After a careful discussion of the risks, benefits, and alternatives (including the risk of sympathetic   ophthalmia), the patient decided to undergo pars plana vitrectomy and repair of the retinal detachment.   Her parents concurred.

PARS PLANA VITRECTOMY

On June 13, 2001 the patient underwent pars plana vitrectomy, scleral buckling, membrane
peeling, silicone oil infusion, cryotherapy, and intraocular foreign body removal OD.

• The globe was inspected, and uveal prolapse was not present at the laceration sites.
• A 3-port vitrectomy was performed by working through incisions 3 mm posterior to the limbus. The vitreous gel was densely hemorrhagic. After a core vitrectomy was completed, 3 foreign bodies were identified and removed: a damaged contact lens, a small glass fragment, and a cilium. The
  first and third specimens were sent to pathology for analysis.
• Vitreous and retina were incarcerated in the inferotemporal scleral laceration. In addition to the retinal laceration at the 5:30-o’clock position, there was a retinal laceration just posterior to the equator at 9:00 o’clock and a dialysis between 11:30 and 12:30 o’clock. A meticulous peripheral vitrectomy was done, and the retina was freed from the wound. Substantial subretinal hemorrhage was present, and the overlying retina was atrophic in many areas although the area centralis was relatively spared. Subretinal hemorrhage was drained, and perfluorooctane was used to displace into the vitreous cavity as much of the liquid blood as possible.
• A large solid clot remained in the inferotemporal periphery between 7:00 and 10:00 o’clock,
  outside the area centralis. The surgeon (MAZ) chose to allow the clot to dissolve spontaneously
  and drain it later, if necessary.
• Large retinal breaks were treated with laser photocoagulation and, in the 9:00-o’clock meridian, cryotherapy (owing to the presence of a layer of blood around the margins of the break). The remaining numerous small areas of retinal atrophy were left untreated.
• The surgeon anticipated the development of proliferative vitreoretinopathy; therefore, a #287 exoplant and #240 band were used for scleral buckling. Silicone oil was infused, and an inferior iridectomy was created at the 6:00-o’clock position.
• Postoperatively, the patient was treated with Diamox®, Solumedrol®, and Pepcid®.