Penetrating eye injuries are one of the most important causes of acute and permanent vision loss in children and young people.
- Penetrating Eye Injury
Especially intraocular foreign bodies are emergencies that are common among traumatic ocular injuries and cause very serious problems. In various series, it has been reported that 18% to 40% of penetrating eye injuries are accompanied by GIYCs. In addition to frequently causing damage to different degrees in different tissues, they can create complications such as risk of infection, retinal detachment, and metallosis. In eye injuries associated with an intraocular foreign body (IFB), there is a risk of vision loss depending on many factors such as the mechanism of damage, the location and size of the IFB, and postoperative endophthalmitis. p> Although developing vitreoretinal surgical techniques prevent many sequelae of GIJ injuries, blindness or profound vision loss is a frequently observed result of such injuries. Even in case of successful removal of GIYC, complications such as epiretinal membrane, fibrovascular proliferation, retinal detachment, proliferative vitreoretinopathy are common and sight-threatening. Stranger Stuck in the Retina of the Eye. Object IJJs, which constitute a significant portion of penetrating eye injuries, are frequently seen in the young and male population. It is reported that penetrating injuries that occur with GIYC most commonly occur in the form of work accidents and during the processing of metal with a hammer. The most common causes of this type of injuries in childhood are traffic accidents, work accidents, hunting accidents, game and home accidents. Injuries, especially those caused by toy gun pellets, are a common cause of GIJD in childhood in our country. Preoperative Evaluation: An effective To plan surgery, careful preliminary evaluation is essential. A good anamnesis, a detailed eye examination, and a suitable imaging test to detect the presence, location, and size of GIF. Examination and prophylactic antimicrobial treatment are important stages of the preoperative preparation period. Examination: The mechanism of the injury, what caused it (cutting tools, explosives, etc.). glass, etc.) should be questioned. However, before focusing on the eye, life-threatening factors other than the eye must be identified and necessary precautions must be taken. A complete ophthalmic examination should be performed. However, if there is a rupture or suspicion of rupture in the eyeball, maneuvers that apply even a small amount of pressure to the eye, such as measuring eye pressure, should be avoided. During the ophthalmic examination, factors that may determine future visual prognosis, such as initial visual acuity, presence or absence of endophthalmitis (intraocular infection), globe rupture, perforating injury, retinal detachment, afferent pupillary defect, should be evaluated and noted. If GIF is detected clinically, factors that will negatively affect the visual prognosis have been determined as low initial visual acuity, afferent pupil defect, hyphema, vitreous hemorrhage, retinal detachment, and uveal prolapse. Timing in GIC Removal: During primary globe repair, GIYC The decision to removedepends on many factors. First of all, the patient's general health condition must allow this surgery. Apart from this, the appropriate surgical environment, the surgeon, the supporting staff and the surgical instruments required to remove the foreign body must be ready at that time. Additionally, the removal of GIYC requires an extremely good imaging environment. However, in this type of injuries, especially corneal cloudiness often makes it impossible to visualize the posterior segment of the eye. Only when all these conditions are ready, removal of GİYC should be considered. During Globe repair, GİYC13% to 3% with early vitrectomy performed in the first 24 hours. However, the effect of early or late vitrectomy on the final anatomical and visual success is controversial. In addition to the studies that talk about the positive effect of early vitrectomy on the final visual acuity, there are also those that report that no difference is observed. Intraocular foreign bodies are traumas that are quite common among open eye injuries and cause serious vision loss. The treatment of IOBs requires an algorithm that includes many issues such as the mechanism of injury, the nature of the foreign body, its location, size, the conditions of the surgical environment and personnel, and serious follow-up in terms of the development of potential postoperative complications. Following the detection and treatment of life-threatening extraocular injuries, anamnesis, ophthalmic examination and imaging methods should be applied to determine the location and characteristics of the foreign body. It is important to explain the seriousness of the situation to the patient as much as possible in order to make the patient's expectations realistic. Although early or late removal of GIC is a controversial issue, the condition of the eye and the surgical environment are important in making this decision. It is necessary to evaluate the condition of the surgical staff and provide optimal conditions. Appropriate antibiotic prophylaxis before and after surgery is important in minimizing the risk of endophthalmitis. It is beneficial to see the patient frequently in order to prevent complications such as retinal detachment,PVR, and endophthalmitis, which threaten vision after surgery.
After the preparations are completed, some important strategies regarding the surgery should be determined. These are: time of surgical intervention (early or late), vitrectomy technique, crystalline lens condition (lens preservation or lens extraction), GİYC' The way and tools to remove the GIC are the use of intraoperative antibiotics.
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