Epidemiology of pediatric eye injuries requiring hospitalization in rural areas of Wenzhou and Changsha, China: a 10-year retrospective study

A Retrospective Analysis of Epidemiological Factors and Surgical Outcomes of Patients With Ocular Trauma at Hospital Kuala Lumpur, Malaysia

Background The objective of this review is to study the demographics, aetiology, clinical findings, and surgical outcomes of patients who presented with ocular trauma and underwent emergency operations at Hospital Kuala Lumpur, Malaysia. Methods Patients who presented from 2016 to 2023 with ocular trauma and underwent emergency ocular surgery were identified and their medical records were reviewed with respect to demographics, mechanism of injury, type of injury, initial presenting visual acuity and final visual acuity after surgery. Components of the ocular trauma score (OTS) were also recorded. Results A total of 218 eyes from 214 patients were analysed. The majority of patients are male (185, 86.4%) and are young adults from the age of 21-40 (105, 49.1%). Industrial or workplace injuries are the most common cause of ocular injury (77, 36.5%) followed by domestic household accidents (43, 20.4%) and motor vehicular accidents (40, 19.0%). A total of 123 (56.4%) had open-globe injuries, 63 (28.9%) had injuries to their adnexa and 32 (14.7%) had a closed-globe injury. The majority of patients (61, 96.8%) who sustained adnexal injuries presented with mild visual impairment and had a high OTS. An overwhelming majority (96.4%) had a final visual acuity of at least 20/40 or better. For patients with closed-globe injuries, slightly more than half of them (18, 56.2%) had an OTS of 5, eight (25%) had an OTS of 4 and six (18.8%) had an OTS of 3. After surgical intervention for closed-globe injuries, the majority of patients with OTS 5 (15, 83.3%) and OTS 4 (6, 75%) had a final visual acuity of 20/40 or better. Four (66.7%) of patients with OTS 3 had a final visual acuity of 1/200 to 19/200. Most patients with open-globe injury presented with severe visual impairment and had a low OTS, which carries a poorer prognosis. Forty-one (33.3%) had OTS 1, 19 (15.4%) had OTS 2, 31 (25.2.%) had OTS 3, 31 (25.2%) had OTS 4 and only six (5.4%) had OTS 5. Even after surgical intervention to repair these open-globe injuries, 56.1% (23) of patients with OTS 1 had a vision of no perception to light (NPL) and 26.8% (11) had severe visual impairment of perception to light (PL) or hand movements (HM) after surgery. Thirty-three per cent (five) of patients with open-globe injuries and OTS 4 had final visual acuity of only PL or HM. The percentage of a better final visual outcome gradually increased for patients with higher OTS scores. Conclusion We have identified that young male adults are most at risk for sustaining ocular trauma while at the workplace and are more likely to sustain open-globe injury with lasting visual impairment. Our study also found that the OTS is a helpful tool to help healthcare practitioners predict the final visual acuity based on initial findings. Targeted approaches should be taken to reduce visual morbidity.

Pattern of eye trauma among pediatric ophthalmic patients in upper and lower Egypt: A prospective two-center medicolegal study

Background

Ocular trauma is the leading cause of monocular blindness in children. This study aimed to identify and compare pediatric ocular injuries at two national university hospitals: Benha University Hospital (BUH) and South Valley University Hospital (SVUH) while evaluating the predictive utility of the Ocular Trauma Score (OTS) for post-traumatic permanent visual infirmity.

Design and methods

This multicenter observational study enrolled children under 18 years at BUH and SVUH Ophthalmology Departments from May 31 to December 31, 2022. Comprehensive medical histories and detailed data on eye trauma were obtained, with each undergoing thorough eye examinations at the initial presentation and during the 6-month follow-up period. The final visual outcome was permanent visual infirmity that was defined as the Best Corrected Visual Acuity in the better eye worse than 3/60 or near vision worse than N6 according to the International Classification of Diseases 11.

Results

The study included 120 cases evenly distributed between the two hospitals, with a mean age of 10.03 (±3.30) years, 74.17% male and 51.67% urban residents. Blunt, sharp, and foreign objects were the most common causes (39.17%, 33.33%, and 11.67%, respectively). Closed-globe injuries prevailed at BUH (83.33%) than SVUH (40.0%). Most injuries were accidental and outdoors, with an average interval of 9.93 (±23.57) hours to seek medical care. Lack of education, open-globe injuries, poor initial visual acuity, longer intervals from admission to intervention, and lower OTS were associated with visual impairment.

