Ординатура / Офтальмология / Учебные материалы / Clinical Diagnosis and Management of ocular trauma

156

Clinical Diagnosis and Management of Ocular Trauma

Descemet’s membrane results in a Kayser-Fleischer

identifies multiple foreign bodies.14-16 It is a noninvasive

ring, which appears as a peripheral greenish blue ring.

technique requiring minimal patient cooperation and

Deposition in the lens capsule forms greenish blue ring.

can be used to image radioluscent and radiopaque

Deposition in the lens capsule causes a greenish brown

foreign bodies. CT scanning does have limitations, in

sunflower cataract. Deposits of copper have been

that metallic IOFBs often create significant scattering

demonstrated in the internal limiting membrance of

artifact that may obscure their precise location. This

the retina and intraretinal glial tissue.

can be particularly bothersome when attempting to

determine whether a foreign body is intraretinal or

Localization of IOFB

intrascleral. In addition, identify some of the lower

density foreign bodies, such as wood, may be difficult

Thirty-two percent of all intraocular foreign bodies are

with CT scanning.17

located in the anterior segment. Fifteen percent of

Magnetic resonance imaging (MRI) has proved

intraocular magentic foreign bodies are found in the

useful for imaging intraocular tumors and other lesions.

anterior chamber, 8% in the lens, 70% in the posterior

However, the magnetic fields and heat generated

segment, and 7% in the orbit as a result of perforation.

during MRI scanning preclude examination of patients

When IOFBs are retained, their precise localisation

with potential intraocular of intraorbital metallic foreign

is important in surgical decision-making. For many

bodies. MRI’s main role is in accurately and safely

years, the standard technique of localizing of foreign

localizing wood and plastic intraocular foreign bodies.

bodies involved special applications of conventional

radiographic imaging. These methods were inaccurate

Management

and difficult, could cause iatrogenic damage to the

Patient should be put on frequent topical steroid

globe, and were not useful in detecting radioluscent

foreign bodies. Now a days, radiographic localization

antibiotic combination drops with intravenous broad

of intraocular foreign bodies has been replaced by

spectrum antibiotics. The management of an

ultrasonography and CT scan.

intraocular foreign body begins with primary repair

Ultrasound B scan can accurately localise

of the perforated globe. Primary surgery, when

intraocular foreign bodies in majority of cases. The

appropriate, must include closure of entrance wounds

examination often must be performed gently through

and repositioning or removal of incarcerated uvea to

closed lids in open globe. The usefulness of echography

prevent risk of endophthalmitis.

is limited by shadowing caused by highly reflective

Removal of an IOFB is recommended at the time

surfaces such as air, reverberation artifacts creating by

of repair of the entry site or soon afterward as soon

some intraocular foreign bodies. Ultrasonography is

as corneal clarity permits. IOFBs cause inflammation

not accurate in determining whether a foreign body

and often are rapidly surrounded by a fibrous capsule

is intraocular or extraocular or if it is embedded in

that can make delayed surgical removal more difficult.

the eye wall when the foreign body is located within

Foreign bodies may contain copper, which can cause

1 mm of the sclera.10

immediate severe inflammatory changes, or iron, which

Ultrasound biomicroscopy (UBM), a high-

can cause chronic siderotic damage to the eye.18 In

frequency (50 MHz), high-resolution imaging techni-

addition, traumatic endophthalmitis, particularly

que, offers cross-sectional images of the anterior

associated with the Bacillus cereus, is more commonly

segment to a depth of 5 mm and is helpful in localizing

seen with IOFBs than with other forms of penetrating

aneriorly placed intraoular foreign bodies. However,

injuries.

B-scan ultrasound cannot be used to assess anterior

Vitreous hemorrhage associated with an intraocular

segment structures as its resolution is not sufficiently

foreign body can result in the development of fibrotic

high.11-13

bands that may detach the retina. Tolentino and

CT scan has emerged as the imaging technique of

colleagues demonstrated in rabbits that vitreous

choice in the evaluation of IOFBs. CT scan can

hemorrhage in the presence of an intraocular foreign

demonstrate a perforation of the globe and localize

body resulted in a proliferative fibroblastic reaction that

metallic and nonmetalic foreign bodies. The CT scan

caused retinal detachment and phthisis bulbi. Animals

also provides valuable information about intraocular

with intraocular foreign bodies but without vitreous

structural alterations, including the presence of a

hemorrhage did not develop these changes. Early

dislocated lens or choroidal hemorrhage 2 mm sections

vitrectomy in eyes with foreign bodies and vitreous

on CT scan are able to localize IOFB as small as 0.7 mm

hemorrhage can either prevent or eliminate these

in size. The CT scan is noninvasive and can be

changes before significant intraocular damage has

performed on uncooperative patients and easily

occurred. In a series by Percival19 on late complications

Retained IOFB

157

from intraocular foreign bodies, retinal detachment

was present in 42% of patients with vitreous

hemorrhage but only 4% of those without

hemorrhage. The incidence of retinal detachment was

only slightly higher if the foreign body was embedded

in the retina rather than lying in the vitreous.

