Characteristics of severe ocular detonator explosive injury and the therapeutic effect of vitreoretinal surgery

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YAO Yi(Department of Ophthalmology,the General Hospital of PLA,Beijing 100853,China)
WANG Zhi-jun(Department of Ophthalmology,the General Hospital of PLA,Beijing 100853,China)
WEI Shi-hui(Department of Ophthalmology,the General Hospital of PLA,Beijing 100853,China)
Journal Title:
Volume 25, Issue 01, 2009
Key Word:
Eye injuries,penetrating/surgery;Eye foreign bodies/surgery;Retinal detachment/surgery;Vitrectomy;Explosive agents

Abstract: Objective To observe the clinical characteristics of severe ocular detonator explosive injuries and to evaluate the therapeutic effects of vitrectomy on it.Methods Clinical data of 37 consecutive patients (65 eyes) with severe ocular detonator explosive injuries were retrospectively analyzed.The patients included 36 males and 1 female with the average age of 28.6 years.The biocular injuriy was in 31 cases (83.8 %),and one-eyed injury was in 6 cases (16.2%).A total of 48 eyes had severe explosive injury.The visual acuity was no light perception in 9 eyes in which 3 eyeballs were obviously atrophic,light perception in 28 eyes,hand moving in 4 eyes,and counting finger/33 cm in 7 eyes.Vitrectomy was performed on 46 eyes,in which 41 had severe ocular explosive injury.There were no vitreous surgery indications in 13 eyes of 19 eyes didn't undergo surgery;the other 6 eyes didn't undergo surgery due to the atrophic eyeballs or economic reasons.The treating time after trauma was within 1 week in 7 patients (18.9%),1 week to 1 month in 13 (35.2%),and more than 1 month in 17 (45.9%).The follow-up duration lasted 6 months to 2 years after operation with the average of 8.6 months.Results In 65 eyes,the occupation ratio of conjunctival foreign bodies was 66.2%;corneal foreign bodies was 46.2;vitreous hemorrhage was 70.8% ;intraocular foreign bodies (IOFB) was 69.20%;retinal shocking injury or optic nerve blasting injury was 56.90%.The visual acuity improved in 33 eyes,remained unchanged in 25 eyes,and decreased in 7 eyes.In 46 eyes which had undergone vitrectomy,IOFB injuries was in 35 eyes (76.1%);the visual acuity increased in 26 eyes (59.5%),remained unchanged in 13 eyes (28.3%),and didn't cure in 7 eyes (15.2%) in which 2 eyes underwent ocular enucleation and 5 eyes were atrophic.The increasing rate of visual acuity in the patients who accepted the treatment more than 1 month after injury was low.The occupation ratio of monocular blindness was 51.40% and biocular blind was 8.1%.Conclusions Most of severe ocular explosive injuries by detonator are with IOFB.The causes of the high blinding rate are late treatment and serious injury.Strengthening the diagnosis and treatment of retinal shock and optic nerve blast,and performing vitrectomy as soon as possible can improve prognositc visual function of injured eyes.

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