Epidemiology and Visual Outcome of Pediatric Ocular Trauma in a Major Tertiary Eye Center in Tunisia: A 6-Year Retrospective Study

Purpose

To describe the epidemiological profile, clinical characteristics, and visual outcome of pediatric ocular trauma in Tunisia.

Methods

In this retrospective cohort study, we reviewed the charts of 398 children younger than 16 years of age, presenting to the Emergency Department "B" of Hedi Rais Institute of Ophthalmology, for ocular trauma. The study period was between January 1, 2013, and January 1, 2019. The final best-corrected visual acuity (BCVA) was measured at the end of the follow-up period, which was 6 months. We used the Chi-squared test to compare the two groups of final visual acuities (good vs. poor visual outcome) for different prognostic factors. The ocular trauma score (OTS) and the pediatric OTS (POTS) were calculated for each child. We used the Cohen's kappa coefficient to evaluate the agreement between our final visual acuities using OTS and POTS.

Results

The mean age was 7.95 years with a sex ratio (males to females) of 5.32. Closed-globe injury (CGI) was found in 321 eyes, while 101 eyes had open-globe injury (OGI). Injuries were bilateral in 24 children. The majority of injuries occurred at home. The predominant mechanism of injury was fall in CGI and tree branch in OGI. Initial and final BCVA were predominantly ≤0.3 logMAR in both CGI and OGI. OTS category 3 and POTS category 2 were the most common. Factors associated with poor prognosis included delay to consultation >24 h (P = 0.0001); initial BCVA >1 logMAR (P = 0.0001); OGI (P = 0.001); size of injury ≥5 mm (P = 0.01); zone III in OGI (P = 0.032); endophthalmitis (P = 0.001); OTS 1 and 2 (P = 0.01); POTS 1 (P = 0.0001); and the following associated lesions: cataract (P = 0.006), retinal detachment (P = 0.03), and intraocular foreign body (P = 0.03). We found that both OTS (P = 0.001) and POTS (P = 0.003) were predictive of the final BCVA, with a moderate agreement between them (Cohen's kappa = 0.56).

Conclusions

Studying the epidemiological profile and identifying the risk factors for poor visual outcome of pediatric ocular trauma are necessary to implement preventive measures. A thorough clinical evaluation and close patient follow-up are crucial for identifying these risk factors. Both OTS and POTS were predictive of the final visual outcome. POTS has the advantage of bypassing the initial visual acuity which may be difficult to assess in children.

Ocular Trauma in Children: An Epidemiological Study

OBJECTIVES

This study aimed to determine the epidemiology of eye injuries in children and the influential factors involved.

METHODS

Eighty cases of confirmed ocular trauma were included in this cross-sectional study. Data were obtained via a checklist containing demographic information, site of the insult, the interval between the injury and physician visit, trauma mechanism, and medical history, including previous history of ocular trauma.

RESULTS

Among 80 children with ocular trauma, 72.5% (n = 58) were boys. A marked preponderance (46.2%) of injuries was seen in the age group younger than 6 years. The youngest patient was a 1-year-old, and the oldest was aged 17. Most (76.25%) of the incidents occurred indoors. A total of 67.5% of accidents were induced by sharp objects (knife and glass). Most accidents occurred in spring, whereas the least number of accidents occurred in winter. The corneoscleral laceration was the most common manifestation, followed by the laceration of the iris, uveal prolapse, hyphema, and cataracts. Furthermore, rare cases of retinal detachment, hypopyon, and corneal epithelial defects were seen.

CONCLUSIONS

The highest incidents of ocular trauma occurred in boys, especially those younger than 6 years. The high number of sharp object injuries is also concerning. These findings provide us with evidence that further educational interventions and supervision are required in these groups to minimize the possible devastating injuries before the opportunity even arises.

A study on the clinical profile and visual outcome of pediatric ocular trauma in Eastern India

PURPOSE

Ocular trauma in children is the leading cause of ocular morbidity and unilateral blindness. This study aims to analyze the clinical profile and predictors of final visual outcomes of ocular injuries in the pediatric age group presenting to a tertiary care institute in Eastern India.

