This case highlights the use of the bimanual technique in treating a dense vitreous hemorrhage that could not be managed with standard vitrectomy in a patient with a history of open globe trauma.
37-year-old male with a one-month-old history of open globe trauma in left eye (OS) caused by a nail. Examination revealed visual acuity (VA) of light perception (LP), sutured sclero-corneal wound, cataract with posterior staining due to hemorrhage, and no view of posterior pole. B-scan reported vitreous hemorrhage and focal retinal detachment. We performed phacoemulsification, IOL implantation, scleral buckle, and vitrectomy. There was significant difficulty in vitrectomizing the hemorrhage despite adjusting to low cut rates and high vacuum settings, leading to the decision to use the bimanual technique to cut and subsequently chop the pieces. This also aimed to avoid traction on the vitreous base. The retina was found attached. After five months, the final VA of the OS was 20/25, and retina remained attached.
Bimanual technique is primarily described for complicated tractional retinal detachments, among other applications. Its use in very dense vitreous hemorrhages has not been previously described.
Retinal surgery is dynamic, and various techniques should always be considered to improve patient outcomes. Our patient improved from LP to 20/25, despite an Ocular Trauma Score indicating only a 1% chance of achieving a VA of 20/40 or better. This illustrate the importance of providing treatment opportunities to trauma patients, regardless of their initial prognosis.
The authors have no financial interests in any material discussed in this article. There are no conflicts of interest to disclose.