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Pelletier J, Koyfman A, Long B. High risk and low prevalence diseases: Open globe injury. Am J Emerg Med 2023; 64:113-120. [PMID: 36516669 DOI: 10.1016/j.ajem.2022.11.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 11/20/2022] [Accepted: 11/29/2022] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Open globe injury (OGI) is a rare but serious condition that carries with it a high rate of morbidity. OBJECTIVE This review highlights the pearls and pitfalls of OGI, including presentation, diagnosis, and management in the emergency department (ED) based on current evidence. DISCUSSION OGI refers to full-thickness injury to the layers of the eye. OGI can be caused by blunt or sharp trauma, and subtypes include penetration, perforation, intraocular foreign body (IOFB), globe rupture, or mixed types. OGI is more common in males and usually secondary to work-related injury, but in women it is most commonly associated with falls. Emergency clinicians should first assess for and manage other critical, life-threatening injuries. Following this assessment, a thorough eye examination is necessary. Computed tomography (CT) may suggest the disease, but it cannot definitively exclude the diagnosis. While point-of-care ultrasound (POCUS) is highly sensitive and specific for some findings in OGI, its use is controversial due to potential globe content extrusion. Management includes protecting the affected eye from further injury, preventing Valsalva maneuvers that could extrude ocular contents, updating tetanus vaccination status, administering broad-spectrum antibiotics, and ophthalmology consultation for surgical intervention to prevent the sequelae of blindness and endophthalmitis. CONCLUSION An understanding of OGI can assist emergency clinicians in diagnosing and managing this sight-threatening traumatic process.
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Affiliation(s)
- Jessica Pelletier
- Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Alex Koyfman
- Department of Emergency Medicine, UT Southwestern, Dallas, TX, USA
| | - Brit Long
- SAUSHEC, Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, TX, USA.
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Placide J, Ip CS, Le BHA, Ali SF, Ghergherehchi LM. An Update on the Management of Traumatic Pediatric Open Globe Repair: Prognostication and Complication Management. Int Ophthalmol Clin 2022; 62:203-218. [PMID: 34965235 DOI: 10.1097/iio.0000000000000399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Osterried L, Gruber M, Böhringer D, Agostini H, Reinhard T. The Upper Paralimbal Zone is Especially Susceptible to Ruptures Due to Blunt Trauma. Klin Monbl Augenheilkd 2021; 239:1248-1258. [PMID: 34731899 DOI: 10.1055/a-1521-5124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Globe ruptures are ophthalmological emergencies where the primary diagnosis using a slit lamp is often a challenge. OBJECTIVES The retrospective case study aimed to characterise the predilection sites, the demographic profile and the causes of bursts due to blunt globe trauma. MATERIALS AND METHODS The surgical plan of the Eye Centre of the Medical Centre (University of Freiburg) was electronically searched using the keyword "globe rupture" over a period of 18 years (2000 - 2018). This led to 350 hits, which were scrutinised by hand. 134 globe ruptures due to blunt globe trauma were then identified. RESULTS The most common predilection sites were the upper nasal and the upper temporal paralimbal zones with 37 and 32% of the examined globe ruptures, respectively. The average age at the time of rupture was 60 (from 2 to 97) years. The median age was 62.5 years. 37% (49/134) of patients were female. The most frequent causes of accidents were falls (43%), "flying" wooden and metal objects (18%) and acts of violence (10%). CONCLUSIONS Special attention should be paid to the upper paralimbal zone in the exploratory primary care of globe ruptures. If the rupture occurred due to "flying" wooden and metal objects, the posterior sclera burst most frequently. The epidemiological data suggest that targeted prevention against falls for individuals over 60 years and consistent wearing of protective eyewear when working with wood or metal could reduce the incidence of bulbar bursting. It was also noticeable that acts of violence were the third most frequent cause of rupture, although woman did not report that they were affected by this. Given the high occurrence of violence against women, shame and stigma may lead to an incorrect inquiry about the cause of the accident. This could be mitigated by training employees specifically to take a sensitive history.
