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Editor,—Perforation of the eye is a challenging emergency in ophthalmology and requires immediate treatment. Visual outcome after penetrating injuries with and without intraocular foreign bodies depends on the visual acuity after injury, age of patient, and the severity of the ocular trauma.1 2 We report a case of globe laceration following an accident with a fishing hook which was successfully treated without surgery.
A 12 year old boy presented with visual disturbance and a small lid wound on the left eye at our emergency department. He had been playing with a fishing rod while sitting on a tree, and was trying to hook fruit on the ground. The line recoiled swiftly and pierced the upper lid of the left eye. He jumped from the tree and the hook jerked itself out of the boy’s eye. A small wound of the left upper lid was found. The visual acuity was 20/20 in the right eye and 20/25 in the left eye. The anterior segment and the intraocular pressure were normal. The fundus of the right eye was normal. The fundus of the left eye showed a mild localised vitreous haemorrhage superomacular near the temporal vessels. From there the scleral rupture went straight up to the equator. Partly orbital fat could be seen through the wound gap (Fig1A). The ultrasound disclosed a partly detached vitreous with adherence at the site of penetration (Fig 1B). No foreign body was detected by the orbital computed tomograph scan. The patient was admitted to hospital for 8 days and treated with intravenous antibiotics during 1 week followed by an oral antibiotic in the second week. He also received cortisone systemically for 10 days. Three weeks later the visual acuity was 20/20. On funduscopy a sclerochorioretinal scar was disclosed. The edges of the retinal tear were attached and vitreous haemorrhage was completely dissolved (Fig 2). After 1 year of follow up the situation remained unchanged.
Although penetrating injuries of the posterior segment often require surgical treatment (that is, pars plana vitrectomy), in this case antibiotic therapy was used in order to prevent an endophthalmitis3 in combination with orally administered cortisone to reduce the inflammatory reaction. Because of an excellent fundus view, postponing surgery seems to be more appropriate, since surgery implies additional risks (for example, cataract formation, retinal detachment, etc) for the eye.4-6 Significant predictors for a final visual acuities of 20/50 or better are a visual acuity of 20/800 or better and youth (⩽ 18 years).1 In a mammalian study it was disclosed that simple penetration of the equator with vitreous loss does not lead to retinal detachment.7An intact tamponading vitreous at the time of injury seems to prevent fibrous ingrowth due to antiproliferative effects of the hyalocytes.8 The findings of this case suggest that surgery is not the first treatment strategy for similar penetrations of the posterior segment.
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