Szemészet, 2004 (141. évfolyam, 1-4. szám)
2004-06-01 / 2. szám
270 Szemészet Ocular trauma today Robert Morris, С. Douglas Witherspoon, Ferenc Kuhn, Charles L. Tucker Birmingham, USA Eye injury is an important and dramatic form of vision loss, to which no one can claim complete immunity. But even as subspecialization in ophthalmology has become common place, ocular traumatology has remained a kind of step-child. Eye injury is rarely so concentrated that an interested physician can restrict his practice to its treatment. Nonetheless, ocular traumatology has an important role. Eye injuries occur frequently, and their successful management often requires the skills of nearly all the ophthalmic subspecialties. With the new era of primarily outpatient ophthalmic surgery, ocular trauma has become the leading cause of inpatient eye care in the United States. For a clinician engrossed in a busy ophthalmology practice, the march of progress in modern ocular traumatology could easily go little noted. This progress, however, has been made in step with the more familiar advances in ophthalmology. In 1969, the first men reached the moon, probably the landmark technical achievement of our lifetime. At almost the same time, to little public notice, Robert Machemer first reached the back of the human eye with the development of vitrectomy. No field of ophthalmology benefited more from this discovery than did ocular trauma. In the past, repair of the injured eye meant only suturing the external wounds. Now, for the first time, we were able to reconstruct the inner eye. Pars plana vitrectomy introduced the modern era of ocular traumatology. Building on this new tool, subsequent advancements were made: • Klaus Heimann and Steve Ryan were among the first to apply vitrectomy to repair of the injured eye. • Maurice Landers and Gary Faulks developed the temporary keratoprosthesis which made vitrectomy reconstruction of the most severely injured eyes possible. • Robert Morris, Douglas Witherspoon, and Robert Phillips, through extensive use of the temporary keratoprosthesis, proved that “no light perception” is not a reliable indicator for permanent blindness in the recently injured eye with opaque media. • Paul Sternberg advanced the employment of vitrectomy in retinal reattachment and avoidance of proliferative vitreoretinopathy. • Relja Zivonovich joined silicone oil techniques with retinotomy for reattachment of the scarred retina. • Steve Charles regularly introduced technical innovations to aid treatment of the detached, injured retina. • William Meiler described techniques to remove intraocular foreign bodies as well as prevent and treat traumatic endophthalmitis. • Laser treatment was introduced into the operating room during the late 1980’s • Stanley Chang introduced perfluorocarbon liquids to flatten retinal detachments caused by giant tears. These advances allowed salvage of the retina in most injuries, with ciliary body trauma and secondary phthisis often replacing retinal detachment as the limiting factor in ocular reconstruction. Dramatic anterior segment advances, such as viscoelastic fluids, iridoplasty, improved corneal transplantation, and the permanent keratoprosthesis also enable eyes to be restored to better function. Standardization of terminology, prospective surveillance data collection systems, and professional work groups have allowed for continuing advances in ocular traumatology. The International Society of Ocular Trauma, founded by Giora Treister, and the United States Eye Injury Registry, started by Douglas Witherspoon and Robert Morris, both began in 1988. Ferenc Kuhn introduced the Birmingham Eye Trauma Terminology in 1996 to simplify eye injury classification. Recently, the internet has become a tool to report serious eye injuries and enable collaboration of ophthalmologists worldwide to accelerate progress in the treatment of the injured eye. (The World Eye Injury Registry, WEIR) 2004. JÚNIUS 4. - A SZEMÉSZET ÉS A LÁTÁSKUTATÁS VÁRHATÓ JÖVŐJE II.