METHODS

This is a retrospective, observational study conducted on 114 cases of pediatric ocular injuries over 4 years (between 2016 and 2020) at a tertiary care academic hospital in Eastern India. All the data were analyzed based on the demography, nature of the injury, location of the injury, ocular trauma score (OTS), the initial and final visual acuity, and management protocol. The ocular trauma classification was based on the Birmingham Eye Trauma Terminology and the Ocular Trauma Classification System.

RESULTS

Majority of the injuries (n = 51, 44.7%) occurred in children between 6 and 10 years and in males from the rural areas (60.75%). The mean age of children was 9 ± 3.47 years (range: 3-16 years). Most of the injuries occurred during outdoor activities (57.9%). Majority of ocular injuries were caused by sharp objects (34, 30%), followed by blunt objects (24, 21%). Open globe injuries (OGIs) were more common (85, 48.3%) as compared to closed globe injuries (CGIs) (71, 40.3%) and nonglobe injuries (20, 11.4%). Mean OTS was 2.8 in 11-16 years indicating a good final visual outcome. Final visual outcome on multivariate analysis showed that the odds of blindness in CGI were 82% less as compared to OGI (odds ratio [OR] 0.18 [confidence interval (CI) 0.03-0.88]; P < 0.03) and that in late presenting (>6 h) group was 47% more (OR 1.47 [0.13-16.47]; P < 0.75) compared to early reporting group.

CONCLUSION

Children with ocular trauma commonly present as emergency cases, especially during the festivals in India. Our study reported OGIs to be more common with high risk for blindness. OTS is a useful tool for predicting the visual outcome of OGIs in children. Hence, strategic planning is needed with a focus on the early detection and intervention and also on creating the awareness activities for its prevention. The primary treatment is the key to a successful visual outcome.

Epidemiological Characteristics of Pediatric Ocular Trauma in China: A Multicenter Retrospective Hospital-Based Study

Purpose

The objective of the study was to obtain the incidence characteristics of pediatric ocular trauma in mainland China and provide some feasible suggestions of prevention.

Methods

The patients with pediatric ocular injuries, who were (≤14) hospitalized between January 1, 2019, and December 31, 2020, were included. Patient demographics (age and sex), injury natural characteristics (causes, site, and types), geographic location, and interval of hospital admission were analyzed.

Results

A total of 13525 cases were identified, and 1973 (14.6%) occurred in children (male accounts 70.9%) with a mean (SD) age of 6.5 (3.4) years. Cases among minors in 2020 dropped by 8.3% compared to 2019, while the former vulnerability to eye injuries has been shifted from the outdoors to home (51.4%, 1015/1973). The main causes of injury are flying objects (31.9%), traffic injury (23.5%), and blunt injury (21.8%), which lead to the main types of injury such as penetrating injury (48.3%), rupture of the globe (18.1%), and contusion trauma (13.1%). If the VA after injury is above CF, the VA after discharge is more likely to be above CF (OR 18.3, 11.9-28.1; p < 0.001). Similarly, age (OR 2.0, 1.3-3.1; p=0.001) and intraocular pressure after injury (OR 0.9, 0.9-1.0; p=0.009) also affect the intraocular pressure at discharge.

Conclusions

In mainland China, the main injury types are penetrating injury and rupture of the globe with home being the most dangerous place. Prevention strategies should focus on parents' education and protective measures indoors. Visual acuity after injury can be used as a predictor of visual acuity after treatment.

Paediatric traumatic cataracts in Southwest China: epidemiological profile

BACKGROUND

Paediatric traumatic cataracts are an important but preventable cause of acquired blindness. Understanding the epidemiology of paediatric traumatic cataracts is a prerequisite for prevention. This study aimed to characterize the epidemiological profile of paediatric traumatic cataracts in southwest China.

METHODS

The medical records of children (age range, 0-14 years old) who developed traumatic cataracts following open-globe injuries and were hospitalized at the Department of Ophthalmology at West China Hospital, between January 2011 and December 2020 were retrospectively analyzed. The demographic data, causes of injuries, posttraumatic complications, and visual acuity were recorded and analysed.

