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Systematic approach to assess management of severe eye blunt trauma with substantial iridodyalisis, traumatic cataract and glaucoma

Poster Details

First Author: I.Žuljan CROATIA

Co Author(s):                        

Abstract Details

Purpose:

To show how, with careful planning, severe eye blunt trauma can be solved in stages. Middle-aged male suffered a severe left eye trauma upon being stuck by the metal hooked end of an elastic luggage strap. He was conservatively treated in another facility for 30 days. He had iridodyalisis from six to 11 o'clock with vitreus prolapse, so that the iris made a kind of bend over the optical zone, which together with opaque and swollen lens compromised visualization of deeper structures. Vision was hand motion and eye pressure (IOP) 30 mm Hg with therapy. Echography showed attached retina.

Setting:

University Eye Hospital Svjetlost Zagreb, branch Split, Croatia

Methods:

Step one: to manage iridodialisis to form the pupil and to do a phacoemulsification of the traumatic cataract, anterior vitrectomy and implant three piece intraocular lens. During the follow up, we found peripheral retinal tear which we managed with laser photocoagulation (LF). In spite of the topical treatment, the intraocular IOP valued about 30 mm of Hg. Second step: four weeks after LF we made trabeculectomy with Mytomicin C and peripheral iridectomy. After 15 days IOP was normalized. The third step entailed narrowing the pupil with a stitch, improving the patient's vision. Step four: Neodymium-YAG laser posterior capsulotomy.

Results:

Finally, one month post trabeculectomy the eye had no inflammation. IOP was 17 mm Hg without any medication. The patient reached best uncorrected visual acuity 0,4, and best corrected visual acuity 0,5 with correction of -1,25 dcyl ax 85°. He had slight photophobia in condition of strong light due to wider pupil opening. Structural changes in meaning of thinning of the macula caused by the primary trauma is the reason of limited maximum level of vision to be reached. Aesthetically patient was satisfied with well centrated, round shaped and discrete wider pupil.

Conclusions:

Blunt trauma with large iridodialysis, complicated cataract and secondary glaucoma present eye threatening condition that requires very careful planning and risk assessment. After well controlled inflammation and IOP main goal of this step by step approach is to restore the anaterior eye segment and visual pathway by managing iridodyalisis and cataract surgery to achieve better visualization of the retina. This approach confirmed our doubt of existing retinal break as one of the most frequent complication of blunt trauma. It was reasonable to leave surgically treatment of glaucoma after recovery period of laserphotocoagulation. With pupilopastics he achieved 10 percent better vision.

Financial Disclosure:

NONE

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