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Shah M, Shah S, Gupta S, Singh R. Innovative method for wound debridement in open globe injury. Indian J Ophthalmol 2022; 70:2210. [PMID: 35648029 PMCID: PMC9359287 DOI: 10.4103/ijo.ijo_1259_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background: Open globe injury is a serious sight threatening condition. Full-thickness, non-selfsealing corneal lacerations require repair in the operating room. During repair, debridement of the wound is an important step. Incarceration of the intraocular structures in the wound eg. Iris, lens capsule, vitreous leads to improper healing if not removed properly. Purpose: To demonstrate the technique of wound debridement in open globe injury. Synopsis: Manual removal of incarcerated tissue contents leads to incomplete cleaning & enormous traction on intra ocular contents. In this video, we have tried vitrectomy cutter with higher vacuum for cleaning the edges of the wound especially in the posterior aspect and debri removal, followed by easy suturing. All tissue in the wound edges are removed effectively without any traction on intraocular contents. Highlights: Vitrectomy cutter is a very useful and effective tool to clean wound edges and good apposition & suturing of wound. Video link: https://youtu.be/y_kCxLdwhuQ
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Affiliation(s)
- Mehul Shah
- Ocular Trauma Service, Drashti Netralaya, Dahod, Gujarat, India
| | - Shreya Shah
- Ocular Trauma Service, Drashti Netralaya, Dahod, Gujarat, India
| | - Satyam Gupta
- Ocular Trauma Service, Drashti Netralaya, Dahod, Gujarat, India
| | - Romi Singh
- Ocular Trauma Service, Drashti Netralaya, Dahod, Gujarat, India
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Shrestha SM, Anthony CL, Justin GA, Thapa M, Shrestha JB, Khatri A, Hoskin AK, Agrawal R. Factors affecting final functional outcomes in open-globe injuries and use of ocular trauma score as a predictive tool in Nepalese population. BMC Ophthalmol 2021; 21:69. [PMID: 33541290 PMCID: PMC7860627 DOI: 10.1186/s12886-021-01819-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 01/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Open globe injury (OGI) is one of the most devastating form of ocular trauma. The aim of the study is to identify the epidemiology and predict visual outcomes in traumatic open globe injuries using ocular trauma score (OTS) and correlate with final visual acuity (VA) at 3 months. METHODS Patients older than 5 years, presenting to B.P. Koirala Lions Centre for Ophthalmic Studies (BPKLCOS) from March 2016- March 2017 with OGI that met inclusion criteria were evaluated. Patient profile, nature and cause of injury, and time to presentation were recorded. Patients were managed accordingly and followed up to 3 months. An OTS score for each patient was calculated and raw scores were categorized accordingly. The VA after 3 months were compared to the predicted OTS values. RESULTS Seventy-three eyes of 72 patients were examined. 76 % were male, and the mean age was 26.17 years (median, 23.5 years). The mean time from injury to presentation was < 6 hours (30 patients, 41 %). Thirty-seven eyes (51 %) had zone I trauma, followed by twenty eyes (27 %) with zone II, and sixteen eyes (22 %) with zone III trauma. Sixty-five patients (90 %) were managed surgically, and fifty (68 %) received intravitreal antibiotics with steroid. When compared, the projected VA as per OTS were able to predict actual final visual outcomes in 60 % of the eyes with OGI of various zones. CONCLUSIONS OTS can be an accurate predictive tool for final visual acuity even with a short follow up period of 3 months; with poor presenting visual acuity, delayed presentation, posterior zones of injury, need for intravitreal injections, endophthalmitis, and globe rupture associated with poorer prognosis.