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Affiliation(s)
- Lea Osterried
- Klinik für Augenheilkunde, Universitätsklinikum Freiburg, Deutschland
| | - Markus Gruber
- Klinik für Augenheilkunde, Universitätsklinikum Freiburg, Deutschland
| | - Daniel Böhringer
- Klinik für Augenheilkunde, Universitätsklinikum Freiburg, Deutschland
| | | | - Thomas Reinhard
- Klinik für Augenheilkunde, Universitätsklinikum Freiburg, Deutschland
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Wolf A, Schrader W, Agostini H, Gabel-pfisterer A. Diagnostik und Akuttherapie von Augenverletzungen durch Feuerwerkskörper. Ophthalmologe 2019; 116:1152-1161. [DOI: 10.1007/s00347-019-01000-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Arad T, Voßmerbäumer U, Pfeiffer N, Gericke A. Bulbustrauma durch Konfettipartikel. Ophthalmologe 2018; 115:1056-1058. [DOI: 10.1007/s00347-018-0672-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Chronopoulos A, Ong JM, Thumann G, Schutz JS. Occult globe rupture: diagnostic and treatment challenge. Surv Ophthalmol 2018; 63:694-699. [DOI: 10.1016/j.survophthal.2018.04.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 03/27/2018] [Accepted: 04/02/2018] [Indexed: 11/17/2022]
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Crowell EL, Koduri VA, Supsupin EP, Klinglesmith RE, Chuang AZ, Kim G, Baker LA, Feldman RM, Blieden LS. Accuracy of Computed Tomography Imaging Criteria in the Diagnosis of Adult Open Globe Injuries by Neuroradiology and Ophthalmology. Acad Emerg Med 2017; 24:1072-1079. [PMID: 28662312 DOI: 10.1111/acem.13249] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 06/06/2017] [Accepted: 06/25/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The objective was to evaluate the sensitivity and specificity of computed tomography (CT) diagnosis of open globes, determine which imaging factors are most predictive of open globe injuries, and evaluate the agreement between neuroradiologist and ophthalmologist readers for diagnosis of open and closed globes. METHODS This study was a retrospective cohort study. Patients who presented to Memorial Hermann-Texas Medical Center with suspicion for open globes were reviewed. One neuroradiologist and two ophthalmologists masked to clinical information reviewed CT images for signs concerning for open globe including change in globe contour, anterior chamber deformation, intraocular air, vitreous hemorrhage, subretinal fluid indicating retinal or choroidal detachment, dislocated or absent lens, intraocular foreign body, and orbital fracture. Using the clinically or surgically confirmed globe status as the true globe status, sensitivity, specificity, and agreement (kappa) were calculated and used to investigate which imaging factors are most predictive of open globe injuries. RESULTS A total of 114 patients were included: 35 patients with open globes and 79 patients with closed globes. Specificity was greater than 97% for each reader, and sensitivity ranged from 51% to 77% among readers. The imaging characteristics most consistently used to predict an open globe injury were change in globe contour and vitreous hemorrhage (sensitivity = 43% to 57%, specificity > 98%). The agreement of impression of open globe between the neuroradiologist and ophthalmologists was good and excellent between ophthalmologists. CONCLUSIONS Computed tomography imaging is not absolute, and the sensitivity is still inadequate to be fully relied upon. The CT imaging findings most predictive of an open globe injury were change in globe contour and vitreous hemorrhage. Clinical examination or surgical exploration remains the most important component in evaluating for a suspected open globe, with CT imaging as an adjunct.
