Ординатура / Офтальмология / Учебные материалы / Ocular Traumatology Springer

Patients with certain conditions (such as a traumatic macular hole or EMP) should not be operated on unless visual acuity drops to a predetermined certain level (e.g., 20/40)

Use of an “antidote” is recommended when irrigating for a chemical injury: i.e., use an acid if the agent was an alkali

Even if surgery is urgent, it should be delayed until general anesthesia becomes available

There is no justification for the ophthalmologist to have a paternalistic attitude and determine for the patient what his visual needs are; instead of a predetermined cut-off visual value (which, incidentally, has no scientific basis anyway), the indication is up to the patient, based on proper counseling

Dilution of the agent is the goal; this is much more effective and less risky than balancing two agents against each other;7 certain fluids, however, are more effective than water (see Chap. 3.1)

If an emergency presents,8 other forms of anesthesia, even if they involve some compromise regarding the operation, may be preferred to deferral (see Chap. 1.8)

Lacerations involving the upper canalicular system need not be repaired since the upper canaliculus has an insignificant role in tear transport

Patching a corneal erosion results in faster healing

In some people the upper canalicular system is more important in tear transport than the lower one; since this cannot be determined before/during reconstruction, both lid’s canaliculus must be repaired

Although patching may be preferred by the patient, it can extend the healing process by causing corneal temperature elevation

Bilateral patching of the patient with a monocular open globe injury reduces ocular motility and thus the risk of further injury

In a cooperative patient, unilateral shielding is sufficient to prevent further tissue extrusion and ECH; uncooperative patients should be restrained or sedated; bilateral patching can be counterproductive by increasing anxiety even though this can indeed facilitate retinal reattachment

A breached lens capsule is synonymous with cataract formation

Even if an intralenticular FB is present or the lens has been traversed, the lens opacity may remain localized and stationary;9 in addition, primary lens removal has side effects and potential risks, which should be carefully weighed before lens removal is performed (see Chap. 2.7)

If the vitreous hemorrhage is organized and the presence of retinal detachment cannot be ruled out, the surgeon should proceed in a “horizontal”, layer-peeling fashion to avoid iatrogenic retinal injury

Blind cryopexy over a Zone III injury helps prevent retinal detachment

To prevent retinal detachment, all posterior retinal breaks should be treated with laser

The risk of extensive retinal injury is much greater with “horizontal” sweeping; “vertical digging” on the nasal side may indeed create a small retinectomy, but once the retina is identified, progression is easier, and the risk of additional retinal damage is much smaller (see Chap. 2.12)

Blind cryopexy implies that the surgeon is unable to visualize the pathology and thus control probe placement10 or freezing time. This in turn means that the intervention is not only ineffective but outright dangerous since the increased inflammation involves a higher PVR risk

If the vitreous has been completely removed from the edges of the break and in its vicinity,11 the RPE is healthy, and there is no posterior staphyloma, detachment from a posterior retinal break is extremely unlikely. Conversely, anterior breaks require (laser) treatment as it is impossible to completely remove the vitreous at the base

The advent of vitrectomy did not improve the prognosis of eyes with serious trauma

An eye has a much higher chance of recovering vision today than in the previtrectomy era – provided that the posterior retina and the optic nerve had not been destroyed at the time of injury

If the vitreous hemorrhage is caused by contusion, it is safe to observe the patient and consider vitrectomy after 3 months

The “3 months” is an unscientific, artificial waiting period; retinal detachment can occur early; therefore, either surgery should be considered sooner than 3 months if the hemorrhage does not rapidly resolve. Following the case with serial ultrasonography to detect vitreous organization may not be feasible. Vitrectomy achieves early visual rehabilitation and allows prevention of secondary complications (see Chap. 2.9)

Rupture has a better prognosis than contusion since the risk of subfoveal choroidal rupture is smaller

Orbital FBs should be removed to prevent secondary complications

Orbital floor fractures invariably require surgical repair and this should be done as soon as possible

It is true that subfoveal choroidal rupture is much less common in ruptures than in contusions, but a ruptured eye still has a much higher risk of losing vision than a contused eye

Removal of deep FBs involves significant risk; unless they do cause secondary complications (i.e., infection, compression of the optic nerve), they should be left in situ

Many orbital floor fractures do not result in significant enophthalmos or diplopia and thus do not require surgical repair; early repair of an orbital fracture in the presence of associated intraocular injury (i.e., a posterior scleral wound) may result

in additional iatrogenic trauma and should be deferred

related eye injuries declined in the observed period; most occur at home and are unintentional; blacks are at the highest risk for ocular trauma from firearms

the most devastating firework; poor initial visual acuity, open globe trauma, APD, and endophthalmitis are poor prognostic factors

during unsupervised play; 55% final monocular blindness rate

major cause of poor outcome