Endoscopy-guided vitreoretinal surgery following penetrating corneal injury: a case report

Motoko Kawashima¹, Shinichi Kawashima², Murat Dogru^1,3, Makoto Inoue⁴, Jun Shimazaki^1,5
1Department of Ophthalmology, Tokyo Dental College, Chiba, Japan; ²Department of Ophthalmology, International University of Health and Welfare, Tokyo, Japan; ³Department of Ocular Surface and Visual Optics, Keio University School of Medicine, Tokyo, Japan; ⁴Kyorin Eye Center, Tokyo, Japan; ⁵Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan

Introduction: Severe ocular trauma requires emergency surgery, and a fresh corneal graft may not always be available. We describe a case of perforating eye injury with corneal ­opacity, suspected endophthalmitis, and an intraocular foreign body. The patient was successfully treated with a two-step procedure comprising endoscopy-guided vitrectomy followed by corneal transplantation. This surgical technique offers a good option to vitrectomy with simultaneous keratoplasty in emergency cases where no graft is immediately available and there is the ­possibility of infection due to the presence of a foreign body.

Case presentation: A 55-year-old Japanese woman was referred to our hospital with a ­perforating corneal and lens injury sustained with a muddy ferrous rod. Primary corneal sutures and lensectomy were performed immediately. Vitreoretinal surgery was required due to ­suspected endophthalmitis, vitreous hemorrhage, retinal detachment, dialysis and necrosis of the peripheral retina. Instead of conventional vitrectomy, endoscopy-guided vitreous surgery was performed with the Solid Fiber Catheter AS-611 (FiberTech, Tokyo, Japan) due to the presence of corneal opacity and the unavailability of a donor cornea. The retina was successfully attached with the aid of a silicon oil tamponade. Following removal of the silicon oil at 3 months after surgery, penetrating keratoplasty and intraocular lens implantation with ciliary sulcus suture fixation were performed. At 6 months after penetrating keratoplasty, the graft remained clear and visual acuity was 20/40.

Conclusion: Primary endoscopic surgery for vitreoretinal complications in eyes with perforating injury performed prior to penetrating keratoplasty appears to be advantageous in terms of avoiding damage to the corneal endothelium.

Keywords: vitreoretinal surgery, emergency, foreign body