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Affiliation(s)
- Eric L. Crowell
- Ruiz Department of Ophthalmology and Visual Science; McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth); Houston TX
- Robert Cizik Eye Clinic; Houston TX
- Memorial Hermann-Texas Medical Center; Houston TX
| | - Vivek A. Koduri
- Ruiz Department of Ophthalmology and Visual Science; McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth); Houston TX
| | - Emilio P. Supsupin
- Department of Diagnostic and Interventional Imaging; McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth); Houston TX
- Memorial Hermann-Texas Medical Center; Houston TX
| | | | - Alice Z. Chuang
- Ruiz Department of Ophthalmology and Visual Science; McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth); Houston TX
| | - Gene Kim
- Ruiz Department of Ophthalmology and Visual Science; McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth); Houston TX
- Robert Cizik Eye Clinic; Houston TX
- Memorial Hermann-Texas Medical Center; Houston TX
| | | | - Robert M. Feldman
- Ruiz Department of Ophthalmology and Visual Science; McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth); Houston TX
- Robert Cizik Eye Clinic; Houston TX
- Memorial Hermann-Texas Medical Center; Houston TX
| | - Lauren S. Blieden
- Ruiz Department of Ophthalmology and Visual Science; McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth); Houston TX
- Robert Cizik Eye Clinic; Houston TX
- Memorial Hermann-Texas Medical Center; Houston TX
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Yucel OE, Demir S, Niyaz L, Sayin O, Gul A, Ariturk N. Clinical characteristics and prognostic factors of scleral rupture due to blunt ocular trauma. Eye (Lond) 2016; 30:1606-1613. [PMID: 27589050 DOI: 10.1038/eye.2016.194] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 07/11/2016] [Indexed: 11/09/2022] Open
Abstract
PurposeTo describe and identify ocular and wound characteristics, and prognostic factors associated with final visual acuity (VA) in patients with scleral rupture due to blunt ocular trauma.MethodsThe medical records of 61 patients with globe rupture due to blunt ocular trauma who underwent primary repair were reviewed retrospectively. The data recorded included demographic characteristics, initial and final VA, ocular signs, wound characteristics, and surgeries. Initial VA, ocular signs, wound characteristics, and surgeries were analyzed to determine the association with the final VA.ResultsForty three women and 18 men with a mean age of 43.6±23.5 years were included in the study. The locations of scleral wounds were mostly in the superonasal quadrant (41.0%) and zone 2 (75.4%). In eyes with hyphema (P=0.009), vitreous hemorrhage (P=0.001), and retinal detachment (P=0.004), final VA was statistically worse than eyes without these signs. A moderate positive correlation was found between the initial and final VA (P<0.001). Final VA was statistically worse in eyes with horizontal midline wounds than in eyes with vertical midline wounds (P=0.002). A moderate negative correlation was found between scleral wound length and final VA (P<0.001). Patients who underwent cataract surgery had statistically better final VA (P=0.002).ConclusionsScleral rupture was detected mostly in females, superonasal quadrant and zone 2. Poor final VA was significantly associated with poor initial VA, longer wound length, horizontal midline wound, presence of hyphema, vitreous hemorrhage and retinal detachment at presentation, and cataract surgery not performed during follow-up period. Scleral ruptures have different demographic, ocular and wound characteristics than other open globe injuries.
