Late versus prophylactic chorioretinectomy for the prevention of trauma-related proliferative vitreoretinopathy.

INTRODUCTION: Certain injuries, especially those with a deep-impact (involving the choroid and even the sclera) intraocular foreign body (IOFB), have a high risk for developing either full-blown proliferative vitreoretinopathy (PVR) or full-thickness retinal folds. Although less severe than the former, this so-called 'stage 0 PVR' can severely impact vision, and effective treatment for these folds has not existed heretofore.

PATIENTS AND METHODS: Four eyes of 4 patients sustained an IOFB injury with deep impact. All eyes underwent vitrectomy and IOFB removal soon after the injury, and all eyes showed substantial visual improvement postoperatively. However, in a few months the visual acuity dropped again, due to the development of full-thickness retinal folds radiating from the scar. All four eyes then underwent a second vitrectomy with (late rather than prophylactic) chorioretinectomy by creating a 1-mm-wide ring of bare sclera around the scar. The highest setting of the diathermy machine was used as the endodiathermy probe evaporated both the retina and the choroid to create the ring. Laser retinopexy to surround the ring was used only if the lesion was not in the posterior pole.

RESULTS: Within a few days, the retinal folds completely disappeared in each eye, and the visual acuity reached the highest earlier value seen after the initial surgery. All patients have long-term follow-up (mean, 22 months) with no postoperative complications.

CONCLUSIONS: Chorioretinectomy, although it is ideally used as a prophylaxis against PVR formation and the development of retinal fold formation, also proved equally effective as a late treatment option in the presence of such folds. Such late chorioretinectomy, however, is applicable only for eyes with deep-impact IOFB injuries, not for eyes with a perforating injury or rupture.