Vitrectomy after open-globe injury (ocular trauma)

This is a video shared by Dr. Thiago Siqueira from Niterói – Brazil

This is a case of a 60-year-old female patient, with a recent history of open- globe injury with rupture following blunt ocular trauma.
In her past ocular history, the patient had already had visual loss in her left eye after a retinal detachment.

In the first procedure, performed on the same day of trauma, the patient was submitted to sclerocorneal sutures, and the intraocular lens was removed.

One month after the first surgery, a vitrectomy was programmed to remove a persistent vitreous hemorrhage. In the slit-lamp examination, it was possible to see a large blood clot into the anterior chamber, associated with iridodialysis.

The B-scan ocular Ultrasound showed no signs of retinal detachment in the right eye. The best corrected visual acuity preoperatively was hand motion in the right eye and no light perception in the left eye.

In the beginning of the procedure, the surgeon placed the infusion line into the anterior chamber once it wouldn’t be possible to check its correct position if it were placed in the pars plana.

Anterior vitreous and the blood clot were carefully removed from the pupillary area to allow better visualization during posterior vitrectomy.

Then a posterior vitrectomy was made, keeping the infusion line into the anterior chamber, and removing the dense preretinal hemorrhage with active aspiration attached in a soft tip cannula.

The vitreous base was removed, and no retinal tears were found in this case.

So, in the end of the procedure, the surgeon performed fluid air exchange and no other ocular tamponade was necessary.

Despite the severity of the ocular trauma, and the fact of this patient had been kept aphakic, the best corrected visual acuity after the procedure improved from hand motion to 20/40.

Thiago Siqueira – MD
Niterói – BR

Filipe Lucatto MD
Juliana Prazeres MD
Salvador – BR