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Affiliation(s)
- O E Yucel
- Department of Ophthalmology, Medical Faculty, Ondokuz Mayis University, Samsun, Turkey
| | - S Demir
- Department of Ophthalmology, Medical Faculty, Gaziosmanpasa University, Tokat, Turkey
| | - L Niyaz
- Department of Ophthalmology, Medical Faculty, Ondokuz Mayis University, Samsun, Turkey
| | - O Sayin
- Clinic of ophthalmology, Develi Hatice Muammer Kocaturk State Hospital, Kayseri, Turkey
| | - A Gul
- Department of Ophthalmology, Medical Faculty, Ondokuz Mayis University, Samsun, Turkey
| | - N Ariturk
- Department of Ophthalmology, Medical Faculty, Ondokuz Mayis University, Samsun, Turkey
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Margo JA, Feldman S, Addis H, Bodanapally UK, Ellish N, Saeedi O. Open Globe Injuries Presenting With Normal or High Intraocular Pressure. Eye Contact Lens 2016; 42:256-61. [PMID: 26372477 DOI: 10.1097/ICL.0000000000000188] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To determine the frequency, clinical characteristics, and visual outcomes of patients who present with high or normal intraocular pressure (IOP) and open globe injuries. DESIGN Retrospective chart review. SETTING University of Maryland Medical Center, a level 1 trauma center. PATIENT OR STUDY POPULATION All cases of open globe injury presenting to The University of Maryland Medical Center from July 2005 to January 2014. OBSERVATION Demographics, initial physical examination, computed tomography findings, IOP of the affected and unaffected eyes, and follow-up evaluations. MAIN OUTCOME MEASURES (1) IOP 10 mm Hg or greater and (2) visual acuity. RESULTS Of 132 eyes presenting with open globe injury, IOP was recorded in 38 (28%). Mean IOP for the affected and unaffected eyes was 14±10.3 mm Hg and 16.6±4.1 mm Hg, respectively. Twenty-three (59.4%) eyes had IOP greater than 10 mm Hg. Six eyes (16.2%) had IOP greater than 21 mm Hg. Using bivariate analysis, IOP greater than 10 mm Hg was associated with posterior open globe injury (P=0.01), posterior hemorrhage (P=0.04), and intraconal retrobulbar hemorrhage (P=0.05). Adjusting for age, sex, and race, IOP greater than 10 mm Hg was associated with the presence of posterior open globe injury on clinical examination (P=0.04). Higher presenting IOP was found to predict light perception or worse vision (P=0.01). Multivariate analysis showed that poor presenting vision was the best predictor of poor final vision (P<0.01). CONCLUSIONS High IOP does not exclude open globe injury. It is a frequent finding in patients with open globe injuries and may be associated with posterior injury and poor visual prognosis.
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Dharmasena A, Park DY, Vishwanath M. Does high intraocular pressure exclude an open globe injury? Int J Ophthalmol 2014; 7:389-90. [PMID: 24790891 DOI: 10.3980/j.issn.2222-3959.2014.02.36] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Accepted: 11/25/2013] [Indexed: 11/02/2022] Open
Affiliation(s)
- Aruna Dharmasena
- Manchester Royal Eye Hospital, Manchester M13 9WH, United Kingdom
| | - Dong Young Park
- Manchester Royal Eye Hospital, Manchester M13 9WH, United Kingdom
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Affiliation(s)
- Kwan Hoon Lee
- Department of Ophthalmology, Dankook University College of Medicine, Cheonan, Korea
| | - Won Hyuk Lee
- Department of Ophthalmology, Armed Forces Cpital Hospital, Seongnam, Korea
| | - Jae Hoon Jeong
- Department of Ophthalmology, Armed Forces Cpital Hospital, Seongnam, Korea
| | - Young Min Park
- Department of Ophthalmology, School of Medicine, Pusan National University & Medical Research Institute, Pusan National University Hospital, Busan, Korea
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Abstract
A 3½-year-old, female (spayed) working black Labrador Retriever was referred to the Unit of Comparative Ophthalmology at the Animal Health Trust after a penetrating lead gunshot injury to the right eye. Clinical examination revealed penetrating injuries to the right cornea, left lateral canthus, and left forelimb. Radiography revealed the presence of multiple metallic foreign bodies in the head and one in the left forelimb. B-mode ocular ultrasonography confirmed the presence of an intraocular metallic foreign body within the posterior tunics of the right eye. Medical treatment of the right eye over a period of 1 month resulted in a comfortable, visual eye. Long-term follow-up over 4½ years revealed a slow deterioration in vision because of progressive lens opacification and the presence of a localized area of chorioretinopathy.
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Affiliation(s)
- Jane Sansom
- Centre for Small Animal Studies, Animal Health Trust, Lanwades Park, Kentford, Newmarket, Suffolk CB8 7UU, UK.
