Possibilities of microinvasive vitreoretinal surgery in the rehabilitation of patients with post-traumatic phthisis bulbi

Post-traumatic phthisis bulbi (PB) is a severe complication of the eyeball mechanical trauma. With the development of the technology of eye microsurgery and microinvasive vitreoretinal surgery (VRS), it became possible to preserve the anatomical integrity of the injured eye, in cases where enucleation or evisceration of the injured eyeball was previously performed. Purpose - to assess the possibilities of surgical rehabilitation of patients with PB using microinvasive VRS. Materials and methods: examined 49 patiens (49 eyes; 42 male и 7 female; average age - 36.9±14.8 years) with post-traumatic phthisis bulbi. All patients underwent combined organ preservation microinvasive vitreoretinal surgery. Results. In 95.9% of cases, microinvasive VRS managed to preserve the anatomical integrity of the ciliary body, choroid, cornea and anterior chamber structures of the damaged eyeball. During VRS in 14 patients (28.6%), after performing a circular retinotomy, it was possible to straighten and fix the retina using endolaser coagulation. After performing microinvasive VRS, an increase in visual functions was noted, which in 14.3% of patients was 20/1000. According to the results of the treatment, in 57.2% of cases, the progression of subatrophy stopped, in 42.8% of cases it was possible to obtain a slight increase in APS indices compared to the initial values, which averaged 19.7±1.9 mm. In the early postoperative period, normalization of ophthalmotonus was noted in 12.2% of cases, in the rest - a slight increase in IOP with persisting hypotension. In 6.1% of cases, when the IOP level was insufficient after silicone tamponade, repeated administration of silicone oil was performed a few days after vitreoretinal surgery. Subsequently, the IOP level in the postoperative period was in the range from 16 to 22 mm Hg, averaged 19.4±2.7 mm Hg, and remained stable throughout the observation period (p≤0.05). When examining intact eyes in these patients, no cases of sympathetic ophthalmia were recorded (the maximum observation period reached 10 years after injury). Conclusion. Microinvasive VRS with the use of retinotomy and long-term tamponade of the vitreous chamber of the eye with silicone oil allows in 95.9% of cases not only to save the eye, but also in 36.8% of cases, residual visual functions, and also prevents the development and progression of post-traumatic phthisis bulbi.