New approach possible to management of perforating ocular injuries

New Orleans-A new preventive approach to perforating ocular injuries seems to prevent the almost inevitable development of proliferative vitreoretinopathy (PVR) that follows this type of injury, according to Ferenc Kuhn, MD, PhD, of the University of Alabama, Birmingham.

Standard treatment of perforating injuries includes closing the entrance wound during an initial surgery, a pars plana vitrectomy 6 to 10 days later to clear the hemorrhage and apply laser retinopexy around the exit wound. After the development of retinal detachment and PVR, another and possibly additional surgeries are needed to remove proliferative tissue.

Dr. Kuhn advised using a new approach during retina subspecialty day at the American Academy of Ophthalmology annual meeting.

"Prevent the PVR and retinal folds from developing," he said. In his treatment approach, he advised closing the entry and exit wounds and performing anterior segment manipulations. Postoperative care includes heavy topical occasionally systemic steroid therapy to minimize the inflammation. In a second surgery performed 3 days later, vitrectomy is then performed. Diathermy is applied around the exit wound involving the retina and the choroids.

Dr. Kuhn reported that in the five patients who have undergone this procedure, no PVR or retinal folds have developed.

"The traditional approach increases complications. The new approach should be offered as a better option to patients," he said.