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Abstract
PURPOSE To assess the prognostic value of a new ocular trauma score (OTS) in pediatric penetrating injuries. METHODS Children ≤ 15 years of age that presented to the emergency room with penetrating eye injuries between April 2007 and August 2008 were evaluated prospectively. All patients were reviewed on the basis of age, gender, time of injury and how it happened, time of admission, time of surgery, type of penetrating injury, initial and final visual acuity (VA), and concomitant eye pathology. Injuries were classified based on a new OTS, and we assessed the relationship with final VA and the new OTS. RESULTS In total, 30 eyes in 29 patients (41.38% female, 58.62% male) with a mean age of 6.83 ± 4.00 years (range: 1-15 years) were included in the study. Initial VA, which was evaluated in 22 patients, was as follows: no light perception (NLP) in 2 (9.09%) patients, light perception (LP) to hand motion (HM) in 8 (36.36%) patients, counting fingers in 6 (27.27%) patients, 0.1-0.5 in 4 (18.18%) patients, and ≥ 0.6 in 2 (9.09%) patients. Final VA, which was evaluated in 27 patients, was as follows: NLP in 3 (11.11%) patients, LP to HM in 3 (11.11%) patients, counting fingers in 2 (7.41%) patients, 0.1-0.5 in 11 (40.74%) patients, and ≥ 0.6 in 8 (29.63%) patients. The relationship between initial VA and final VA was statistically significant (P < 0.001). CONCLUSIONS The new OTS calculated at initial examination may be of prognostic value in children with penetrating eye injuries.
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Affiliation(s)
- U Acar
- Ministry of Health, Ankara Diskapi Yildirim Beyazit Training and Research Hospital, Department of Ophthalmology, Ankara, Turkey.
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Macsai MS. Surgical Management and Rehabilitation of Anterior Segment Trauma. Cornea 2011. [DOI: 10.1016/b978-0-323-06387-6.00154-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Motolese I, Motolese PA, Frezzotti P, Fruschelli M, Motolese E. Pseudophakic eye globe disruption. Eur J Ophthalmol 2010; 20:966-8. [PMID: 20155701 DOI: 10.1177/112067211002000527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Scleral rupture due to bulb bursting can result from a heavy contusion. Owing to refined surgical techniques and the use of antibiotics and cortisone-based medication, more conservative concepts have followed. In major ruptures, the results were almost always very poor, with atrophy or subatrophy of the eyes. METHODS A 63-year-old man with major left ocular trauma and intraocular lens dislocation in the subconjunctival area was referred to the authors for clinical and surgical evaluation. RESULTS Surgery was performed 3 weeks after the trauma to allow for improvement in the patient's condition. The reabsorption of a palpebral-frontal hematoma, which made bulb exploration almost impossible, was fundamental in order to proceed. After 1 year, the best-corrected visual acuity was 0.9. In fact, great improvements in surgical techniques in recent years have allowed us to consider the problem of major rupture in a new way, both technically and from an organizational point of view. CONCLUSIONS In terms of organization, the concept of urgent surgical procedures must be reevaluated, because besides traumatic damage, incomplete surgical measures may result. This makes all treatment useless, in both barely equipped and highly specialized centers.
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Affiliation(s)
- Ilaria Motolese
- Department of Ophthalmology, University of Siena, Siena, Italy.
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Jing Y, Yi-qiao X, Yan-ning Y, Ming A, An-huai Y, Lian-hong Z. Clinical analysis of firework-related ocular injuries during Spring Festival 2009. Graefes Arch Clin Exp Ophthalmol 2010; 248:333-8. [DOI: 10.1007/s00417-009-1292-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2009] [Revised: 12/23/2009] [Accepted: 12/24/2009] [Indexed: 10/19/2022] Open
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Takayama K, Yasukawa T, Okada M, Sumida A, Watanabe N, Uchida S. Large blunt scleral rupture without retinal detachment. Ophthalmic Surg Lasers Imaging Retina 2008; 39:242-5. [PMID: 18556952 DOI: 10.3928/15428877-20080501-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Eyes with scleral rupture after blunt trauma are often complicated by proliferative vitreoretinopathy. A 56-year-old man sustained blunt trauma to his left eye. Visual acuity was light perception. The fundus was obscured by hyphema. Computed tomography imaging and the presence of extensive subconjunctival hemorrhage suggested scleral rupture. Prompt primary surgery to repair a 25-mm scleral rupture was performed under general anesthesia. No retinal detachment developed. Two years postoperatively, visual acuity increased to 12/20. This case shows that retinal detachment and proliferative vitreoretinopathy may not complicate extensive scleral ruptures under certain circumstances.