Foreign bodies in the anterior segment of the eye

are usually easy to remove. The pupil should be

constricted before removal is attempted. IOFBs located

in corneal stroma can be removed by cutting down

directly over the foreign body. Magnetic foreign bodies

located in the anterior chamber or on the iris can be

taken out through a limbal incision with a magnet or

foreign body forceps or a toothed forceps.

The posterior segment intraocular foreign bodies

whether magnetic or nonmagnetic should be removed

as their retention may severely damage the eye. Two

types of magnets are used to remove magnetic

intraocular foreign bodies. The Electromagnets are

heavy, bigger in size and exert a substantially stronger

force. These magnets can pull a foreign body at great

speeds, and when misaligned, the foreign body can

strike intraocular structures or the eye wall with

damaging effect. Other type of magnet commonly

used these days are Rare Earth magnets, and their

magnetic pole is located at the tip. The magnetic pull

of these instruments is coaxial with the tip. The pulling

force only affects the magnetic foreign body when the

instrument closely approaches it, which minimizes

unwanted movements of the foreign bodies. Different

tips sizes of rare earth magnets are available which can

be introduced through the 20 gauge sclerotomy

opening.

For posterior segment IOFBs, removal by external

approach may be adopted when a small magnetic IOFB

is present in region of pars plana.

Accurate localization is necessary to mark the

incision point. Conjunctival peritomy is performed and

if necessary, rectus muscles are isolated and looped

with sutures to allow adequate exposure. Either partial

thickness scleral flap or full thickness sclerotomy is

performed. IOFB is removed with help of magnet

(metallic IOFB) or toothed forceps. In most of the cases,

IOFB is difficult to remove with magnet because of

fibrotic strands or encapsulation of IOFB. Shock and

Adams reported good anatomic and visual results

following attempted pars plana external magnetic

extraction in 13 patients with retained intraocular

foreign bodies.

In most of the cases of posterior segment IOFBs,

a primary vitrectomy is indicated when a foreign body

is associated with media opacities, IOFB is in vitreous

Figs 26.1A to D: Retained IOFB with traumatic endo-

cavity or adherent to the retina or vitreous strands or

phthalmitis (A) At presentation: PL +, (B) 1 week after

located intraretinally. A Standard 3 port vitrectomy is

vitrectomy, IOFB removal and silicon iol injection, (C and D)

done.

At 3 months after surgery

Retained IOFB

159

2.

Armstrong MFJ: A review of intraocular foreign body

injuries and complications in N. Ireland from 1978-1986.

Int Ophthalmol 1988;12:113-17.

3.

Khan D, Kundi N, Mohammed Z, et al: A 6½ years survey

of intraocular and intraorbital foreign bodies in the North-

west Frontier Province, Pakistan. Br J Ophthalmol

1987;71:716-19.

4.

Trevor-Roper PD: The later results of removal of intraocular

foreign bodies with the magnet. Br J Ophthalmol 1944;

28:361-65.

5.

Williams DF, Mieler WF, Abrams GW: Intraocular foreign

bodies in young people. Retina 1990;10(suppl):S45-49.

6.

O’NeillE,EaglingEM:Intraocularforeignbodies:Indications

for lensectomy and vitrectomy. Trans 1954;38:727-33.

7.

Ballantyne JF: Siderosis bulbi. Br J Ophthalmol

1954;38:727-33.

8.

Williams DF, Mieler WF, Abrams GW, et al: Results and

prognosticfactors in penetrating ocular injuries with retained

intraocular foreign bodies. Ophthalmology 1988;85:

911-16.

9.

Knave B: Electroretinography in eyes with retained

intraocular metallic foreign bodies: A clinical study. Acta

Ophthalmol 1969;100(suppl):1-63.

10.

Loffredo A. Cennamo G. Sammartino A, et al: The value of

the association of radiological methods with echographic

examination in the study of intraocular foreign bodies,

Ophthalmologica 1979;179:18-24.

