Fig. 14.64 This patient has had a 360¡ retinotomy and has a purse string subretinal proliferative vitreoretinopathy which is being removed from the back surface of the retina

of the more disrupted posterior segment and possibility of retinal or choroidal elevation. With wide-angle viewing systems, a small area of clear cornea is sufÞcient to allow surgery; only very rarely is recourse to keratoprosthesis required.

14.5.3 Visual Outcome

These types of injury are associated with a poor visual outcome with 77.8 % with 20/200 or worse vision and 27.8 % with phthisis bulbi, with only 60 % achieving a ßat retina (Meredith and Gordon 1987). Poor starting vision, the presence of an RAPD and a large or posterior wound are reported to result in poorer prognosis (Pieramici et al. 2003; Esmaeli et al. 1995).

14.6Trauma Scores

Fig. 14.65 In a patient with dislocated lens from trauma or other causes, iris hooks can be used to stabilise the capsule whilst the lens is aspirated. If possible, the capsule should be retained for insertion of a posterior chamber lens often with a capsular tension ring to maintain the shape of the capsule

The surgical management is similar to blunt injury with rupture except that there may be damaged or undamaged crystalline lens in situ, and visualisation through the anterior segment may be poorer because of corneal lacerations, hyphaema or cataract. Corneal or scleral lacerations require primary repair immediately. If the penetrating object is likely to be infective, intravitreal antibiotics may be necessary, but this is less indicated than in IOFB. An intravitreal injection may be hazardous in penetrating injury because

Table 14.4 Ocular trauma score (Kuhn et al. 2002): calculate the score for the traumatised eye

Table 14.5 Ocular trauma score: probability of achieving a visual acuity depending on the score attained

There are two models for the prediction of visual outcome in open-globe injury, the ocular trauma score (OTS) and the classiÞcation and regression tree (CART) (Kuhn et al. 2002; Schmidt et al. 2008); both have been found to be predictive of outcome (Man and Steel 2010).