..Trauma management ..Trauma management is significantly different is significantly different from surgery of other from surgery of other diseases..diseases..

(F. Kuhn)(F. Kuhn)

……Treating eyes with severe injuries is like Treating eyes with severe injuries is like navigating through uncertainly territorynavigating through uncertainly territory……

(F. Kuhn)(F. Kuhn)

……Trauma does not tolerate dogmasTrauma does not tolerate dogmas……

HIGH SCHOOLOCULAR TRAUMA

Nowadays the ophthalmic surgical activityis more and more linked to advanced

and standardized technologies and ophthalmologists look like

users of machines only(to optimize surgical time and scheduling).

Traumatology represents one of those fieldswhere the ophthalmologist can

rediscover the real role of being a doctor.Moreover, in addition to the most recent

technologies, in traumatology field ophthalmologists can and must use their own experience, passion and commitment

without considering time and surgery duration

We can rediscovery the sense of the MISSIONin developed countries

In the latest years, with the development of In the latest years, with the development of new technologies and materials and new technologies and materials and the continuous effort to improvethe continuous effort to improve

the surgical treatment of Ocular Traumas,the surgical treatment of Ocular Traumas,we assisted to important improvements we assisted to important improvements

in terms of functional results after surgeryin terms of functional results after surgerywith a great advantage for the patient with a great advantage for the patient

The GOAL OF THIS SCHOOL IS CREATING AND The GOAL OF THIS SCHOOL IS CREATING AND SPREADING AS MUCH AS POSSIBLE A CULTURE OF SPREADING AS MUCH AS POSSIBLE A CULTURE OF

THE APPROACH AND TREATMENT OF OCULAR THE APPROACH AND TREATMENT OF OCULAR TRAUMA TRAUMA

1) YOUNG OPHTHALMOLOGISTS1) YOUNG OPHTHALMOLOGISTS-- DECISION MAKINGDECISION MAKING

-- EMERGENCY SURGERY (?)EMERGENCY SURGERY (?)-- FOLLOWFOLLOW--UPUP

2) DEPARTMENT DIRECTORS2) DEPARTMENT DIRECTORS-- -- ORGANIZATIONORGANIZATION

-- SURGERY IMPROVEMENTSURGERY IMPROVEMENT-- DOCTORS AND NURSES TRAINING DOCTORS AND NURSES TRAINING

GOAL OF THE SCHOOL

IN FRONT OF A TRAUMA THE PATIENT USUALLYIN FRONT OF A TRAUMA THE PATIENT USUALLYGOES TO THE CLOSER HOSPITALGOES TO THE CLOSER HOSPITAL

WITHOUT POSSIBILITY TO CHOOSE WITHOUT POSSIBILITY TO CHOOSE

AS MANY CENTERS ARE ABLE TO TREAT SOON THE TRAUMA, AS MANY CENTERS ARE ABLE TO TREAT SOON THE TRAUMA, AS MUCH IS POSSIBLE TO OBTAIN POSITIVE RESULTSAS MUCH IS POSSIBLE TO OBTAIN POSITIVE RESULTS

THE FIRST APPROACH IS IMPORTANT FOR THE FINAL DESTINY THE FIRST APPROACH IS IMPORTANT FOR THE FINAL DESTINY OF THE TRAUMATIZED EYEOF THE TRAUMATIZED EYE

ALL THIS MEANS:QUALITY OF THE ASSISTANCE WIDESPREAD IN THE COUNTRY

..because we have to ..because we have to ““navigatenavigate”” through uncertain through uncertain territory the ocular traumatology field needs the territory the ocular traumatology field needs the

greatest experience and creativitygreatest experience and creativity……

……and and people full of passion people full of passion (like all the Trauma Surgeons)(like all the Trauma Surgeons)

that are flexible to change using the innovation,that are flexible to change using the innovation,in order to solve the complex situations .. in order to solve the complex situations ..

………….. wich present always in different way .. wich present always in different way

E.B.M. principles are not applicable to the field E.B.M. principles are not applicable to the field of ocular trauma of ocular trauma

Only the dicussion on single cases Only the dicussion on single cases and the sharing of and the sharing of

personal experiences and organization, personal experiences and organization, leads to a certain progress leads to a certain progress

Faculty (since 2007)

• Rupesh Agarwal MD (Singapore). William Aylward, MD (UK). Florian Balta,MD ( Romania ). Ernest Boiko,MD ( Russia)• Jose Dalma, MD (Mexico)• Khaled El-Rakhawy, MD (Egypt)• Faisal Fayad,MD (Jordan)• Cesare Forlini, MD (Italy)• Matteo Forlini, MD (Italy)• Michele Fortunato, MD (Italy)• Ferenc Kuhn, MD (USA)• Gregorio Gabela, MD (Ecuador)• Gianpaolo Gini, MD (Italy). Tatiana Imshanetskaya,MD (Belarus)• Stefano Lippera, MD (Italy) • Carlos Mateo, MD (Spain)

. William Mieler, MD ( USA )

