Use of temporary keratoprosthesis in the management of severe ocular trauma with retinal detachment and proliferative vitreoretinopathy

Severe penetrating ocular trauma like windshield injuries and explosions have devastating effects on both anterior and posterior segments of the eye. Large corneoscleral perforations, traumatic iris coloboma or aniridia, cataract or expulsion of the lens, vitreous loss and intraocular hemorrhage set the stage for a fibroplastic proliferative reaction beginning 1-3 weeks after the initial trauma. Retinal traction detachment and proliferative vetreoretinopathy may follow this chain of events. Early management within 2 weeks after the primary wound repair has the best chance to prevent irreversible retinal fibrotic infiltration.
Corneal scarring may prevent visualization of the posterior segment for evaluation of the extent of the retinal damages. Ultrasonographic examination provides - usually incomplete - information on ocular dimensions, retinal detachment, choroidal effusion and - using the B-scan mode - mobility of intraocular structures like vitreous, intravitreal hemorrhage, and detached retina. The use of a temporary keratoprosthesis (KP) during the surgical repair of these cases stabilizes the globe and allows vitreoretinal surgery in a closed system to remove membranes, unfold the retina and introduce a silicone oil tamponade. This paper describes the use of a temporary KP in cases of severe penetrating ocular trauma.