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Affiliation(s)
- Kohei Takayama
- Department of Ophthalmology, Kurashiki Central Hospital, Kurashiki, Japan
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Arey ML, Mootha VV, Whittemore AR, Chason DP, Blomquist PH. Computed tomography in the diagnosis of occult open-globe injuries. Ophthalmology 2007; 114:1448-52. [PMID: 17678689 DOI: 10.1016/j.ophtha.2006.10.051] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2006] [Revised: 10/07/2006] [Accepted: 10/17/2006] [Indexed: 10/23/2022] Open
Abstract
PURPOSE To determine the radiographic signs present on computed tomography (CT) most suggestive of occult open-globe injury. DESIGN Retrospective chart review. PARTICIPANTS Forty-eight eyes (of 46 patients), 34 of which were found to have an occult open-globe injury on surgical exploration. METHODS A retrospective chart review of all eyes of patients 18 years or older undergoing surgical exploration to rule out occult open-globe injury after CT examination at Parkland Memorial Hospital between October, 1998, and September, 2003, was conducted. Patients with obvious corneal or corneoscleral lacerations or with uveal prolapse were excluded. The CT films were obtained and independently reviewed by 3 masked observers (2 neuroradiologists and 1 ophthalmologist). MAIN OUTCOME MEASURES Presence of occult open-globe injury with respect to radiographic globe and orbital findings. RESULTS The sensitivity of CT for determining occult open-globe injury varied from 56% to 68% between the observers, specificity ranged from 79% to 100%, positive predictive value ranged from 86% to 100%, and negative predictive value ranged from 42% to 50%. Open-globe injuries averaged more CT findings per patient compared with intact globes (P = 0.047). Statistically significant CT findings for occult open-globe injury included any change in globe contour (P = 0.001), obvious volume loss (P = 0.003), an absent or dislocated lens (P = 0.048), vitreous hemorrhage (P = 0.003), and retinal detachment (P = 0.044). Additionally, moderate to severe change in globe contour, obvious volume loss, total vitreous hemorrhage, and absence of lens were seen only in eyes with occult rupture. CONCLUSIONS Although CT scanning may provide valuable information in patients in whom an occult open-globe injury is suspected, its sensitivity and specificity are inadequate to be relied on fully, and such patients generally should be taken to the operating room for formal surgical evaluation. Significant changes in globe contour or obvious volume loss are strong predictors of globe rupture, and any vitreous hemorrhage should be a concern for occult injury.
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Affiliation(s)
- Mark L Arey
- Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, Texas 75390-9057, USA
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Schmidt GW, Broman AT, Hindman HB, Grant MP. Vision survival after open globe injury predicted by classification and regression tree analysis. Ophthalmology 2007; 115:202-9. [PMID: 17588667 DOI: 10.1016/j.ophtha.2007.04.008] [Citation(s) in RCA: 143] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2006] [Revised: 04/04/2007] [Accepted: 04/04/2007] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVE To assist ophthalmologists in treating ocular trauma patients, this study developed and validated a prognostic model to predict vision survival after open globe injury. DESIGN Retrospective cohort review. PARTICIPANTS Two hundred fourteen patients who sought treatment at the Wilmer Ophthalmological Institute with open globe injuries from January 1, 2001, through December 31, 2004, were part of the data set used to build the classification tree model. Then, to validate the classification tree, 51 patients were followed up with the goal to compare their actual visual outcome with the outcome predicted by the tree grown from the classification and regression tree analysis. METHODS Binary recursive partitioning was used to construct a classification tree to predict visual outcome after open globe injury. The retrospective cohort treated for open globe injury from January 1, 2001, through December 31, 2004, was used to develop the prognostic tree and constitutes the training sample. A second independent sample of patient eyes seen from January 1, 2005, through October 15, 2005, was used to validate the prognostic tree. MAIN OUTCOME MEASURES Two main visual outcomes were assessed: vision survival (range, 20/20-light perception) and no vision (included no light perception, enucleation, and evisceration outcomes). RESULTS A prognostic model for open globe injury outcome was constructed using 214 open globe injuries. Of 14 predictors determined to be associated with a no vision outcome in univariate analysis, presence of a relative afferent pupillary defect and poor initial visual acuity were the most predictive of complete loss of vision; presence of lid laceration and posterior wound location also predicted poor visual outcomes. In an independent cohort of 51 eyes, the prognostic model had 85.7% sensitivity to predict no vision correctly and 91.9% specificity to predict vision survival correctly. CONCLUSIONS The open globe injury prognostic model constructed in this study demonstrated excellent predictive accuracy and should be useful in counseling patients and making clinical decisions regarding open globe injury management.
