|Year : 1984 | Volume
| Issue : 5 | Page : 303-306
Retinal detachment due to perforating injury
Rajvardhan Azad, HK Tewari, PK Khosla
Dr. Rajendra Prasad Centre for Ophthalmic Sciences, AJIMS, New Delhi, India
Dr. Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi-1110 029
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Azad R, Tewari H K, Khosla P K. Retinal detachment due to perforating injury. Indian J Ophthalmol 1984;32:303-6
Retinal pathology may be one of the major causes of poor visual acuity in cases of perforating injury who have had their primary surgery. It is, therefore, advisable that the management of retinal pathology is done at the first instance for best results but multiplicity of factors prevent this kind of management in our country. Poor diagnostic and therapeutic facilities in most of the centres are amongst the important factors besides an unaware ophthalmologist and an uncooperative patient. Hence, majority of patients with retinal detachment report to the retinal surgeons either after the primary repair of perforating injury or after extraction of retained intraocular foreign body.
All characteristics (i.e. latent period, age of patient, type of presentation, nature of injury, type of objective evidence, etc.) of cases retinal detachment associated with perforating injury were compared with those of nonperforating traumatic retinal detachment to evolve guidelines for better management of such cases.
| Material and methods|| |
59 cases retinal detachment were included in this study out of a total 1100 cases of retinal detachment admitted for surgery at the Dr.Rajendra Prasad Centre for Ophthalmic Sciences during 1979-1982. All the cases were fully investigated including ultrasonography for assessment of posterior segment. Diagnosis of traumatic retinal detachment was made on following strict criteria.
(i) positive history of trauma, (ii) unilaterality of retinal detachment and (iii) objective evidence of trauma.
These cases were divided into three groups:
Group I - 22 cases, retinal detachment seen after primary repair with evidence of minimal vitreous insult.
Group 11 - 7 cases, retinal detachment detected after removal of intraocular foreign body with evidence of gross viterous insult.
Group II: 30 cases of nonperforating traumatic retinal detachments with no direct vitreous insult.
| Observations|| |
These are enumerated in [Table - 1][Table - 2][Table - 3][Table - 4][Table - 5][Table - 6].
| Discussion|| |
Traumatic retinal detachment is assuming more and more importance in present day era of rapid industrialisation of our country. Coopers (1859) first described traumatic retinal detachment but over the years detachments have been classified into two groups due to blunt trauma and due to perforating trauma. Concussional retinal detachment is more common while the one due to perforating injury is comparatively rare. We observed an incidence of 2.68% for the retinal detachments due to perforating injury as against 8% of all traumatic retinal detachment, and it is in consonance with the incidence of 7 to 35% for traumatic retinal detachment.
Early diagnosis of retinal detachment in a case of perforating injury is not easy as these cases invariably present with lot of anterior segment changes in the form of corneal oedema, hyphaema and traumatic cataract.
Analysis of age and sex in [Table - 2] shows an overall preference for young males in all the groups. In group 154.54% in Group 1171.43% and in Group 111 86.66% were males. Similar finding is obtained as far as age is concerned in the three groups (Group I Av. age 15.6. years, Group 1125.4 years and Group 11130.5 years) Hence we conclude that young males are more prone to perforating injuries leading to retinal detachment
Most of the injuries were domestic in nature i.e. 89.65% while traffic or vehicular injuries contributed 10.35%. In majority of occasions Cornea (44.37%) and sclera (44.84%) were ruptured either along or together (13.75%).
The latent period (the period between time of injury and onset of detachment) inmost of the cases (72.43%) with perforating injury (Group I and Group II) was between 15 days to 3 months while only 50% of patients of Group III i.e. nonperforating detachment group reported between 15 days to 3 months [Table - 4]. As the ocular damage is usually much more due to perforating injury to herald the symptoms of diminished vision, these patients report earlier. Group II cases do not report in early as compared to Group I presumably they wait for vitreous haemorrhage to disappear after primary repair of the injury and land up only with visual loss due to tractional retinal detachment. They are thus having poorer prognotic as they are less emenable to surgery.
Analysis of retinal breaks in different groups revealed presence of irregular tears in the groups with perforating injury (Group I 31.05% Group 1110.34%). Retinal dialysis was common in Group I (17.24%) while giant tear was more common in Group II i.e. the frequency of occurrence of retinal holes was same in all the Groups, thus we find that giant tears were more frequently present in cases where vitreous insult was more which was evident clinically and vitreous graphically.
Vitreous haemorrhage was seen in different groups but was more so in Group II where five out of 7 cases had vitreous haemorrhage. All the 7 cases in Group II had some form of vitreous change either in the form of haemorrhage or membrane. Group III showed vitreous base avulsion and pars plana detachment. It is, thus, concluded that blunt trauma causes more changes to the vitreous base while perforating injury causes more damage to the vitreous body. It is stressed that ultrasonography is an important diagnostic tool for cases where the retinal details are not visible on first examination, for assessment of the state of vitreous and retina in such cases.
The role of ultrasonography in such cases is immense and can help design better management of retinal detachment by indicating emergency of the treatment of posterior segment pathology. In cases with intraocular foreign body use of ultrasonography can be made for detection of intraocular foreign body and presence or absence of retinal detachment besides vitreous changes and this will be of great value from the management point of view. The success rate (anatomical and functional) was different in various groups and could be correlated to the presence of vitreous pathology and hence best results were obtained where no obvious retinal pathology could be observed i.e. in cases with blunt trauma.
Early diagnosis of vitreortinal pathology with ultrasound and its management with associated vitreous surgery is advised. If all facilities are not available special care must be exercised during primary repair or during extraction of intraocular foreign body in the form of mandatory scleral buckling in the area of sclerotomy from where foreign body is removed and/or encirclage to relieve the vitreous traction to achieve best results.
| Summary|| |
Retinal detachment associated with perforating injuries revealed a younger age group, a smaller latent period, a poor anatomical and functional prognosis particularly if there has been gross vitreous insult after the removal of intraocular foreign body.
| References|| |
Khosla P.K, Azad Rajvardhan and Tewari H.K, 1979, East. Arch. Ophthalmol. Vol 7: 200.
Malbraun O., Dodds R, and Hulsbus R., 1972. Mod. Prob. Ophthalmol. Karger Basel Vol. 10: 479
[Table - 1], [Table - 2], [Table - 3], [Table - 4], [Table - 5], [Table - 6]