The first experience in the treatment of large penetrating wounds of the sclera using expanded primary microsurgical treatment

Abstract

BACKGROUND: According to the literature, the absence of pattern vision in the outcome of open wounds of the eyeball is observed in 25–30% of cases, and in the presence of large wounds with multiple injuries of intraocular structures, it is 61–80%.

AIM: to present the results of expanded microsurgical treatment of large penetrating corneoscleral and scleral wounds involving the zone III, to evaluate the results of the given algorithm for severe penetrating injury care.

MATERIALS AND METHODS: Presented are the results of treatment of 24 patients with large penetrating corneoscleral and scleral wounds, massive hemophthalmos, and other injuries. All patients underwent primary microsurgical treatment according to a modified, expanded algorithm, which, in addition to suturing the fibrous capsule of the eye, included subtotal vitrectomy, primary treatment of retinal and choroidal wounds, the use of autologous conditioned plasma (P-PRP) , tamponade with silicone oil or a gas-air mixture.

RESULTS: Evaluation of treatment results was carried out on day 3, after 1 and 6 months. Special attention was paid to the identification of signs of proliferative vitreoretinopathy as most important in terms of prognosis. After 6 months, visual acuity above 0.1 was noted in 10 patients, 0.02–0.09 in 12, absence of pattern vision in 2. Signs of development and progression of PVR during 6 months were noted in 7 patients (29.2%), of which repeated surgeries were performed in 5 cases.

CONCLUSIONS: The new advanced algorithm of primary microsurgical treatment allows to improve functional results in severe cases of penetrating eye injury.

Keywords

primary microsurgical treatment / proliferative vitreoretinopathy / penetrating wounds of the sclera / vitrectomy / P-PRP / autologous conditioned plasma

References

[1] Kolesnikov AV, Kirsanova IV, Averina MM, Grishina TD. Results of treatment of penetrating wounds of the eyeball. Sovremennye Tekhnologii v Oftal’mologii. 2021;3:330–332. (In Russ.) DOI: 10.25276/2312-4911-2021-3-330-332

[2] Колесников А.В., Кирсанова И.В., Аверина М.М., Гришина Т.Д. Результаты лечения проникающих ранений глазного яблока // Современные технологии в офтальмологии. 2021. № 3. С. 330–332. DOI: 10.25276/2312-4911-2021-3-330-332

[3] Gundorova RA. Priority trends in the sphere of eye traumatism. The Russian Annals of Ophthalmology. 2004;110(1):12–14. (In Russ.)

[4] Гундорова Р.А. Приоритетные направления в проблеме глазного травматизма // Вестник офтальмологии. 2004. Т. 120, № 1. С. 12–14.

[5] Gundorova RA, Stepanov AV, Kurbanova NF. Sovremennaya oftal’motravmatologiya. Moscow: Meditsina. 2007. 256 p. (In Russ.)

[6] Гундорова Р.А., Степанов А.В., Курбанова Н.Ф. Современная офтальмотравматология. Москва: Медицина, 2019. 256 с.

[7] Knyazer B, Levy J, Rosen S, et al. Prognostic factors in posterior open globe injuries (zone-III injuries). Clin Exp Ophthalmol. 2008;36(9):836–841. DOI: 10.1111/j.1442-9071.2009.01922.x

[8] Knyazer B., Levy J., Rosen S., et al. Prognostic factors in posterior open globe injuries (zone-III injuries) // Clin Exp Ophthalmol. 2008. Vol. 36, No. 9. P. 836–841. DOI: 10.1111/j.1442-9071.2009.01922.x

[9] Blackford BG, Justin GA, Baker KM, et al. Proliferative vitreoretinopathy after combat ocular trauma in Operation Iraqi Freedom and Operation Enduring Freedom: 2001–2011. Ophthalmic Surg. Lasers Imaging Retina. 2020;51(10):556–563. DOI: 10.3928/23258160-20201005-03