. Jorge Mitre , MD ( Brasil )•Hassan Mortada ( Egypt )•Musat Ovidiu, MD ( Romania )•Sundaram Natarajan, MD (India)•Athanasios Nikolakopoulos, MD (Greece)•David Pelayes, MD (Argentina)•Vito Primavera, MD (Italy)•Hugo Quiroz Mercado, MD (USA)• Robert Rejdak ,MD ( Poland )•Vincent Reppucci, MD (USA)•Paolo Rossini, MD (Italy)•Khalid Sabti ,MD (Kuwait )•Sergio Z. Scalinci, MD (Italy)•Wolfgang Schrader, MD (Germany)•Mahmoud Soliman, MD (Egypt)•Paul Sullivan, MD (UK)•Peter Szurman,MD (Germany)

Trauma Courses

Montecarlo 07….…Vienna 08… …Nice 09

PARIS 2010 …. LONDON 2011MILAN 2012 …. HAMBURG 2013

.. LONDON 2014

LLUGANO Switzerland

Lugano, Switzerlandwww.esaso.org

)

EVRSMeeting with masters

Malta 2011Dresden 2012Rhodes 2013PORTO 2014

EVTRS BremenDOHA- Quatar

TBLISI -GeorgiaLUBLIN –Poland

EDINBURGH – UKMOSKOW – Russia

THESSALONIKI - GreeceSINAIA – RomaniaMINSK – Belarus

S. PETERSBURG – RussiaOHRID – MakedoniaKUWAIT CITY – Kuwait

Padoa, Rome, Milan, Lecce, Perugia, Turin, Ravenna Italy

Romanian Society of Ophthalmology

Sinaia 2013

CESARE FORLINI

FLORIAN BALTA

OVIDIU MUSAT

Dubronvik 2014

RAVENNARAVENNAITALYITALY

“Pole to pole” Surgery

• It consists of a contemporary multidistrict surgical approach,

alternating manoeuvres on the different compartments.

• This is useful to gain as many passages as possible to reach the best final result

in a very short time, reducing the number of operations, the stress for the

patient and the costs of the sanitary system.

In case of eye injuries where it is necessary to develop a global strategy, according to a strategically planned approach, it is important that the surgeon is able to manage the entire procedure according to a double-directional and not mono-directional model, that is “dancing” inside the eye, moving between

anterior segment and posterior segment

+

Cornea 1’ IrisV / R Surgery

IOL implant Cornea 2’ Final tamponade

+ +

+

One surgery multiple step:“4 L-rules”

• Less costs for Sanitary System ( number of operations)

• Less surgical stress• Less psycological stress (convenience to patient)• Less risk of secondary complications (synaechie,

PVR and glacucoma prophylaxis)

“ POLE to POLE “SURGERYSURGERY

TAKE HOME MESSAGE

WHERE THE WHOLEWHERE THE WHOLEIS MORE THAN IS MORE THAN AN ADDITION AN ADDITION OF ITS PARTSOF ITS PARTS

When anterior meets posterior• For "middle earth" we intend the inclusive

anatomical area between the back surface of the iris and the anterior vitreous chamber

• It represents a border area among the anterior and posterior segment and often it is an uncertainty reason in the surgical treatment (it is not clear if it is pertinence of the anterior or posterior segment surgeon)

Middle Earth

When anterior meets posterior• In the ocular surgery there is an academic distinction that

interests the surgeons, according to which they operate on the anterior or posterior segment of the bulb. This often creates a separation of the roles and operational surgical ability, sometimes very well interdistincted.

• Often the vitreoretinal surgeon has the tendency to neglect the iris plane and its possible changes, as the surgeon of the anterior segment doesn't even conceive manipulations over this area and stops himself before the pupilpupil’’s "abysss "abyss””

Middle Earth

“Archer shooting at Saint Christopher”(A. Mantegna, XV sec.)

In the new technological world of Ophthalmology, Traumatology represents a field in which a doctor’s role is valued

even when under pression, stress, hours and will to win Traumatology represents the most exciting field where passionate people can

realize their own vocation

MINI-INVASIVE SYSTEMS DID CHANGE SOME SURGICAL STRATEGIES

TAKE HOME MESSAGE

MORE COMPLEX IS THE CASEMORE COMPLEX IS THE CASEMORE USEFUL IS MORE USEFUL IS

THE MINITHE MINI--INVASIVE SURGERYINVASIVE SURGERY

MINI-INVASIVE SURGERY in OCULAR TRAUMA:

DOES IT MAKE SENSE?

YES !!!…because…

WeWe can do can do EverythingEverything !!!!!!MIVS MIVS doesndoesn’’t t meanmean MinimalMinimal VitrectomyVitrectomy

• MIVS allowed us to avoid adding trauma to an already traumatized eye

•• Open your mindOpen your mind•• Use combined systems: Use combined systems: (20 + 23 + 25 G)(20 + 23 + 25 G)

•• CostsCosts•• IOFB removalIOFB removal•• AndAnd……..

Time for HSO extraction (-)

HIGH HIGH SCHOOLSCHOOLOCULAR OCULAR TRAUMATRAUMAOf course……

The best treatment is…

…the PREVENTION ! ! !

HIGH SCHOOLOCULAR TRAUMACourse Organizer: Cesare Forlini (Italy)

Of course……The best

treatment is……the

PREVENTION ! ! ! !!

New strategies in New strategies in Ocular TraumaOcular Trauma

Cesare Forlini, MDCesare Forlini, MDRavenna Ravenna –– ItalyItaly