TRAUMATIC CORNEAL PERFORATION: THE IMPORTANCE OF ASSESSING THIS OLD OCULAR EMERGENCY WITH THE NEWEST IMAGING TECHNIQUES

Published 2023 - 27th ESCRS Winter Meeting

Reference: P021 | Type: Free Paper Submission | DOI: 10.82333/00jd-5z40

Authors: Victoria Segura Fernandez Nogueras* ¹ , Jose Manuel Diaz Bernal ¹ , Ignacio Garcia Basterra ¹ , Szymon Gluszko ¹

¹Ophthalmology,Hospital Universitario Virgen de la Victoria,Malaga,Spain

Purpose

Management of traumatic corneal perforation is challenging and requires medical and surgical accurate strategies. Our aim is to demonstrate that anterior pole imaging has become crucial to assess the unique features of each case of corneal perforation and therefore to offer the safest treatment to every patient.

Setting

Department of Ophthalmology in a tertiary level hospital of Spain (Universitary Hospital Virgen de la Victoria in Malaga, Spain).

Methods

A four case series with traumatic corneal perforation (TCP) seen in the Emergency Room (ER). Initial treatment included topic and oral antibiotic and corneal wound closure. During the narrow follow up, the anterior pole was evaluated with anterior segment optical coherence tomography (AS-OCT, Topcon DRI-OCT Triton, ANTERION Heidelberg Engineering) and one of them required an ultrasound test (GE Logiq E9, 16MHz linear probe).

Results

Case 1: 40 year old man with a self-sealed TCP who developed a white traumatic cataract in 48 hours. An ultrasound test demonstrated posterior capsule (PC) rupture. Pars plana approach with lensectomy and intraocular lens (IOL) iris fixation was performed.

Case 2: 53 year old man with a long standing corneal foreing body that was removed resulting in a microperforation. Corneal gluing and amniotic membrane graft (AMG) were needed to seal the wound. AS-OCT was crucial to evaluate the optimal integration of the AMG into the corneal stroma.

Case 3: 32 year old man with a self-sealed TCP and a tear in the anterior capsule. The spread of lens material in the anterior chamber (AC) made it impossible to perform a funduscopy. Integrity of PC was objectived by AS-OCT and so a low pressure phacoemulsification with capsular bag IOL implantation was performed.

Case 4: 86 year old man with a TCP and iris incarceration in the wound. After the first surgery, traumatic hyphema blurred the AC, so AS-OCT was performed and anterior capsule rupture and zonular damage were shown. Smooth phacoemulsification using a capsular tension ring and IOL implantation were done.

Conclusion

Traumatic corneal perforation is an important cause of deep vision loss among young males. Anterior pole imaging techniques are essential to prepare the safest approach and so improve the prognosis of this severe condition.