RESULTS

A total of 716 eyes from 716 patients were analysed in this study, including 521 (72.8%) males and 195 females in a gender ratio of 2.67:1; 117 of the patients were of ethnic minorities. Paediatric traumatic cataracts occurred more frequently in winter (32.5%). Sharp metal objects (scissors/knives/needles/sheet metal/nails/darts) - induced ocular injuries accounted for the highest proportion, followed by botanical sticks (wooden sticks /bamboo sticks /bamboo skewers)-induced injuries, and then stationery items (pencils/pens/rulers/paper)-induced injuries. The majority (68.7%) of the patients were aged 2-8 years, and the peak range of age was 4 - 6 years. The injuries were a result of penetrating trauma in 64.9% of patients, and blunt force trauma in the remainder (35.1%). Additionally, 131 (18.3%) cases developed posttraumatic infectious endophthalmitis after injuries. Patients with eye injuries caused by needles (P < 0.001), wooden sticks (P = 0.016), and bamboo skewers (P = 0.002) were at a greater risk of developing infectious endophthalmitis. The most common identified foreign organism was Streptococcus, which accounted for 42% (21/50) of all culture-positive specimens and was sensitive to vancomycin. Among the children who were younger than 5 years, 44.4% (55/124) of those with traumatic cataracts presented a corrected distance visual acuity less than or equal to 0.1 after undergoing cataract surgery, but among the children who were older than 5 years, this proportion was significantly smaller, just 20.4% of children aged 6-10 years (P < 0.001) and 18.4% of children aged 11-14 years (P < 0.001).

CONCLUSION

The main causative agents of paediatric traumatic cataracts in southwest China were sharp metal objects, botanical sticks, and stationery items. Specific preventive measures are essential to reduce the incidence of paediatric traumatic cataract.

Analysis of Improvement Time and Influencing Factors of Diplopia after Intermittent Exotropia in Children

Objective

To observe and analyze the occurrence rate, improvement time, and influencing factors of diplopia after intermittent exotropia in children.

Methods

A total of 135 children with intermittent exotropia treated in our hospital from February 2019 to April 2021 were recruited. A reasonable surgical plan was exerted according to the preoperative examination of the children, the children were divided into groups according to their age, degree of strabismus, visual acuity, and binocular visual function, and the postoperative diplopia occurrence rate and improvement time of diplopia in different groups were observed and compared.

Results

Postoperative diplopia occurred in 74 of 135 children with intermittent exotropia, and the postoperative incidence of diplopia was 54.81%. All diplopia occurred on the first day after the operation. There were 62 cases of contradictory diplopia (83.78%) and 12 cases of fusion of powerless diplopia (16.22%). Except for 1 case of amalgamated powerless diplopia, diplopia was not significantly improved after 6 months, which seriously affected the life of the children after the second operation, and all the others were significantly improved within 90 days. The improvement time of diplopia was 3-90 days, and the average improvement time of diplopia was 13.25 ± 3.16 days. According to their age, the children were divided into the 3-6 years old group (n = 69), the 7-10 years old group (n = 47), and the 11-14 years old group (n = 19). Postoperative diplopia occurred in 25 cases (36.23%) in the 3-6 years old group, 34 cases (72.34%) in the 7-10 years old group, and 16 cases (84.21%) in the 11-14 years old group. There was a significant difference in the incidence of postoperative diplopia among the three groups (P < 0.05). There was a significant difference in the improvement time of diplopia among the three groups (P < 0.05). According to the degree of strabismus before the operation, the children were divided into the <50△ group (n = 74) and the ≥50△ group (n = 61). Postoperative diplopia occurred in 32 cases (43.24%) in the <50△ group and 43 cases (70.49%) in the ≥50△ group. There was a significant difference in the incidence of postoperative diplopia between the two groups (P < 0.05). There was a significant difference in the improvement time of diplopia among the three groups (P < 0.05). According to the results of the visual acuity examination, the patients were divided into the ≥0.8 (naked eye) group (n = 21), the ≥0.8 (ametropia) group (n = 32), and the <0.8 (amblyopia) group (n = 32). Among them, diplopia occurred in 10 cases (47.62%) in the ≥0.8 (naked eye) group, 40 cases (48.78%) in the ≥0.8 (ametropia) group, and 24 cases (75.00%) in the <0.8 (amblyopia) group. The incidence of diplopia in the <0.8 (amblyopia) group was significantly higher than that in the ≥0.8 (naked eye) group and the ≥0.8 (ametropia) group, and the difference was statistically significant (P < 0.05). The postoperative diplopia improvement time in the <0.8 (amblyopia) group was significantly higher than that in the ≥0.8 (naked eye) group and the ≥0.8 (ametropia) group, and the difference was statistically significant (P < 0.05). There was no significant difference in diplopia occurrence rate and diplopia improvement time between the ≥0.8 (naked eye) group and the ≥0.8 (ametropia) group (P > 0.05). According to the results of binocular visual function examination, 92 cases had a primary function, 45 cases (48.91%) had diplopia after the operation, the average recovery time of diplopia was 12.58 ± 3.16, 43 cases had no primary function, and 30 cases (69.77%) had diplopia after the operation. The average recovery time of diplopia was 13.02 ± 3.84. There was a significant difference in the incidence of diplopia between the two groups (χ 2 = 5.162). There was no significant difference in the recovery time of diplopia between the two groups (χ 2 = 0.570, P < 0.05). In 80 cases with secondary function, diplopia occurred in 36 cases (45.00%), and the average recovery time of diplopia was 10.14 ± 2.88; in 55 cases without secondary function, diplopia occurred in 39 cases (70.91%), and the average recovery time of diplopia was 14.86 ± 3.73. There was a significant difference in the incidence of diplopia between the two groups (χ 2 = 8.861, P < 0.002). There was a significant difference in the recovery time of diplopia between the two groups (χ 2 = 6.469, P < 0.001). In 77 cases with tertiary function, diplopia occurred in 32 cases (41.56%), and the average recovery time of diplopia was 9.61 ± 2.39; in 58 cases without tertiary function, diplopia occurred in 43 cases (74.14%), and the average recovery time of diplopia was 13.11 ± 3.05. There was a significant difference in the incidence of diplopia between the two groups (χ 2 = 14.221 P < 0.001). There was a significant difference in the recovery time of diplopia between the two groups (χ 2 = 5.355, P < 0.001).

