J Korean Ophthalmol Soc.  2009 Sep;50(9):1442-1446. 10.3341/jkos.2009.50.9.1442.

Isolated Posterior Pole-Penetrating Ocular Injury Treated by Nonsurgical METHODS: A Case Report

• Jeoung SM
• Im JS
• Park D

• KMID: 2212633
• DOI: http://doi.org/10.3341/jkos.2009.50.9.1442

Abstract

PURPOSE
To report a case of isolated posterior pole-penetrating ocular injury treated by nonsurgical methods such as argon laser photocoagulation and administration of antibiotics. CASE SUMMARY: A 46-year-old male visited the hospital complaining of floaters in his left eye which had occurred when his cheek was penetrated by scissors from the inferior posterior part to the superior anterior part while working earlier that day. Upon initial examination, his best corrected visual acuity (BCVA) in the left eye was 0.8, and his intraocular pressure (IOP) was 10 mmHg. No cells or aqueous flares were observed in the anterior chamber. Fundus examination was performed, and three disc diameter-large breaks of the retina and choroid, scleral rupture and vitreous hemorrhage were observed at the posterior pole three disc diameters away from the fovea. It was difficult to make a surgical approach as the lesion was situated on the posterior pole, and there was the risk of prolapse of the eye contents. Therefore, we first performed argon laser photocoagulation around the lesion and administered topical as well as and systemic antibiotics. After admission the patient was observed carefully as the tractional retinal fold was located at the posterior pole. Additional argon laser photocoagulation was performed. After six months of treatment, BCVA in the left eye was 1.0, IOP was 16 mmHg, and no pathologic change was observed on fundus examination.

Keyword

Nonsurgical method; Penetrating ocular isolated posterior pole injury

MeSH Terms

Anterior Chamber
Anti-Bacterial Agents
Aqueous Humor
Argon
Cheek
Choroid
Eye
Humans
Intraocular Pressure
Light Coagulation
Male
Middle Aged
Prolapse
Retina
Retinaldehyde
Rupture
Traction
Visual Acuity
Vitreous Hemorrhage
Anti-Bacterial Agents
Argon
Retinaldehyde

Figure

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  Figure 1. At the first visit. (A) Clinical photograph shows the scissors penetrating injury from the left lateral cheek to the middle of the lower eyelid. When he came to the clinic, primary repair had already been done at a local plastic clinic. (B) Fundus photograph of the left eye shows 3 disc diameter-large breaks of the retina and choroid, scleral rupture and vitreous hemorrhage were observed at the posterior pole 3 disc diameters away from the fovea. (C) Illustration shows mechanism of ocular isolated posterior pole injury by scissors.

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  Figure 2. Fundus photographs after photocoagulation as conservative therapy. (A) After 1 day, photocoagulation is well-applied around the lesion. (B) After 11 days, The vitreous hemorrhage has decreased and the lesion border has not advanced.

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  Figure 3. Fundus photographs after 6 months. A well healed fibrous scar at the site of penetrating injury is seen and the posterior pole is well attached.

Reference

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