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Affiliation(s)
- G W Schmidt
- Wilmer Ophthalmological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA
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Abstract
PURPOSE We investigated the epidemiology, clinical findings and functional outcome of open-globe injuries caused by cow horns over a 50-year period in eastern Switzerland. METHODS We retrospectively evaluated the files of cases with ruptures of the globe caused by cow horns between 1950 and 1999. RESULTS We found 59 cases with ruptures of the globe by cow horns, accounting for 5% of all open-globe injuries. The incidence of these accidents did not change during the observation period. Twenty-two eyes (37%) were enucleated. Only 7 eyes (12%) retained a vision of > or = 0.1. Between 1950 and 1989 only 2/43 eyes (5%) reached a vision of > or = 0.1. In the 1990's, with the introduction of vitreous surgery 5/16 eyes (31%) had a vision of > or = 0.1. Four patients (7%) had blinding eye disease in the partner eye, and three (5%) had a second open-globe trauma. CONCLUSIONS In rural regions, with cattle breeding, open-globe injuries by cow horns are relatively common and the frequency is still the same as 50 years ago. The visual prognosis of these eyes is still guarded, but functional results have improved with the introduction of vitreous surgery. Patients who have had a rupture of the globe appear to have an increased risk for partner eye trauma. Therefore, all efforts are justified to preserve even limited vision in severely injured eyes.
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Affiliation(s)
- H Helbig
- Department of Ophthalmology, Kantonsspital St. Gallen, Switzerland.
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23
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Sathish S, Chakrabarti A, Prajna V. Traumatic Subconjunctival Dislocation of the Crystalline Lens and Its Surgical Management. Ophthalmic Surg Lasers Imaging Retina 1999. [DOI: 10.3928/1542-8877-19990901-16] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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24
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Abstract
PURPOSE The purpose of this investigation was to evaluate the surgeon's ability to assess various types of globe injury, to determine the force necessary to rupture the globe with these types of injuries, and to determine typical orbital retraction forces used in the clinical setting. MATERIALS AND METHODS Forty-four enucleated globes from recently killed cows were divided into four equal groups-one uninjured control group, one group with a through-and-through scleral laceration, another group with a subtotal scleral laceration, and the last group with an 18-gauge needle perforation. Twenty-seven boarded or board eligible oral and maxillofacial surgeons were asked to assess one sample from each of the four groups. They were then asked to retract a simulated globe on a custom-fabricated jig to determine clinical retraction forces. Ten globes from each of the four groups were then subjected to forces until rupture on an Instron 8501M mechanical testing unit. Accuracy of the clinical assessment was determined, and means and standard deviations of the retraction forces and globe rupture forces were derived. RESULTS Through-and-through lacerations were assessed by surgeons with 100% accuracy, subtotal lacerations with 96% accuracy, uninjured globes with 74% accuracy, and perforated globes with 15% accuracy. Globe rupture occurred at 16.72+/-7.87 kg in the control group, 20.36+/-7.87 kg in the perforated group, 15.38+/-6.06 kg in the subtotal laceration group, and 4.94+/-2.56 kg in the through-and-through laceration group. Statistically significant differences (P < .001) were noted between the total laceration group and all other groups. The mean retraction force was 0.35+/-0.47 kg, which was statistically less than the force used in all of the rupture groups (P < .001). CONCLUSIONS Severe injuries (through-and-through lacerations) were assessed with 100% accuracy by the clinicians, and less severe injuries with less accuracy. Rupture forces for globes with perforations and subtotal lacerations were no different than for the control group, but substantially less than for the total laceration group. The simulated clinical retraction forces were substantially more than the rupture forces in all of the groups, including the through-and-through laceration group.
