A Severe Trauma

Steven Vold, MD, presents an odyssey in the surgical management of a severe trauma case following a tree branch injury that resulted in uncontrolled angle recession glaucoma, hyphema, iridodialysis, dislocated cataract, and vitreous hemorrhage. This ophthalmology surgical video details the steps including anterior vitrectomy, iris-sutured IOL, iris cerclage, and trabeculectomy.

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Comments (6)

In this case, i would like to do posterior vitrectomy with lensectomy with Glued IOL followed by filtering surgery. I have seen glued iol really works very well in such cases and also there is less inflammation postoperatively as the iris is not disturbed. The stability of the lens is also excellent. The filtering surgery then follows as usual.

PriyaNarang (42 months ago)

With proper surgical technique, the risk of developing a surgically-induced retinal tear can be almost entirely eliminated. Furthermore, the postoperative size of the pupil here is more than adequate for proper evaluation of the retina, improves the quality of vision and reduces glare difficulty following surgery. However, surgeons uncomfortable with this approach certainly may want to include a vitreoretinal surgeon in the care of these types of patients. I do urge clinicians to aggressively rehabilitate these eyes whenever possible. Unfortunately, in my experience, many of these eyes do poorly when advanced surgical techniques are not utilized.

Svold (42 months ago)

this case had a high risk of RD with a giant tear. I would have done a posterior vitrectomy and lensectomy, carefully inspected the retina after a complete posterior vitrectomy and only then proceeded with the consideration of lens implantation and iris repair. and trabeculectomy. Doing thie anterior work and reducing the pupil size in the abscence of the above could compromise future retinal examinations, delay diagonsis and and apporpriate treatment.

mea2020 (42 months ago)

Nicely done on a tough case.

eye_2_eye (42 months ago)

Hi Steve, Why not repair the iridodialysis too? No glare I suppose. Why Ologen AND MMC? I thought Ologen was supposed to replace mito-- maybe the Ologen creates a diffuse bleb while the MMC prevents episcleral fibrosis. Great case which was very well done -- you rock my friend!!! See you at the Krupin dinner in Chicago!! George

ghtanaka (42 months ago)

very elegant!!! i would dilute triessence 10:1 so you would not have white out.

EyeBugr (43 months ago)