[10] Blackford B.G., Justin G.A., Baker K.M., et al. Proliferative vitreoretinopathy after combat ocular trauma in Operation Iraqi Freedom and Operation Enduring Freedom: 2001–2011 // Ophthalmic Surg Lasers Imaging Retina. 2020. Vol. 51, No. 10. P. 556–563. DOI: 10.3928/23258160-20201005-03

[11] Soni NG, Bauza AM, Son JH, et al. Open globe ocular trauma: functional outcome of eyes with no light perception at initial presentation. Retina. 2013;33(2):380–386. DOI: 10.1097/IAE.0b013e318263cefb

[12] Soni N.G., Bauza A.M., Son J.H., et al. Open globe ocular trauma: functional outcome of eyes with no light perception at initial presentation // Retina. 2013. Vol. 33, No. 2. P. 380–386. DOI: 10.1097/IAE.0b013e318263cefb

[13] Jin Y, Chen H, Xu X, et al. Traumatic proliferative vitreoretinopathy. Clinical and histopathological observations. Retina. 2017;37(7):1236–1245. DOI: 10.1097/IAE.0000000000001350

[14] Jin Y., Chen H., Xu X., et al. Traumatic proliferative vitreoretinopathy. Clinical and histopathological observations // Retina. 2017. Vol. 37, No. 7. P. 1236–1245. DOI: 10.1097/IAE.0000000000001350

[15] Morescalchi F., Duse S., Gambicorti E., et al. Proliferative vitreoretinopathy after eye injuries: an overexpression of growth factors and cytokines leading toa retinal keloid. Mediators Inflamm. 2013:269787. DOI: 10.1155/2013/269787

[16] Morescalchi F., Duse S., Gambicorti E., et al. Proliferative vitreoretinopathy after eye injuries: an overexpression of growth factors and cytokines leading toa retinal keloid // Mediators Inflamm. 2013. P. 269787. DOI: 10.1155/2013/269787

[17] Andreoli M, Andreoli C. Surgical rehabilitation of the open globe injury patient. Am J Ophthalmol. 2012;153(5):856–860. DOI: 10.1016/j.ajo.2011.10.013

[18] Andreoli M., Andreoli C. Surgical rehabilitation of the open globe injury patient // Am J Ophthalmol. 2012. Vol. 153, No. 5. P. 856–860. DOI: 10.1016/j.ajo.2011.10.013

[19] Stepanyants AB. Metody ballonirovaniya v khirurgii povrezhdenii sklery. Oftal’mokhirurgiya. 2008;(2):50–55. (In Russ.)

[20] Степанянц А.Б. Методы баллонирования в хирургии повреждений склеры // Офтальмохирургия. 2008. № 2. С. 50–55.

[21] Pieramici DJ, MacCumber MW, Humayun MU. Open-globe injury. Update on types of injuries and visual results. Ophthalmology. 1996;103(11):1798–1803. DOI: 10.1016/s0161-6420(96)30424-7

[22] Pieramici D.J., MacCumber M.W., Humayun M.U. Open-globe injury. Update on types of injuries and visual results // Ophthalmology. 1996. Vol. 103, No. 11. P. 1798–1803. DOI: 10.1016/s0161-6420(96)30424-7

[23] Kasymov FO, Kulikov VS, Nikolaenko VP, Zumbulidze NG. Mekhanicheskaya travma organa zreniya. Saint Petersburg: SZGMU im. I.I. Mechnikova. 2015. 51 p. (In Russ.)

[24] Касымов Ф.О., Куликов В.С., Николаенко В.П., Зумбулидзе Н.Г. Механическая травма органа зрения. Санкт-Петербург: ГБОУ ВПО СЗГМУ им. И.И. Мечникова, 2015. 51 с.

