Surgical treatment of patients with chorioretinitis sclopetaria caused by blast eye injury

Abstract

Introduction: Chorioretinitis Sclopetaria (СS) refers to post-traumatic pathology of the choroid and retina caused by a closed eyeball injury. CS is a rare disease, however, its signifcantly increased during the war in Ukraine. Aim: to study the clinical features and results of surgical treatment of patients with CS caused by an eye blast injury. Material and methods: A retrospective analysis of 18 cases (18 eyes) of CS in patients after explosive injuries in the period from 2022 to 2024 was conducted. Blind orbital lesions were diagnosed in 15 patients, in 60% of cases with the FB presence. The main indications for pars planum vitrectomy (PPV) were the vitreous hemorrhages (VH), retinal detachment (PD) and/or macular hole (MH). In dynamics, the best corrected visual acuity (BCVA), the retina attachment and MH closing were studied. The results: The most frequent was vitreous hemorrhages (61.1%), optic neuropathy (55.6%), MH (27.8%). RD was detected in 5 cases before surgery, and in 1 patient with VH after PPV. All patients underwent 25G PPV Peeling of the internal limiting membrane was performed on 6 eyes. The initial BCVA was ranged up the no light perception (LP) to 0.07: no LP in 4 patients (22.2%), incorrect LP–in 9 (50), correct LP–in 2 (11.1%), vision less than 0.01–in 1 (5.6%), vision up 0.01 to 0.07–in 2 (11.1%). Final BCVA ranged up the no LP to 0.3: the no LP persisted despite the treatment in 2 cases (11.1%), incorrect LP remained in 6 (33.4%), correct LP–in 4 (22.2%), up 0.01 to 0.1–in 4 (22.2%), more than 0.1–in 2 (11.1%). The location of the CS was signifcantly associated with the fnal BCVA. The higher risk of poor outcomes associated with the location of choroidal tears in the macular (16.7%), temporal (33.4%), and superior (27.8%) part of the fundus. The anatomical result of the performed surgical treatment was retinal attachment in 80% of patients and complete closure of MH in all patients. One patient, who did not have retinal attachment after vitrectomy, is scheduled to undergo scleral buckling. Conclusion: CS caused by an explosive eye injury is characterized by a signifcant persistent decrease in visual functions, a high frequency of massive VH, MH and the RD. PPV for CS has shown sufcient efectiveness in improving visual functions, retinal attachment, and closing macular holes in patients with the consequences of explosive eye injuries.