Surgical Treatment of Severely Traumatized Eyes With No Light Perception

Heidari, Ebadollah; Taheri, Navid

doi:10.1097/iae.0b013e3181babd75

Cited by 30 publications

(26 citation statements)

References 11 publications

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“…Morris et al [4] reported favorable vision outcome in severely traumatized eyes with no light perception with opaque media with one eye reaching 20/40 visual acuity, and another reaching 20/100 visual acuity postoperatively. In another study of nineteen eyes with no light perception vision with severe ocular trauma by Heidari et al [7] final visual acuity improved to LP in 3 eyes, hand motion in 4 eyes, counting fingers in 3 eyes, and 20/200 in 7 other eyes. In their study, chi-square test showed no significant association between age, sex, type or location of injury, lens status, hyphema, endophthalmitis, IOFB or RD, and final best-corrected visual acuity.…”

Section: Discussionmentioning

confidence: 95%

Predictive factors for final outcome of severely traumatized eyes with no light perception

2012

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BackgroundAn eye injury that causes no light perception (NLP) typically carries an unfavorable prognosis, and NLP because of trauma is a common indication for enucleation. With advances in vitreoretinal surgical techniques, however, the indication for enucleation is no longer determined by posttrauma NLP vision alone. There are limited studies in the literature to analyse the outcome of NLP eyes following open globe injury. The current study was aimed to evaluate the outcome of surgical repair of severely traumatized eyes with no light perception vision as preoperative visual acuity. Secondary objective was to possibly predict the factors affecting the final vision outcome in this eyes.MethodsRetrospective case analysis of patients with surgical repair of open globe injury over last ten years at a tertiary referral eye care centre in Singapore.ResultsOut of one hundred and seventy two eyes with open globe injury 27 (15.7%) eyes had no light perception (NLP). After surgical repair, final visual acuity remained NLP in 18 (66.7%) eyes. Final vision improved to Light perception/ Hand movement (LP/HM) in 2(7.4%) eyes, 1/200 to 19/200(11.1%) in 3 eyes and 20/50-20/200(14.8%) in 4 eyes. The median follow up was 18.9 months (range: 4–60 months). The factors contributing to poor postoperative outcome were presence of RAPD (p = 0.014), wound extending into zone III (p = 0.023) and associated vitreoretinal trauma (p = 0.008).ConclusionsOne third of eyes had ambulatory vision or better though two third of eyes still remained NLP. Pre-operative visual acuity of NLP should not be an indication for primary enucleation or evisceration for severely traumatized eyes. Presence of afferent papillary defect, wound extending posterior to rectus insertion and associated vitreoretinal trauma can adversely affect the outcome in severely traumatized eyes with NLP. Timely intervention and state of art surgery may restore useful vision in severely traumatized eyes.

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Section: Discussionmentioning

confidence: 95%

Predictive factors for final outcome of severely traumatized eyes with no light perception

2012

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“…Heidari et al [43 ] have recommended that eyes with NPL undergo exploratory surgery to assess the possibility of reparative surgery. This is based on their finding that in 11 eyes with NPL vision which underwent reconstructive temporary keratoprosthesis and vitrectomy 7 (64%) recovered light perception or better postoperatively Ebrahimi et al [44] have also reported improved visual acuity in patients undergoing reparative surgery with 11 of 12 patients with AE4 relative afferent papillary defects recovering visual acuity ranging from hand motion to 6/10.…”

Section: Penetrating Injuriesmentioning

confidence: 99%

“…There is much controversy in the literature about the indications and relative risks and benefits for each operation. Much of this conjecture centres on the concern over the potential for sympathetic ophthalmia [43 ].…”

Section: Penetrating Injuriesmentioning

confidence: 99%

Mechanisms and management of vision loss following orbital and facial trauma

McClenaghan¹,

Ezra

Holmes³

2011

Current Opinion in Ophthalmology

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“…[3456789101112] Unfortunately, optic nerve avulsion can be difficult to confirm in the setting of severe globe trauma because the dural sheath often remains attached to the globe even if retrolaminal neural tissue is disrupted. [131415] In contrast to a complete optic nerve transection, an optic nerve avulsion may be partial, and partial return of visual function has been documented in some cases.…”

Section: Patient Selectionmentioning

confidence: 99%

“…[12] Loss of light perception (LP) after open globe injury, however, does not necessarily mean that the patient will have permanent visual loss. [3456789101112] Reported visual recovery rates from NLP to LP or better after globe rupture range from 4%-33%. [3456789101112] In one study of 73 NLP eyes (73 patients) with OGI that underwent primary repair, final visual acuity was LP or better in 17 (23%) eyes.…”

Section: Introductionmentioning

confidence: 99%

Approach to management of eyes with no light perception after open globe injury

Bhagat¹,

Turbin²,

Langer³

et al. 2016

J Ophthalmic Vis Res

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Loss of light perception (LP) after open globe injury (OGI) does not necessarily mean the patient will have permanent complete visual loss. Findings that seem to be associated reliably with permanent profound vision loss after OGI include optic nerve avulsion, optic nerve transection, and profound loss of intraocular contents, which can be identified with CT/MRI imaging albeit with varying degrees of confidence. Eyes with NLP after OGI that undergo successful primary repair with intact optic nerves may be considered for additional surgery, particularly if there is: (1) recovery of LP on the first day after primary repair; (2) treatable pathology underlying NLP status (e.g., extensive choroidal hemorrhage, dense vitreous and subretinal hemorrhage); (3) NLP in the fellow eye. We counsel patients that the chance of recovering ambulatory vision under these circumstances is very low (~5%).

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Surgical Treatment of Severely Traumatized Eyes With No Light Perception

Cited by 30 publications

References 11 publications

Predictive factors for final outcome of severely traumatized eyes with no light perception

Predictive factors for final outcome of severely traumatized eyes with no light perception

Mechanisms and management of vision loss following orbital and facial trauma

Approach to management of eyes with no light perception after open globe injury

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