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Seven-Year Follow-up of an Exceptionally Severe Rupture from an Explosion

1Koizumi K., 2Hartmann C., 1Joussen A. M., 1Kirchhof B.,
1Universität zu Köln, Zentrum für Augenheilkunde, Abteilung für Netzhaut- und Glaskörperchirurgie (Köln)
2Humboldt-Universität zu Berlin, Charité Campus Virchow-Klinikum, Augenklinik (Berlin)

Purpose: Eyeball rupture is the most serious type of ocular trauma and has a poor prognosis. We report a seven-year follow-up of a patient who suffered a severe rupture of the both eyes.
Case report: A 43-year-old man was injured by a bomb explosion. The left eye was primarily enucleated since there was no retina left. The right eye presented with Òlight-perceptionÓ but was missing completely cornea, lens, iris, ciliary body and peripheral retina and choroid. After scleral reconstruction, Eckardt's temporary keratoprosthesis was placed. The remaining retina was reattached and the eye was filled with silicone oil. Finally, a penetrating keratoplasty was performed. During the follow-up, two re-operations for retrocorneal membranes became necessary. Seven years after the initial operation, the visual acuity is counting fingers. The residual visual field allows ambulatory vision.
Conclusions: It is often difficult to estimate the individual prognosis of eyes with very severe ocular trauma. Some cases show surprisingly favorable outcomes. Therefore primary enucleation should be avoided unless the prognosis is hopeless. This case-report demonstrates that a seemingly hopeless situation can still allow long term useful vision.

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