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Affiliation(s)
- R H Haug
- Division of Oral and Maxillofacial Surgery, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH 44109, USA
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25
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Abstract
PURPOSE To determine which signs are sensitive and specific in the setting of trauma to establish the diagnosis of an occult scleral rupture. METHODS The charts of patients with presumed scleral rupture were identified retrospectively. The ocular findings among the patients who had a rupture based on findings at surgery were compared with those patients who were noted to have normal findings at surgery. RESULTS Visual acuity worse than 20/400, decreased intraocular pressure, intraocular pressure less than that in the nontraumatized eye, and an afferent pupillary defect were all significant indicators of an open globe. CONCLUSION Determining the likelihood of an occult rupture can be facilitated by noting the presence or absence of those indicators that are significant and carry a high specificity.
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Affiliation(s)
- M S Werner
- Department of Ophthalmology and Visual Science, University of Illinois, Chicago College of Medicine 60612
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26
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Abstract
PURPOSE The purpose of this study is to evaluate the accuracy of diagnostic ultrasonography in the preoperative evaluation of eyes with media opacity after penetrating ocular trauma and correlate the preoperative findings with ultimate visual outcome. METHODS A retrospective comparison was made between the preoperative ultrasound diagnoses and the intraoperative findings in 46 eyes of 45 patients undergoing pars plana vitrectomy after penetrating ocular trauma associated with dense media opacities. The preoperative echographic findings were correlated with long-term visual and anatomic outcome. RESULTS Preoperative echography was both sensitive and specific in evaluating traumatized eyes for retinal detachment, intraocular foreign bodies, posterior scleral wounds, and hemorrhagic choroidal detachments. The overall anatomic success rate was 87% (40/46) with 48% (22/46) of eyes obtaining visual acuity of 20/200 or better after surgery. The visual prognosis was worse in those eyes in which preoperative echography detected retinal detachment, subretinal blood, massive choroidals, or posterior exit wounds. CONCLUSION Diagnostic echography is accurate and provides useful prognostic information in eyes with media opacity after penetrating ocular trauma.
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Affiliation(s)
- P E Rubsamen
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami School of Medicine, FL 33101
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27
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Abstract
We conducted a two-part study to define better the clinical predictors of scleral rupture after blunt trauma. In part 1 we ascertained the prevalence of scleral rupture among a population of patients examined in an ophthalmic emergency room with severe blunt ocular trauma over a six-month period. Scleral rupture was diagnosed in ten of 283 patients (3.5%). In part 2 we compared the clinical findings in 29 patients with scleral rupture to those of 273 patients with no scleral rupture after blunt trauma. We noted that eyes with visual acuity of light perception or less, an intraocular pressure of 5 mm Hg or less, an abnormally deep or shallow anterior chamber, or a media opacity preventing a view of fundus details by indirect ophthalmoscopy, should be considered ruptured when severe intra- or periocular hemorrhage is present. This diagnostic algorithm had a sensitivity of 100.0% (98.7% to 100.0%), specificity of 98.5% (97.1% to 99.9%), and a positive predictive value of 71.4% (66.3% to 76.5%).
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Affiliation(s)
- J A Kylstra
- Department of Ophthalmology, University of North Carolina School of Medicine, Chapel Hill 27599-7040
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28
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Affiliation(s)
- B C Joondeph
- Department of Ophthalmology, University of Illinois College of Medicine, Chicago 60612
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