[25] Neroev VV, Chentsova EV, Alekseeva IB, Kulikov AN. Klinicheskie rekomendatsii. Otkrytaya travma glaza: klinika, diagnostika, lechenie. Moscow: Obshcherossiiskaya obshchestvennaya organizatsiya “Assotsiatsiya vrachei-oftal’mologov”; 2017. 32 p. (In Russ.)

[26] Нероев В.В., Ченцова Е.В., Алексеева И.Б., Куликов А.Н. Клинические рекомендации. Открытая травма глаза: клиника, диагностика, лечение. Москва: Общероссийская общественная организация «Ассоциация врачей-офтальмологов». 2017. 32 c.

[27] Stepanyants AB. Sistema kompleksnoi diagnostiki, khirurgicheskogo lecheniya i reabilitatsii patsientov s povrezhdeniyami sklery [dissertation]. Moscow; 2009. 223 p. (In Russ.)

[28] Степанянц А.Б. Система комплексной диагностики, хирургического лечения и реабилитации пациентов с повреждениями склеры: дис. … д-ра мед. наук. Москва. 2009. 223 c.

[29] Kuhn F, Schrader W. Prophylactic chorioretinectomy for eye injuries with high proliferative-vitreoretinopathy risk. Clin Anat. 2018;31(1):28–38. DOI: 10.1002/ca.22906

[30] Kuhn F., Schrader W. Prophylactic chorioretinectomy for eye injuries with high proliferative-vitreoretinopathy risk // Clin Anat. 2018. Vol. 31, No. 1. P. 28–38. DOI: 10.1002/ca.22906

[31] Shishkin MM. Perednyaya proliferativnaya vitreoretinopatiya (patogenez, lechenie, profilaktika) [dissertation abstract]. Saint Petersburg; 2000. 51 p. (In Russ.)

[32] Шишкин М.М. Передняя пролиферативная витреоретинопатия (патогенез, лечение, профилактика. автореф. дис. … д-ра мед. наук. Санкт Петербург. 2000. 51 c.

[33] Volkov VV. Pozitivnyi opyt organizatsii oftal’mokhirurgicheskoi pomoshchi pri otkrytoi travme glaza (OTG) v usloviyakh massovykh porazhenii. In: VIII All-Russian Scientific and Practical Conference with international participation “Fedorovskie chteniya – 2009”: Sbornik tezisov po materialam konferentsii (2009, 1–3 July). Moscow; 2009. Available from: https://eyepress.ru/repository/record.aspx?oai: eyepress.ru: article6556

[34] Волков В.В. Позитивный опыт организации офтальмохирургической помощи при открытой травме глаза (ОТГ) в условиях массовых поражений // VIII Всероссийская научно-практическая конференция с международным участием «Фёдоровские чтения — 2009»: сборник тезисов по материалам конференции (1–3 июля 2009 г.) Москва: Офтальмология. 2009. Режим доступа: https://eyepress.ru/repository/record.aspx?oai:eyepress.ru: article6556

[35] Kuhn F, Morris R. Early vitrectomy for severe eye injuries. Eye (Lond). 2021;35(5):1288–1289. DOI: 10.1038/s41433-020-01308-w

[36] Kuhn F., Morris R. Early vitrectomy for severe eye injuries. Eye (Lond). 2021. Vol. 35, No. 5. P. 1288–1289. DOI: 10.1038/s41433-020-01308-w

[37] Ishikawa K, He S, Terasaki H, et al. Resveratrol inhibits epithelial-mesenchymal transition of retinal pigment epithelium and development of proliferative vitreoretinopathy. Sci Rep. 2015;5:16386. DOI: 10.1038/srep16386

[38] Ishikawa K., He S., Terasaki H., et al. Resveratrol inhibits epithelial-mesenchymal transition of retinal pigment epithelium and development of proliferative vitreoretinopathy // Sci Rep. 2015. Vol. 5. P. 16386. DOI: 10.1038/srep16386

