary treatment and outcome[J]. Graefe's Arch ClinExpOphthalmol, 2000, 238: 28-32.
24. Martin DF, Meredith TA, Topping TM, et al. Perforating (through-and-through) injuries of the globe: surgical results with vitrectomy[J]. Arch Ophthalmol, 1991, 109(7): 951-956.
25. Spalding SC, Sternberg P Jr.Controversies in the management of posterior segment ocular trauma[J]. Retina, 1990, 10 Suppl 1: S76-82.
26. Colyer MH, Chun DW, Bower KS, et al. Perforating globe injuries during operation Iraqi Freedom[J]. Ophthalmology, 2008, 115(11): 2087-2093. DOI: 10.1016/j.ophtha.2008.05.013.
27. Feng K, Hu Y, Wang C, et al. Risk factors, anatomical, and visual outcomes of injured eyes with proliferative vitreoretinopathy: eye injury vitrectomy study[J]. Retina, 2013, 33(8): 1512-1518. DOI: 10.1097/IAE.0b013e3182852469.
28. Abrams GW, Topping TM, Machemer R. Vitrectomy for injury: the effect on intraocular proliferation following perforation of the posterior segment of the rabbit eye[J]. Arch Ophthalmo, 1979, 97(4): 743-748.
29. Tolentino FI, Liu HS, Freeman HM, et al. Vitrectomy in penetrating ocular trauma: an experimental study using rabbits[J]. Ann Ophthalmol, 1979, 11(11): 1763-1771.
30. Williams DF, Mieler WF, Abrams GW, et al. Results and prognostic factors in penetrating ocular injuries with retained intraocular foreign bodies[J]. Ophthalmology, 1988, 95(7): 911-916.
31. Thach AB, Ward TP, Dick JS, et al. Intraocular foreign body injuries during Operation Iraqi Freedom[J]. Ophthalmology, 2005, 112(10): 1829-1833. DOI: 10.1016/j.ophtha.2005.04.024.
32. Wani VB, Al-Ajmi M, Thalib L, et al. Vitrectomy for posterior segment intraocular foreign bodies: visual results and prognostic factors[J]. Retina, 2003, 23(5): 654-660.

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When to treat with vitrectomy and the outcomes of open-globe injured eyes

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