Retinal fixation of traumatic retinal detachment with metallic tacks: a case report with 10 years' follow-up.

摘要

BACKGROUND: Retinal rupture and detachment caused by traumatic ocular perforation has a poor prognosis without extensive repair procedures. The authors describe the phases of treatment of a complex injury in a 21-year-old man with a traumatic retinal rupture in whom metallic tacks were used for retinal fixation. The report does not include histopathology. METHODS: Observational case report and literature review. The outcome of a 10-year follow-up is evaluated at the latest visit by determining the visual acuity (VA) and by observing the state of retina and tacks. RESULTS: A traumatic retinal rupture with detachment was treated with titanium tacks for retinal fixation. By inserting a total of 13 metallic tacks for the repair of a temporal postequatorial retinal rupture and adjacent retinal detachment a successful outcome was achieved. Two additional operations were performed to reattach the retina of nasal hemisphere in the same eye. One dislodged tack was removed at the final operation. Ten years later, at the last intervention, VA was 12/20 in the injured eye. The retina was completely attached, and the remaining 12 tacks were in place, although six of them were partially pushed up by an encircling band. Proliferative vitreoretinopathy (PVR) was absent, and a relatively narrow circumferential zone of scar tissue adjacent to the row of tacks was visible. The patient occasionally experienced glare in the affected eye, but was otherwise symptom-free. CONCLUSION: Reports of long-term experiences with mechanical retinal refixation with metallic tacks are scarce. Especially in extended use, the tacks are claimed to cause several complications, including PVR. Although modern ophthalmic surgery offers a variety of methods for retinal reattachment, the complexity of the damage caused by trauma may lead to a dead end in refixation attempts. Nevertheless, retinal tacks may represent an adjunctive remedy in complex retinal detachment cases.