[39] Tamiya Sh, Liu L, Kaplan H. Epithelial-mesenchymal transition and proliferation of retinal pigment epithelial cells initiated upon loss of cell-cell contact. Invest Ophthalmol Vis Sci. 2010;51(5):2755–2763. DOI: 10.1167/iovs.09-4725

[40] Tamiya Sh., Liu L., Kaplan H. Epithelial-mesenchymal transition and proliferation of retinal pigment epithelial cells initiated upon loss of cell-cell contact // Invest Ophthalmol Vis Sci. 2010. Vol. 51, No. 5. P. 2755–2763. DOI: 10.1167/iovs.09-4725

[41] Popov EM, Kulikov AN, Churashov SV, et al. Comparison of indicators of autologous serum obtained by different methods and used for the treatment of macular hole. Ophthalmology Journal. 2021;14(4):27–34. (In Russ.) DOI: 10.17816/OV89413

[42] Попов Е.М., Куликов А.Н., Чурашов С.В., и др. Сравнение показателей получаемой разными способами аутоплазмы, используемой для лечения пациентов с макулярным разрывом // Офтальмологические ведомости. 2021. Т. 14, № 4. С. 27–34.

[43] Pashtaev NP, Arsyutov DG. The use of medical glue in the treatment of progressive myopia and retinal detachment. Oftal’mokhirurgiya. 2009;(3):16–20. (In Russ.)

[44] Паштаев Н.П., Арсютов Д.Г. Использование медицинских клеев в хирургии прогрессирующей миопии и отслойки сетчатки // Офтальмохирургия. 2009. № 3. С. 16–20.

[45] Shkvorchenko DO, Zakharov VD, Shpak AA. Nash pervyi opyt primeneniya bogatoi trombotsitami plazmy krovi v khirurgii makulyarnykh razryvov. Sovremennye Tekhnologii v Oftal’mologii. 2016;(1):245–246. (In Russ.)

[46] Шкворченко Д.О., Захаров В.Д., Шпак А.А. Наш первый опыт применения богатой тромбоцитами плазмы крови в хирургии макулярных разрывов // Современные технологии в офтальмологии. 2016. № 1. С. 245–246.

[47] Arsiutov DG. The use of a new type of platelet-rich plasma — autologous conditioned plasma (ACP) in the surgery of rhegmatogenous retinal detachment with large and multiple breaks, abruption from the dentate line. Sovremennye Tekhnologii v Oftalmologii. 2019;1:22–25. (In Russ.) DOI: 10.25276/2312-4911-2019-1-22-25

[48] Арсютов Д.Г. Использование нового типа обогащённой тромбоцитами плазмы — аутологичной кондиционированной плазмы (ACP) в хирургии регматогенной отслойки сетчатки с большими и множественными разрывами, отрывом от зубчатой линии // Современные технологии в офтальмологии. 2019. № 1. С. 22–25.

[49] Arsiutov DG. Use of Autologous Conditioned Platelet Rich Plasma in the Surgery of Rhegmatogenous Retinal Detachment with Central and Peripheral Tears. Acta Biomedica Scientifica. 2019;4(4):61–65. (In Russ.) DOI: 10.29413/ABS.2019-4.4.8

[50] Арсютов Д.Г. Использование аутологичной кондиционированной плазмы, обогащённой тромбоцитами, в хирургии регматогенной отслойки сетчатки с центральным и периферическими разрывами // Acta Biomedica Scientifica. 2019. Т. 4, № 4. С. 61–65. DOI: 10.29413/ABS.2019-4.4.8

[51] Arsyutov DG. Use of platelet rich plasma, including autologous conditioned plasma, in the surgery of perforating eye injuries. Saratov Journal of Medical Scientific Research. 2020;16(1): 207–210. (In Russ.)

[52] Арсютов Д.Г. Использование обогащённой тромбоцитами плазмы, в том числе аутологичной кондиционированной плазмы, при сквозных ранениях глаза // Саратовский научно-медицинский журнал. 2020. Т. 16, № 1. С. 207–210.

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