Objective: To evaluate the clinical characteristics and therapeutic efficacy of occult scleral rupture.
Methods: It was a retrospective case series. Clinical data of 28 patients (28 eyes) with occult scleral rupture in recent 10 years was reviewed. All patients were performed with I-stage debridement and suturing surgery when the scleral ruptures were confirmed by operation search, and fourteen eyes of them were performed II-stage vitrectomy in following up periods.
Results: In 28 cases with occult scleral rupture, the major clinical signs included bulbar conjunctival edema and subconjunctival hemorrhage (100%), vitreous hemorrhage (89.3%), hyphema (78.6%), ocular hypotension (75.0%), limitation of ocular movement (75.0%), reduction of visual acuity to light perception or less than light perception (67.9%), impairment or dislocation of the lens (39.3%), pupilla distortion or dilatation (35.7%), choroidal hemorrhage or detachment (35.7%) and retinal detachment (32.1%). In 23 patients their eyes were scanned by A/B-ultrasonography, the image of eyeball wall were found to be interrupted or disorder in 5 eyes and the ocular axis was shorten in 4 eyes. X-ray computed tomography (CT) were performed in 10 patients before operation. It was found interruption or unsharpness of ocular ring in 3 eyes, the unevenness of ocular density in 2 eyes, and both signs were seen in 5 eyes. Total 28 eyes, the visual acuity were improved in 18 eyes after operation, no change 9 eyes and decreased 1 eye. Visual acuity was significantly increased postoperation (X2 = 13.29, P < 0.05). The result showed that the visual acuity increased in 21.4% (6/28) of eyes with I-stage operation and 85.7% (12/14) of eyes with II-stage vitrectomy respectively.
Conclusions: The major sign of diagnosis of occult scleral rupture are visual acuity with light perception or less than light perception, bulbar conjunctival edema and subconjunctival hemorrhage, hyphema, ocular hypotension and limitation of ocular movement, etc after ocular trauma. The intraocular damage such as impairment or dislocation of the lens, vitreous hemorrhage, retinal detachment etc. , is regarded as the important references in the diagnosis, treatment and prognosis. The rates of misdiagnosis can reduce if auxiliary examinations of A or B-ultrasonography and CT are applied. The prompt and appropriate surgery play an important role in the recovery of visual function.