0945hrs: Trauma PANEL DISCUSSION

Q: from Dr Mikelberg: ruptured globes classified as within 8hr emergency. Is there really no evidence of need to do that quickly? Do we need to change this within 8hr criteria?

A: from Dr Holland; says from literature review and would agree worth exploring literature in further detail to see if indeed within 24hrs is acceptable. Even war injuries cited as up to 3 weeks before repair.

A: from Dr Hurly, mentions war trauma often very hot and therefore more likely sterile material.

Q: Dr Cornock, often with transit delays for tertiary care, within 24hrs becomes within 36hrs, etc.

A: Dr Holland; also consider getting proper staff for the O.R.

A: Dr Albiani; had case spent along time putting multiple suture in a cornea only to have it replaced by corneal transplant the next day by cornea service. Could have just waited til then?

A: from audience; war trauma does get primary closure quickly then FB might wait til within 3 weeks…so not left with open globe all that time.

Comments: from Dr D Maberley, reiterates need to close the open globe. Asks clarification re gonioscopy.

A: Dr Hurly, yes, when possible, with minimal compression of the eye, important to do gonioscopy.

Q: Dr Gardner; asks about scleral depressed exam in kids

A: Dr Kirker: may need EUA.

Comment from Dr Godinho: would be leary about extending guidelines for repair beyond 8 hrs as this will lead to too long a delay ultimately. Also asks re antibiotic coverage…

A: Dr Albiani, 4th generation ORAL fluoroquinolones offer good intravitreal penetration.