11. . Laroche D, Ishikawa H, Greenfield D, Liebmann J M, Ritch

R. Ultrasound biomicroscopic localization and evaluation

of intraocular foreign bodies. Acta Ophthalmology Scand

1998;76:491-95.

12.

Barash D, Goldenberg-Cohen N, Tzadok D, Lifshitz T,

Yassur Y, Weinberger D. Ultrasound biomicroscopic

detection of anterior ocular segment foreign body after

trauma. Am J Ophthalmol 1998;126:197-202.

13.

Berinstein DM, Gentile RC, Sidoti PA, Stegman Z, Tello C,

Liebmann JM, et al. Ultrasound biomicroscopy in anterior

ocular trauma. Ophthalmic Surg Lasers 1997; 28: 201-07.

14.

Lobes LA Jr, Grand MG, Reece J, et al: Computerized axial

tomography in the detection of intraocular foreign bodies.

Ophthalmology 1981;88:26-29.

15.

Gaster RN, Duda EE: Localization of intraocular foreign

bodies by computed tomography. Ophthalmic Surg

Figs 26.4A to C: (A,B) Preop photo-red glass IOFBs with

1980;25-29.

16.

Leone CR Jr. Wilson FC: Computerized axial tomography

subretinal altered hemorrhage, (C) 2 months postop

of theorbit. Ophthalmic Surg 1976;7(2):34-44.

following vitrectomy and IOFBs removal vision-6/18

17.

Opilow, HW, Ackerman, AL, and Zimmerman, RD:

Limitations of computerized tomography in the localization

with IOFBs have an excellent prognosis, with 75%

of intraocular foreign bodies, Arch Ophthalmol

regaining visual acuity of 5/200 or better in one series,

18.

1986;104:1477-82.

as opposed to only 58% for those patients having a

Neubauer, H: Ocular metallosis, Trans Ophthalmol Soc UK

1979;99:502-10.

penetrating injury without an IOFB.

19.

Percival SPB: Late complications from posterior segment

References

intraocular foreign bodies: With particular reference to

retinal detachment. Br J Ophthalmol 1972;56:462-68.

1. Behrens-Baumann W, Praetorius G: Intraocular foreign

20.

De Juan, E, Sternberg, P, and Michels, RG: Penetrating

bodies: 297 consecutive cases. Ophthalmologica

injuries: types of injuries and visual results, Ophthalmology

1989;198:84-88.

1983;90:1318-22.

Penetrating Posterior Segment Trauma

161

an important role in the stimulation of intravitreal

Investigations

proliferation. The presence of foreign material also

Radiology investigations are important in the determi-

complicates the nature of the trauma. Foreign bodies

nation of the presence of an intraocular foreign body.

contribute to trauma in the following ways: (1) direct

Various methods of evaluation include plain film

tissue injury; (2) increased risk of secondary infection

X-rays and CT scan. CT scan is currently considered the

or inflammation and (3) secondary late ocular toxicity

preferred technique for evaluation of IOFB. It is useful

including toxicity caused by oxidative reactions to some

for imaging radiolucent and radiopaque foreign bodies.

reactive metals (iron, copper).

The absorption characteristics of IOFB can be quantified

in Hounsfield units.11 Wood appears least dense on CT

Classification

followed by plastic and then glass. Metallic foreign bodies

all have the same absorption and, therefore, CT scan

1996 OCULAR TRAUMA CLASSIFICATION10

cannot differentiate the type of metal present.

Ultrasonography is also useful in evaluating the

Term

Definition

traumatized globe. It allows visualization of posterior

Eyewall

Sclera and cornea

segment through opaque media. It can be utilized in

Closed globe

No full thickness wound

the determination of the presence of posterior vitreous

Open globe

Full thickness wound

detachment (PVD), retinal detachment or foreign body.

Rupture

Full thickness due to blunt trauma

Laceration

Full thickness due to sharp trauma

Penetrating

Single laceration

Management

Perforating

2 full thickness lacerations

Intraocular foreign body Retained foreign body

Successful management of penetrating trauma requires

LOCATION

meeting several specific objectives of management. The

primary objectives are: (1) clear optical media; (2)

–

Zone I

prevent future retinal tears and detachment by

•

Cornea / corneoscleral

removing the vitreous scaffold at the laceration site

–

Zone II

and prevent formation of pre retinal membranes and

•

Anterior 5 mm of sclera

(3) remove foreign body.

