Authors
Shamrei D.V., Kulikov A.N., Boiko E.V., Churashov S.V., Kol’bin A.A.
S.M. Kirov Military medical academy, St. Petersburg
Abstract
Post-traumatic phthisis bulbi (PB) is a severe complication of the eyeball mechanical trauma. With the development of the technology of eye microsurgery and microinvasive vitreoretinal surgery (VRS), it became possible to preserve the anatomical integrity of the injured eye, in cases where enucleation or evisceration of the injured eyeball was previously performed.
Purpose — to assess the possibilities of surgical rehabilitation of patients with PB using microinvasive VRS.
Materials and methods: examined 49 patiens (49 eyes; 42 male и 7 female; average age — 36.9±14.8 years) with post-traumatic phthisis bulbi. All patients underwent combined organ preservation microinvasive vitreoretinal surgery.
Results. In 95.9% of cases, microinvasive VRS managed to preserve the anatomical integrity of the ciliary body, choroid, cornea and anterior chamber structures of the damaged eyeball. During VRS in 14 patients (28.6%), after performing a circular retinotomy, it was possible to straighten and fix the retina using endolaser coagulation. After performing microinvasive VRS, an increase in visual functions was noted, which in 14.3% of patients was 20/1000. According to the results of the treatment, in 57.2% of cases, the progression of subatrophy stopped, in 42.8% of cases it was possible to obtain a slight increase in APS indices compared to the initial values, which averaged 19.7±1.9 mm. In the early postoperative period, normalization of ophthalmotonus was noted in 12.2% of cases, in the rest — a slight increase in IOP with persisting hypotension. In 6.1% of cases, when the IOP level was insufficient after silicone tamponade, repeated administration of silicone oil was performed a few days after vitreoretinal surgery. Subsequently, the IOP level in the postoperative period was in the range from 16 to 22 mm Hg, averaged 19.4±2.7 mm Hg, and remained stable throughout the observation period (p≤0.05). When examining intact eyes in these patients, no cases of sympathetic ophthalmia were recorded (the maximum observation period reached 10 years after injury).
Conclusion. Microinvasive VRS with the use of retinotomy and long-term tamponade of the vitreous chamber of the eye with silicone oil allows in 95.9% of cases not only to save the eye, but also in 36.8% of cases, residual visual functions, and also prevents the development and progression of post-traumatic phthisis bulbi.
Keywords: pars plana vitrectomy, retinotomy, silicone oil tamponade, phthisis bulbi.
References
1. Gundorova RA, Neroev VV, Kashnikov VV. Travmy glaza. Moscow: GJeOTAR-Media, 2009. (In Russ).
2. Shamrei DV. Sravnitel’naja ocenka variantov oftal’mohirurgicheskoj reabilitacii pacientov, perenesshih tjazheluju travmu glaznogo jabloka. [aft. dissertation] St. Petersburg; 2012. (In Russ).
3. Lampе Zs, Kolozsvаri L. Ultrasonography in cases of phthisis bulbi. Ophthalmic Echography 13. Documenta Ophthalmologica Proceedings Series. 1993; 55: 381–384.
4. Boiko EV, Sosnovskiy SV, Kulikov AN, et al. Sovremennye vozmozhnosti organosohrannoj vitreoretinal’noj hirurgii v ishode tjazheloj travmy glaza // Zdorov’e. Medicinskaja jekologija. Nauka. 2012; 1–2: 68. (In Russ).
5. Boiko EV, Sosnovskiy SV, Kulikov AN, Shamrei DV. Organosohrannaja kompleksnaja vitreoretinal’naja hirurgija pri tjazhelyh povrezhdenijah glaz. In: Proceedings of the X Russian ophthalmology congress «Modern technologies for the treatment of vitreoretinal pathology — 2012»; Moscow, 22–23 March 2012. Moscow: 2012. pp. 40–42. (In Russ). [URL] Accessed 10.01.2021.
6. Boyko EV, Shamrey DV. Organ surgery for severe eye injury. Vestnik Nacional’nogo mediko-hirurgicheskogo Centra im. N I Pirogova. 2011; 6(3): 105–110. (In Russ).
7. Shishkin MM. Perednjaja proliferativnaja vitreoretinopatija (patogenez, lechenie, profilaktika). [dissertation] St. Petersburg; 2000. (In Russ).
8. Kuhn F, Morris R, Witherspoon CD. Birmingham Eye Trauma Terminology (BETT): terminology and classification of mechanical eye injuries. Ophthalmol Clin North Am. 2002; 15(2): 139–143.
9. Yanoff M, Fine BS. Ocular pathology. Harper and Row; 1975.
10. Greve MD, Peyman GA, Millsap CM. Relaxing retinotomy under perfluorocarbon liquid. Ophthalmic Surg Lasers. 1996; 2(2): 154–155.
11. Faude F, Lambert A, Wiedemann P. 360 degrees retinectomy in severe anterior PVR and PDR. Int Ophthalmol. 1998; 22(2): 119–123.
12. Machemer R, McCuen BW, De Juan E. Relaxing retinotomies and retinectomies. Am J Ophthalmol. 1986; 102(1): 7–12.
13. Yang X, Du S, Ren H. Vitrectomy combined with continuous intraocular injection of silicone oil in the treatment of early atrophy of eyeball. Proceedings of the Congress of the International Society of Ocular Trauma; 2014 May 22–25; Dubrovnik, Croatia; 2014. p. 49.
14. Yang X, Ren H, Du S, et al. The effect of photocoagulation of retinal pigment epithelium on the intraocular pressure of hypotonic rabbit eyes due to retinal defect. Proceedings of the Congress of the International Society of Ocular Trauma; 2014 May 22–25; Dubrovnik, Croatia; 2014. p. 10.
15. Arhipova LT. Simpaticheskaja oftal’mija (patogenez, patomorfologija, klinika, diagnostika, lechenie, profilaktika). Tver’: Triada; 2006. (In Russ).
16. Morphis G, Irigoyen C, Eleuteri A, et al. Retrospective review of 50 eyes with long-term silicone oil tamponade for more than 12 months. Graefes Arch Clin Exp Ophthalmol. 2012; 250(5): 645–652.
17. Patil BA, Mankani NH, Chowdhary R, Nagaraj E. Rehabilitation of Phthisis Bulbi. Journal of Clinical and Diagnostic Research. 2011; 5(8): 1679–1681.
18. Boiko EV, Shamrey DV, Sosnovsky SV, Kulikov AN. Comparative estimation of rehabilitative potentialities after organ preserving operations made on occasion of severe eye damage. Voenno-medicinskij zhurnal. 2012; 333(3): 13–19. (In Russ).
19. Aggarwal H, Jurel SK, Kumar P, et al. Rehabilitation of phthisis bulbi: a case report. J Pak Dent Assoc. 2012; 1(2): 116–120.
20. Chan CK, Chhablani J, Freeman WR. Prognostic indicators for no light perception after open-globe injury: eye injury vitrectomy study. Am J Ophthalmol. 2012; 153(4): 654–662.
21. Dohlman CH, D’Amico DJ. Can an eye in phthisis be rehabilitated? A case of improved vision with 1 year follow-up. Arch Ophthalmol. 1999; 117: 123–124.
22. Froiman PC, Villas Boas Junior CE, Sibinelli MA, et al. Visual rehabilitation in pre phthisis bulbi’s patient: case report. Arq Bras Oftalmol. 2009; 72(4): 540–542.
