Complicated Ocular Trauma with Corneal Opacity

Eye trauma is a relevant cause of blindness and visual impairment worldwide. The cornea and the corneoscleral region are the most common places of injury. The main etiologies of corneal injuries are corneal abrasion, corneal foreign bodies, corneal perforation, and eye burns. Damage to the cornea leads to swelling, increased thickness, and development of opacification due to the healing process. Therefore, a normal cornea allows visualization of intraocular surgical maneuvers in the anterior and posterior segment of the eye during eye surgery. In situations requiring immediate action by the ocular surgeon, numerous abnormalities in the anterior segment (blood in the anterior chamber, iris deformities, pupil membranes, and traumatic cataracts) can be managed if the cornea is transparent. However, the presence of important corneal opacities (such as intense or rapidly progressing corneal edema, large and thick scars, hematic impregnation, and neovascularization of the cornea) impairs a safe and effective vitrectomy, limiting the possibility of reconstruction of the anterior and posterior segments. The posterior segment surgeon is faced with the following choices when dealing with eyes with corneal opacities: postponing posterior segment surgery while waiting for corneal clearing; performing immediate surgery with temporary keratoprosthesis (TKP) combined with pars plana vitrectomy (PPV) or performing endoscopy-guided vitrectomy. The decision will be guided by the urgency to approach the posterior segment and the availability of materials. TKP or endoscopic vitrectomy is ideal in urgent cases that require immediate surgical approach. Furthermore, two cases of trauma with opacities, one with blood in the anterior chamber (hyphema) and the other with corneal opacity.