–

Zone III

There are several principles of management that

•

More than 5 mm posterior to limbus

influence the ease of vitrectomy. Water tight primary

repair of globe during primary repair is crucial.

Clinical Features

Secondary vitrectomy techniques require that the initial

traumatic wounds be watertight to maintain the

While obtaining history is often critical in the diagnosis

integrity of the globe. The timing of vitrectomy appears

and management of patients it is often difficult to obtain

to be important in outcome. Studies suggest that

a clear history in the traumatized patient. This is often

surgery undertaken within 14 days of trauma reduces

related to factors such as secondary injuries and the

the rate of retinal detachment in experimental

influence of alcohol. The mechanism of injury is impor-

models.12,13 Surgery at 14 days is technically easier due

tant to understanding the nature of the ocular injury,

to the development of posterior vitreous detachment.

especially the possibility of intraocular foreign body.

3 port vitrectomy with wide field visualization is the

Important aspects of the clinical examination

standard method of management of complex posterior

include:

segment ocular trauma. There are several technical

• Visual acuity: Visual acuity is an important prognostic

considerations in surgical repair.

factor

•

Presence of a relative afferent pupillary defect

Infusion Port

• Intraocular pressure: The IOP is often low but a

Intraocular infusion is a key component of vitrectomy

normal or elevated IOP does not rule out rupture

as it is required for maintenance of intraocular pressure

of the globe.

during surgical manipulation. Port should be placed

•

Anterior Segment examination: Occult globe

in healthy sclera and well secured to the globe to

rupture results from scleral rupture posterior to the

prevent it being dislodged during surgical

limbus. Anterior segment features suggestive of

manipulation. Infusion port must be free of

occult globe rupture include chemosis and an

incarceration and able to free flowly in the vitreous

asymmetrically deep anterior chamber in the

cavity to avoid secondary retinal or choroidal

traumatized eye.

detachment. Standard 4 mm cannulas are typically

162

Clinical Diagnosis and Management of Ocular Trauma

adequate, however, longer 6 mm cannulas are

that in case of retinal injury it occurs away from the

available for cases with anterior vitreous contraction

macula. PVD creation can be difficult in the eyes of

or choroidal detachments. In cases where the infusion

younger patients. The posterior hyaloid can be

cannot be visualized initially an anterior infusion in the

engaged with active suction and elevated. In difficult

anterior segment of limbus can be employed. A 20

cases a bimanual technique employing suction and a

gauge needle on a separate infusion line can often

lighted membrane pick can be helpful. The posterior

be helpful as an alternate infusion until the pars plana

hyaloid is elevated with the suction instrument and

infusion can be visualized.

the pick is used to engage the hyaloid and lift it from

the retinal surface. Vitreous skirt is peeled anteriorly

Visualization of the Posterior Segment is Essential

to the vitreous base and trimmed as much as safely

Anterior segment hemorrhage should be cleared using

possible, avoiding anterior retinal injury.

passive washout techniques or cutting instruments.

Vitreous Bands

Corneal management can be difficult in traumatized

eyes. In cases of severe corneal trauma a temporary

Vitreous bands may appear white and can be dense,

keratoprosthesis can be employed. Alternatively

elastic membranes. Vitreous bands lead to secondary

endoscopic visualization systems allow posterior

traction on the retina. Vitreous bands can be divided

segment manipulation without need for a clear anterior

and truncated with the vitrectomy instrument or

segment media. Cataract or traumatic disruption of

intraocular scissors.

the lens may prevent visualization. Lens material can

be removed using the vitrectomy instrument or the

Pre-retinal Membranes

pars plana ultrasonic fragmentation instrument

Various techniques of removal of pre-retinal

depending on the density of the lens material. The

membranes have been described including vitreoretinal

decision to preserve the lens capsule for intraocular

picks, barbed MVR blades and intraocular forceps.

lens placement will vary with the nature and complexity

Subretinal membrane removal is typically only

of the trauma. In cases with high risk of vitreous

necessary if the organized bands prevent complete

proliferation complete removal of the lens capsule is

retinal flattening.

often preferred to avoid leaving scaffolding for

membrane formation. Removal of the lens capsule

Retinal Incarceration

should be complete with scleral depression being of

Retinal incarceration can produce traction on the retina

assistance to visualize and remove the peripheral lens

material and capsule.

or prevent complete retinal flattening. Retinotomy is

often required in the management of incarceration.14

Vitrectomy

Endodiathermy is placed around the incarceration site

and the retina is divided with intraocular scissors or

Vitrectomy is accomplished with high speed cutting

the high speed cutter.

