[Severe open globe injury. New treatment concepts].

In spite of the technical progress in vitreoretinal surgery, the anatomical and functional results of severe ocular injuries involving the posterior segment are still discouraging. Perforating injuries and ruptures that extend posterior to the muscle insertions have the worst outcomes. When the secondary intervention is usually performed between days 7 and 14 post trauma, it is not unlikely that a severe proliferative vitreoretinopathy has already occurred. With a new concept--to act rather than to react to alterations secondary to severe posterior segment trauma--the functional results of these injuries may be further improved, according to various studies. The internal reconstruction is in part performed together with the primary wound closure, or, alternatively, within 100 h after the trauma. This idea is currently being further evaluated in a prospective multicenter multinational study conducted by the World Eye Injury Register.