Vitrectomy in double-perforation gunshot injury

OBJECTIVE: This study sought to evaluate the result of pars plana vitrectomy in patients with gunshot wounds involving double perforation. METHODS: This was a retrospective, noncomparative, interventional case series. RESULTS: Eighteen patients (18 eyes) with double-perforation gunshot injuries were treated from February 2010 to March 2012. The group included 16 men (88%) and two women (11%); the mean age was 24 (15–33) years. In each case, vitrectomy was scheduled 1–6 weeks after repair of the entrance site. Associated retinal detachments were observed in two eyes (11%), retinal incarceration was observed surrounding the exit site in three eyes (16%), and retention of an intraocular foreign body was observed in two cases. After a follow-up period of 8 ± 2 months, two eyes (11%) had achieved visual acuity (VA) of 0.5, nine eyes (50%) had achieved VA between 0.5 and 0.1, and seven eyes (38%) had achieved VA between 0.1 and hand movement. The main reasons for functional failure (VA 0.1 to hand movement) were macular dragging (due to fibrosis at the exit site near the macula) in seven cases (38%), submacular hemorrhage in four cases (22%), and epimacular fibrosis in five cases (27%). All cases developed postoperative exotropia. One case (5%) developed postoperative hemorrhage. No cases exhibited signs of postoperative redetachment. CONCLUSION: The outcome of pars plana vitrectomy in cases with double perforations is variable. Factors including the surgeon’s skill level, the time to surgery, and the efficacy of the intraocular tamponade affect the postoperative outcome.