instruments. The vitreous of the traumatized eye is

typically blood stained. The appearance of the blood

Choroidectomy

will vary with the timing of surgery with acute blood

Anecdotal evidence for removal of devitalized choroidal

appearing red but older blood having an ochre

appearance. Older vitreous hemorrhage is often

tissue at the time of vitrectomy to reduce the rate of

associated with a denser, more congealed vitreous gel

secondary PVR and redetachment.

than acute hemorrhages. The objectives during

Foreign Body Removal

vitrectomy include: (1) removal of blood to allow

visualization of the retina and (2) creation of a complete

The objective of surgery is complete and atraumatic

posterior vitreous detachment. Constant visualization

removal of the IOFB. Methods for removal include

of the vitrectomy port is key to avoiding secondary

external magnets and direct removal. External magnets

trauma, particularly in cases where visualization is

have been used for over 100 years in ophthalmology

difficult. The vitrectomy port should be anteriorly

for the removal of foreign bodies, however, they have

oriented and constantly visualized. In cases of extensive

been increasingly replaced by direct removal techni-

vitreous hemorrhage the surgeon should be constantly

ques. Electromagnetic current is used to draw the

looking for signs of retinal vessels to avoid inadvertent

foreign body to the eye wall where it can be removed

retinal trauma. In dense hemorrhages exploration of

via a prepared sclerotomy. Direct removal via direct

the vitreous cavity begins centrally and then progresses

visualization is preferred method for IOFB removal,

peripherally. If the location of the retina is in question,

thus avoiding secondary iatrogenic trauma. Foreign

then posterior dissection is often initiated nasally so

bodies may be encased in an inflammatory capsule

Penetrating Posterior Segment Trauma

163

that must be incised prior to removal. Intraocular

vitreous hemorrhage after closed globe injury

magnets and specialized forceps can be used to

underwent PPV/PPL.20 In a non-randomized

manipulate the foreign body and allow extraction

comparative review of 15 patients with prophylactic

through a limbal sclerotomy.

scleral buckle and 18 without. No difference in retinal

detachment rate (24% with scleral buckle and 17%

Retinal Detachment

without) was observed.

Once all traction from vitreous or pre-retinal

Perfluorocarbon Liquid

membranes is relieved the retina can be flattened. The

Perfluorocarbon liquids can be useful for manipulation

retina is flattened with air-fluid exchange or use of

perfluorocarbon liquids. Perfluorocarbon liquid is often

and stabilization of detached retina. They may also

preferable in trauma cases due to easier visualization

be useful in the manipulation of IOFB.21

of the retina during the application of retinopexy.

Endolaser or indirect laser retinopexy is applied to any

Silicone Oil

retinal breaks observed.

Tamponade is typically required for cases with retinal

Scleral Buckle

detachment. Tamponade can be achieved with intra-

ocular gas or silicone oil. No comparative trials of gas

Encircling scleral buckles support the vitreous base and

versus silicone oil in the context of penetrating ocular

may be useful in preventing later retinal detachment.

trauma exist. the Silicone Oil study excluded patients

Animal models of retinal injury with randomized

with retinal detachment in the setting of prior trauma.

placement of episcleral buckle at the site of the

Silicone oil tamponade may be useful in cases of severe

laceration suggested that the buckle reduced vitreous

ocular trauma. A case series of 23 patients with IOFB

traction and reduced the degree of fibrovascular

with placement of silicone oil at the time of initial repair

proliferation at the injury site.15 Some studies suggest

showed utility.22 61 % had retinal detachment at the

that placement of a scleral buckle significantly reduces

time of initial surgery. 78% had silicone oil removed

the risk of later retinal detachment. A series of eyes

after average of 9.1 months. Complete retinal reattach-

undergoing vitrectomy with and without scleral buckle

ment was achieved in 83% of eyes. Only 30% achieved

suggested that the encircling buckle reduced the rate

reattachment with one procedure with 70%

of subsequent detachment.16 27% developed a detach-

developing PVR. Visual acuity stabilized with an average

ment without a prophylactic buckle compared with

acuity of 20/640 and 55% achieving better than 20/

8% that received a prophylactic buckle. Other series

400. Another case series of 13 eyes undergoing PPV

have found that the detachment rate without a

after trauma examined the role of silicone oil

prophylactic buckle was 23% compared to 13% with

tamponade.23 Cases had lacerations greater than 4 disc

a buckle.17 In a prospective controlled clinical trial of

diameters, primary RD greater than 2 quadrants or

prophylactic scleral buckle with PPV in patients with

persistent intrasurgical hemorrhage. 11 eyes underwent

retained IOFB without retinal detachment 28 patients

silicone oil removal at average of 5.8 months with visual

underwent surgery.18 Rate of secondary retinal

acuity ranging from 20/25 to 20/200. 2 eyes developed

detachment was 6.6% with prophylactic scleral buckle

PVR.