Conclusions

The age, degree of strabismus, visual acuity, and binocular visual function of children with intermittent exotropia are significant factors affecting the occurrence rate and recovery time of diplopia after the operation. The younger the age, the smaller the degree of strabismus, the better the vision and the second or third grade of visual function, the smaller the occurrence rate of diplopia, and the shorter the recovery time of diplopia. Thus, the above influencing factors have a certain guiding significance in predicting the improvement of postoperative diplopia and the time of diplopia disappearance. The purpose of intermittent exotropia surgery in children is not only to correct eye position and improve appearance but also to establish normal retinal correspondence in order to obtain binocular monocular function. Furthermore, postoperative diplopia in children with concomitant exotropia is very common; therefore, careful examination, comprehensive analysis, and surgical plan should be designed according to the above factors. Stereoscopic vision training as early as possible after the operation is beneficial to the establishment of normal retinal correspondence and the elimination of diplopia.

Pediatric Open Globe Injury in a University-Based Tertiary Hospital in the Anatolian Region

Objective: Evaluation of the epidemiological and clinical features of pediatric open globe injury. Methods: Medical records of 51 patients under the age of 18 who presented to the emergency department with open globe injury (OGI) between 2009 and 2021 were evaluated retrospectively. Patient demographics, Birmingham Eye Trauma Terminology (BETT) category, pediatric ocular trauma score (POTS), visual acuity (VA), site of injury, and seasonal distribution were evaluated. Results: Of all patients included, 40 (78.4%) were male, 11 (21.6%) were female, and the mean age was 9.6±5.2 years. Zone I injury was detected in 31 (60.8%) patients. The most common cause of injury was sharp objects such as metal or wood splinters. Of all injuries, 29 (56.9%) occurred outdoors. Ocular trauma occurred more frequently in boys, especially in the summer months. Initial VA was less than 0,1 in 21 (41.2%) of the patients, between 0.1-0.5 in 9 (17.6%) and 0.6 and above in 5 (9.8%) patients. At the final visit, VA was less than 0.1 in 9 (17.6%) patients, 0.1-0.5 in 10 (19.6%) patients, and 0.6 and above in 18 (35.3%) patients. Final VA was related to the Zone and was lower as the Zone increased (p:0.011). VA and POTS scores were positively correlated at the final visit (p=0.001). Conclusion: It is substantial for emergency physicians to have a comprehensive understanding of pediatric globe injuries so that children with suspected ocular trauma should be evaluated by an ophthalmologist to prevent medicolegal problems.

