Severe Ocular Trauma: Surgical Timing and Management Strategies | SamurEye #14

In Episode #14 of the SamurEye Podcast, Dr. David Kohn, a retina and ophthalmology specialist in Chile, shares his experience and strategy for managing severe ocular trauma, from initial care to long-term refractive and cosmetic solutions.

We review complex real-life surgical cases, including the removal of intraocular foreign bodies (IOFB) and the management of traumatic cataracts.

Key points and discussion topics:

• Case 1: Metal IOFB (drill bit tip): Anterior extraction technique, prophylactic laser and visual outcome. [03:00]
• Antibiotic prophylaxis: Debate on intravitreal injection (vancomycin, moxifloxacin) in penetrating wounds. [08:13]
• Case 2: Glass injury and cataract: Surgical management of the wound and second-stage phacoemulsification. [17:15]
• Intraocular lens (IOL) calculation in irregular corneas: Using contralateral biometry and managing post-traumatic irregularity. [21:44]
• Surgical timing: Why the IOL is not always implanted in the first surgery, and the importance of the cooling-off phase. [32:53]
• Managing a damaged capsule: Strategy for preserving or removing the capsule, and the preference for sutured scleral fixation (Yamane, etc.) in trauma. [37:57]
• Managing the pupil: Cosmetic and functional solutions for photophobia and post-traumatic aniridia, including pupilloplasty, cosmetic contact lenses and iris implants (HumanOptics). [41:42]
• Traumatic glaucoma: Long-term management options for secondary glaucoma. [50:51]

A must-watch episode for understanding how to approach these surgical challenges!