Dancing from pole to pole for ocular trauma surgery success

In industrialized countries, ocular trauma is the second leading cause of blindness among the over 50s population and the leading cause of monocular blindness among the general population; thus representing an important social health problem.

Ocular traumatology covers a wide spectrum of clinical situations and it is therefore essential to have a standardized classification system of terminology so that ophthalmologists can use the same language to describe and communicate clinical findings. To this end, in the USA the BETT (Birmingham Eye Trauma Terminology) was introduced and successively adopted by the whole scientific community.

The reconstruction of a traumatized eye can be a very complex procedure: in nature there are no clear boundaries between anterior and posterior segment. Therefore the management of bulbar traumatology is significantly different from the surgery for other diseases.

It is for this reason that surgeons must develop an individualized approach to treating trauma patients, however, they must also be flexible and adapt to each individual situation that they are presented with. In the majority of trauma cases, the initial approach in an emergency situation follows the bulbar reconstruction strategy, which often includes multiple surgeries. This surgical treatment pathway is largely based on the surgeon's ability and experience.

Pole to pole

Cesare Forlini, MD has developed the "pole to pole" surgical concept to treat the anterior and posterior segment simultaneously, which he describes as being akin to a "dance" within the eye. The great advantage of this kind of surgery is that it reduces the need for additional surgical procedures when the healing and proliferative processes become more difficult and risky to manage.

When using this approach, the surgeon must be experienced, as he/she may need to adapt their strategy to sudden and often unpredictable situations. There are many things that need to be taken into consideration when treating a trauma patient, such as which tamponade is best, which IOL to implant, functional or aesthetic anterior segment reconstruction, use of endoscopy, and so on.

Dancing one step at a time

In order to fully describe this approach, we refer to a case that we were presented with of a perforating trauma with corneal leucoma, tractional retinal detachment and post-traumatic aphakia. We decided to use the "pole to pole" bulbar reconstruction technique. Here we present how we successfully treated the patient.