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Full thickness posterior globe perforation managed with laser photocoagulation

Published:March 13, 2021DOI:https://doi.org/10.1016/j.jcjo.2021.02.009
      A 22-year-old male patient was urgently referred following an all-terrain vehicle (ATV) accident. On presentation, the patient had extensive bilateral periorbital fractures. Dilated fundus exam of the right eye demonstrated a full-thickness chorioretinal and scleral perforation infero-nasal to the optic disc with mild vitreous hemorrhage (Fig. 1A). Laser photocoagulation was performed around the perforation site. Three months after the injury, the patient had visual acuity of 20/20 in his right eye with complete resolution of the vitreous hemorrhage. Gliotic tissue had developed over the perforation site with no evidence of retinal detachment or proliferative vitreo-retinopathy (Fig. 1B). Given the extent and location of his orbital fractures in relation to the injury site as imaged by computed tomography of the head and orbit, it was presumed that one of the bony fragments had likely perforated the posterior globe during the accident (Fig. 2). The perforation site had then spontaneously self-sealed and laser was used to reinforce the surrounding retina and prevent further complications.
      Fig 1
      Fig. 1Fundus photo of the right eye at the time of presentation (A) and 3 months after follow-up and laser photocoagulation (B).
      Fig 2
      Fig. 2Computed tomography of the brain and orbit demonstrating a depressed orbital floor fracture in a sagittal view on the left (yellow circle) while both the axial and the coronal views on the right demonstrate a hyperintense structure consistent with a bony fragment (yellow arrow and arrowhead) in very close proximity to the infero-nasal quadrant of the globe where the actual site of injury was found. The fractures also involved the medial orbital wall with extension into the orbital apex. The 4 orbital rims have all been affected as well (not shown in the photo).
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