and 30.8% without scleral buckle. While suggesting

benefit to prophylactic scleral buckle the results did

Antibiotics

not meet statistical significance. In a matched

Endophthalmitis is a potentially devastating compli-

retrospective series of patients undergoing prophylactic

cation of penetrating trauma. Antibiotic prophylaxis

scleral buckle placement at the time of open globe

seems reasonable though there is little evidence that

repair.19 19 patients with prophylactic scleral buckle

clarifies the preferred route of administration or the

placement and 19 patients without scleral buckle were

true efficacy of these measures.

matched by visual grade, zone of injury and

mechanism of injury. Patients with scleral buckle had

Complications

significantly better visual outcome (20/270 versus hand

motions). There was a trend towards lower retinal

ENDOPHTHALMITIS

detachment rate with prophylactic scleral buckle

placement (26% versus 53%) that did not meet

Epidemiology

statistical significance. Some series do not suggest a

significant benefit to prophylactic scleral buckle. In a

Two to seven percent of penetrating injuries result in

series of 33 patients with retinal detachment and

culture proven endophthalmitis.24

Penetrating Posterior Segment Trauma

165

2.

Parver LM, Dannenberg AL, Blacklow B, et al.

Characteristics and causes of penetrating trauma eye

injuries reported to the National Eye Trauma System

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Bajaire B, Oudovitchenko E, Morales E. Vitreoretinal

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Thach AB, Johnson AJ, Carroll RB et al. Severe eye

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Fig. 27.3: Patient underwent secondary repair of the rupture

6.

Delori F, Pmerantzzeff O, Cox MS. Deformation of the

globe under high speed impact: its relation to contusion

right eye on day 4. Surgery involved vitrectomy, 360°

injuries. Invest Ophth Vis Sci 1969;8:290-301.

retinotomy and peeling of membranes, temporary

7.

Cox MS, Schepens CL, Freeman HM. Retinal detachment

keratoprosthesis and corneal transplantation with silicone

due to ocular contusion. Arch Ophthalmol 1966;76:

oil tamponade. Five years later visual acuity was 20/200

678-85.

with aphakic spectacles

8.

Cleary PE, Ryan SJ. Experimental posterior posterior

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9.

Cleary PE, Ryan SJ. Experimental posterior posterior

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Kuhn F, Morris R, Witherspoon CD, et al. A standardized

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Ophthalmol

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Zinreich SJ, Miller NR, Aguayo JB, et al. Computed

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Gregor Z, Ryan SJ. Combined posterior contusion and

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Gregor Z, Ryan SJ. Complete and core vitrectomy in the

treatment of experimental posterior penetrating eye injury

Fig. 27.4: Fundus photo of the right eye shows attached

in the rhesus monkey. Br J Ophthalmol 1983;101:

441-45.

posterior pole under silicone oil with extensive laser

14.

Han DP, et al. Management of traumatic retinal

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incarceration with vitrectomy. Am J Ophthalmol

1988;106:640-45.

eyes 60% of eyes with lacerations anterior to the muscle

15.

Men G, Peyman GE, Kuo PC, et al. The role of scleral

insertions achieved functional vision in comparison to

buckle in experimental posterior penetrating eye injury.

28% where the lacerations extended posterior to the

16.

Retina 2003;23:202-08.

muscles and only 4% where the laceration extended

Brinton GS, Aaberg TM, Reeser FH, et al. Surgical results

in ocular trauma involving the posterior segment. Am J

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IOFB varies with the size and shape of the foreign body

17.

Hutton WL, Fuller DG. Factors influencing final visual

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results in severely injured eyes. Am J Ophthalmol

an IOFB does not necessarily indicate a poor prognosis

1984;97:715-22.

with approximately 1/3 of eyes in most series achieve

18.

Azad RV, Kumar N, Sharma YR, et al. Role of prophylactic

20/40 or better acuity.

scleral buckling in management of retained intraocular

foreign bodies. Clin Exp Ophthalmol 2004;32:58-61.

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Arroyo JG, Postel EA, Stone T, et al. A matched study

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