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15-year-old was seen in the office on August 13, 2009. He was injured in his left eye with a steel dart on August 3rd of 2009. At 2 pm the dart entered his eye, he pulled it right out and then you repaired the eye that evening at a 11 pm for ruptured globe. The dart entered superiorly at the pars plana and his vision is clearing as the blood reabsorbs. VISUAL ACUITY: OD 20/20, OS 20/400. IOP: OD 15, OS 12. SLIT EXAMINATION: The right eye is normal with clear lens. The left eye has a corneal striae. The cornea is though almost clear. The lens is clear in the left eye. There is trace cell and flare of the anterior chamber. EXTENDED OPHTHALMOSCOPY: OS: Vertical C/D ratio is 0.1. The macula looks smooth. Superior to the macula there is a impact site, just 2 disc-diameters above the superior temporal arcade at about 11 o’clock from the back of it to about superotemporal of the optic nerve and adjacent to that there are 2 choroidal ruptures. There are chorio vitreous bands attaching anteriorly to the impact site posteriorly. The retina is everywhere attached. Photos confirm clinical findings. IMPRESSION: 1. STATUS POST PERFORATING INJURY TO THE LEFT EYE WITH A DART 2. HISTORY OF RUPTURED GLOBE REPAIR – LEFT EYE 3. VITREOUS HEMORRHAGE – LEFT EYE 4. PERIPHERAL CHORIORETINAL SCAR – LEFT EYE 5. RETINAL TEAR – LEFT EYE DISCUSSION: I explained to the patient he does have clearing blood in the left eye. He is at a relatively high risk of retinal problems, because of the impact posteriorly and the vitreous traction along the edge. I added three rows of laser at the edge of the impact site today without any difficulty. He tolerated the laser pretty well. I asked him to return urgently should he notice any shadows in his side vision, otherwise I am going to follow him weekly. Should his retina begin to detach, then a vitrectomy with silicone oil may be a reasonable consideration. At this moment I do not believe that the risk of surgery is worth the potential benefit.

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Steel Dart Perforating Injury - 15 year old - 3 weeks post-injury Vision 20/400399 views15-year-old injured in his left eye with a steel dart. The dart entered superiorly at the pars plana and his vision is clearing as the blood absorbs.

VISUAL ACUITY: OD 20/20, OS 20/400.
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Steel Dart Perforating Injury - 15 year old - 3 weeks post-injury Vision 20/400135 views15-year-old injured in his left eye with a steel dart. The dart entered superiorly at the pars plana and his vision is clearing as the blood absorbs.

VISUAL ACUITY: OD 20/20, OS 20/400.
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Steel Dart Perforating Injury - 15 year old - 3 weeks post-injury Vision 20/400141 views15-year-old injured in his left eye with a steel dart. The dart entered superiorly at the pars plana and his vision is clearing as the blood absorbs.

VISUAL ACUITY: OD 20/20, OS 20/400.
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Steel Dart Perforating Injury - 15 year old - 3 weeks post-injury Vision 20/400125 views15-year-old injured in his left eye with a steel dart. The dart entered superiorly at the pars plana and his vision is clearing as the blood absorbs.

VISUAL ACUITY: OD 20/20, OS 20/400.
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Steel Dart Perforating Injury - 15 year old - 3 weeks post-injury Vision 20/40099 views15-year-old injured in his left eye with a steel dart. The dart entered superiorly at the pars plana and his vision is clearing as the blood absorbs.

VISUAL ACUITY: OD 20/20, OS 20/400.
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Steel Dart Perforating Injury - 15 year old - 3 weeks post-injury Vision 20/400146 views15-year-old injured in his left eye with a steel dart. The dart entered superiorly at the pars plana and his vision is clearing as the blood absorbs.

VISUAL ACUITY: OD 20/20, OS 20/400.
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Steel Dart Perforating Injury - 15 year old - 3 weeks post-injury Vision 20/400106 views16-year-old had a dart injury to the left eye August 3rd of 2009. He has had a few surgeries since then, although he never did require a vitrectomy. His vision is improving remarkably.

VISUAL ACUITY: OS: Without correction 20/40
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Perforating Steel Tip Dart Injury - 1 year later - no vitrectomy - 20/40 Vision 131 views16-year-old had a dart injury to the left eye one year ago. His vision is improving remarkably.

VISUAL ACUITY: OS: 20/40
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Perforating Steel Tip Dart Injury - 1 year later - no vitrectomy - 20/40 Vision 92 views16-year-old had a dart injury to the left eye one year ago. His vision is improving remarkably.

VISUAL ACUITY: OS: 20/40
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Perforating Steel Tip Dart Injury - 1 year later - no vitrectomy - 20/40 Vision 139 views16-year-old had a dart injury to the left eye one year ago. His vision is improving remarkably.

VISUAL ACUITY: OS: 20/40
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Perforating Steel Tip Dart Injury - 18 Months Post Injury - no vitrectomy - 20/40 Vision 163 views16-year-old had a dart injury to the left eye 18 months post injury. No vitrectomy. VISUAL ACUITY: OS: Without correction 20/4000000
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Perforating Steel Tip Dart Injury - 18 Months Post Injury - no vitrectomy - 20/40 Vision 149 views16-year-old had a dart injury to the left eye 18 months post injury. No vitrectomy. VISUAL ACUITY: OS: Without correction 20/4000000
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15-year-old was seen in the office on August 13, 2009. He was injured in his left eye with a steel dart on August 3rd of 2009. At 2 pm the dart entered his eye, he pulled it right out and then you repaired the eye that evening at a 11 pm for ruptured globe. The dart entered superiorly at the pars plana and his vision is clearing as the blood reabsorbs. VISUAL ACUITY: OD 20/20, OS 20/400. IOP: OD 15, OS 12. SLIT EXAMINATION: The right eye is normal with clear lens. The left eye has a corneal striae. The cornea is though almost clear. The lens is clear in the left eye. There is trace cell and flare of the anterior chamber. EXTENDED OPHTHALMOSCOPY: OS: Vertical C/D ratio is 0.1. The macula looks smooth. Superior to the macula there is a impact site, just 2 disc-diameters above the superior temporal arcade at about 11 o’clock from the back of it to about superotemporal of the optic nerve and adjacent to that there are 2 choroidal ruptures. There are chorio vitreous bands attaching anteriorly to the impact site posteriorly. The retina is everywhere attached. Photos confirm clinical findings. IMPRESSION: 1. STATUS POST PERFORATING INJURY TO THE LEFT EYE WITH A DART 2. HISTORY OF RUPTURED GLOBE REPAIR – LEFT EYE 3. VITREOUS HEMORRHAGE – LEFT EYE 4. PERIPHERAL CHORIORETINAL SCAR – LEFT EYE 5. RETINAL TEAR – LEFT EYE DISCUSSION: I explained to the patient he does have clearing blood in the left eye. He is at a relatively high risk of retinal problems, because of the impact posteriorly and the vitreous traction along the edge. I added three rows of laser at the edge of the impact site today without any difficulty. He tolerated the laser pretty well. I asked him to return urgently should he notice any shadows in his side vision, otherwise I am going to follow him weekly. Should his retina begin to detach, then a vitrectomy with silicone oil may be a reasonable consideration. At this moment I do not believe that the risk of surgery is worth the potential benefit.