Epidemiology of Pediatric Open Globe Injuries in a University Hospital in Thailand

Objective: To describe the epidemiology, clinical characteristics, and clinical outcomes of pediatric traumatic open globe injuries and to determine the risk factors for poor visual outcome.

Methods: The medical records of patients aged younger than 15 years of age who were diagnosed with open globe injuries from January 2005 to December 2015 were retrospectively reviewed. The patients’ demographic data were collected, including age, sex, injury date, place of injury, mechanism of injury, cause of injury, and the activity related to the injury. Clinical data were recorded, including initial visual acuity (VA), wound size, wound location, associated ocular findings at presentation, and complications. The prognostic factors for a poor visual outcome were assessed.

Results: In total, 46 pediatric patients were included in this study. The mean age was 6.8 years old. Most patients were male (65.2%). The most common type of injury was penetrating injury (60.9%) and mostly occurred during playing (60.9%). Household appliances/furniture and scissors/knives were common causes of injuries (17.4%, 15.2%, respectively). Poor final VA worse than 6/60 was found in 17 patients (37%). Wound location and retinal detachment (RD) at the time of presentation were significant prognostic factors for a poor visual outcome according to the univariate analysis (p = 0.008, <0.001). Only wound location at zone II and III was found to be significantly correlated with poor final VA in the multivariate analysis (adjusted risk ratio (RR) = 2.87, 95% confidence interval (CI), 1.26-6.55, p = 0.012). Traumatic cataract was the most common associated injury (45.7%).

Conclusions: One-third of pediatric patients with open globe injuries had a poor visual outcome. Wound location at zone II and III significantly correlated with a poor visual outcome in pediatric open globe injuries. The parents and caregivers should be made aware of the seriousness of open globe injuries in order to prevent children from possible injuries.

Firework injuries are increasing in the United States: An analysis of the National Emergency Department Sample

BACKGROUND

Firework-related injuries cause significant morbidity to persons in the United States and globally. Prior studies have shown that hands and eyes are frequently injured, with loss of hand function and blindness being common after serious injury. Many jurisdictions in the United States have relaxed laws governing sales of consumer fireworks in recent years. Given the increased availability of consumer fireworks, we sought to determine the incidence of firework-related injuries compared with historical controls.

METHODS

Firework-related injuries were identified in the National Emergency Department Sample (NEDS) using the corresponding International Classification of Disease codes for the years 2008-2017. Demographics, timing of presentation, and hospital characteristics were analyzed. Data were weighted to approximate population estimates of injury. Statistical analyses were completed using SAS. The National Electronic Surveillance System was also queried for firework-related visits to check for consistency in observed trends.

RESULTS

There were an estimated 7699 injuries attributed to fireworks in 2017 (2.37 per 100,000 population) compared with 5727 (1.88 per 100,000 population) in 2008. The majority of victims were male (74.6%), and injuries clustered in the pediatric and young adult age groups. The Midwest and South (both 38.1%) had more firework-related injuries compared with the West (15.6%) and Northeast (8.2%) regions. Most visits occurred in July (71.4%) with smaller peaks in June (6.9%) and January (6.0%). Patients were disproportionately seen in trauma centers (34.0%) and teaching hospitals (49.6%).

CONCLUSION

Emergency department visits for firework injuries are increasing in the United States. Pediatric patients and young adult males comprise the majority of victims. Injuries are clustered around the Fourth of July and New Year's holidays. Public health interventions targeted at high-risk groups may reduce the burden of injury.

Rupture of the Globe: What to Do, What not to Do

Due to their complexity, globe ruptures are highly compromising traumas for the patient. This is due on the one hand to the eye injury itself with the accompanying loss of vision and on the other hand due to the need for extended treatment with uncertain prognosis and the resulting psychological stress. Globe ruptures are among the prognostically most unfavorable injuries due to the force and peak pressure impacting the eye. Furthermore, contusional retinal necrosis may be of significance prognostically. In the present review, we discuss treatment of globe ruptures involving retinal surgery. We discuss the primary sugery, its chronological planning and extent as well as the necessity for follow-up interventions. We also discuss the origin of traumatic retinal detachment with differential diagnosis of giant retinal tear versus oradialysis as well as secondary sequelae of traumas such as formation of macular holes and their treatment. On this basis, the use of buckling surgery versus pars-plana vitrectomy is discussed. Further focus is set on the role of the iris lens diaphragm in surgery of globe ruptures.