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Affiliation(s)
- Saurav M Shrestha
- B.P. Koirala Lions Centre for Ophthalmic Studies, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal. .,Department of Vitreoretina, Mechi Eye Hospital, Birtamode, Nepal.
| | | | - Grant A Justin
- Department of Ophthalmology, Brooke Army Medical Center, San Antonio, TX, USA.,Department of Surgery, Uniformed Services University of the Health Science, Bethesda, MD, USA
| | - Madhu Thapa
- B.P. Koirala Lions Centre for Ophthalmic Studies, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Jyoti B Shrestha
- B.P. Koirala Lions Centre for Ophthalmic Studies, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Anadi Khatri
- Department of Vitreoretinal services, Birat Eye Hospital, Biratnagar, Nepal.,Department of Ophthalmology, Birat Medical College and Teaching Hospital, Biratngar, Nepal
| | - Annette K Hoskin
- Save Sight Institute, University of Sydney, Sydney, Australia.,Lions Eye Institute, University of Western Australia, Perth, Australia
| | - Rupesh Agrawal
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore.,Singapore Eye Research Institute, Singapore, Singapore.,Moorfields Eye Hospital, NHS Foundation Trust, London, UK
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Prat D, Tsumi E, Madgar S, Goldberg H, Zloto O, Osaadon P, Tal Mushinski L, Chen J, Nadler R, Moisseiev J, Alhalel A, Ben Simon GJ. Ocular injuries incurred by Israeli defense forces during low-intensity conflicts. Injury 2021; 52:292-298. [PMID: 32972723 DOI: 10.1016/j.injury.2020.09.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 09/02/2020] [Accepted: 09/18/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND To describe ocular injuries sustained by Israeli Defense Forces (IDF) soldiers during low-intensity conflicts from 1998 to 2017, and to evaluate the use of protective eyewear. METHODS Retrospective analysis of data retrieved from two tertiary Israeli medical centers and the military trauma registry. The analysis included all IDF soldiers with ocular injuries who were referred to these centers between 1998 and 2017. Data on injury type, the use of protective eyewear, and interventions were retrieved and analyzed. Additional data regarding the use of protective eyewear and ocular injuries in 108 patients with head and neck injuries in one operation was analyzed. RESULTS A total of 126 soldiers, all males, mean age 22 (SD 5.3) years, sustained ocular injuries during low-intensity conflicts and treated at one of the two participating medical centers. Blast was the most common type of injury (n = 70/126, 56%), followed by shrapnel (n = 37/126, 29%) and gunshot wound (n = 12/126, 9%). The Birmingham Eye Trauma Terminology System (BETTS) injury pattern disclosed lamellar laceration (n = 34/126, 27%), intraocular foreign body (n = 27/126, 21%), penetrating (n = 10/126, 8%), and perforating (n = 7/126, 6%) injuries. Average VA improved from 20/140 at presentation to 20/60 after surgical or conservative intervention, the median VA improved from 20/40 to 20/30 (P < 0.001). Forty-nine patients (49/126, 39%) had poor visual outcome. The mean follow-up lasted 22 (SD 31) months. The use of protective eyewear was correlated with better initial VA(20/30 vs 20/217, P = 0.07). Among 108 patients with head and neck injuries, there was a higher rate of ocular injuries in the group of patients who did not use protective eyewear (n = 26/73, 36% vs n = 4/35, 11%, P = 0.016). CONCLUSIONS Ocular injuries are common occurrences in low-intensity conflicts. The use of protective eyewear significantly reduces these injuries and should be mandatory. LEVEL OF EVIDENCE III, prognostic.
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Affiliation(s)
- Daphna Prat
- Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Erez Tsumi
- Ophthalmology Department, Soroka Medical Center, Beer Sheva, Israel, affiliated to Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Shiran Madgar
- Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hila Goldberg
- Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ofira Zloto
- Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Perach Osaadon
- Ophthalmology Department, Soroka Medical Center, Beer Sheva, Israel, affiliated to Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Liza Tal Mushinski
- Ophthalmology Department, Soroka Medical Center, Beer Sheva, Israel, affiliated to Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Jacob Chen
- Israel Defense Forces, Medical Corps, Tel Hashomer, Ramat Gan, Israel
| | - Roy Nadler
- Israel Defense Forces, Medical Corps, Tel Hashomer, Ramat Gan, Israel
| | - Joseph Moisseiev
- Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amir Alhalel
- Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Guy J Ben Simon
- Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Shah MA, Agrawal R, Teoh R, Shah SM, Patel K, Gupta S, Gosai S. Pediatric ocular trauma score as a prognostic tool in the management of pediatric traumatic cataracts. Graefes Arch Clin Exp Ophthalmol 2017; 255:1027-1036. [PMID: 28224290 DOI: 10.1007/s00417-017-3616-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [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: 09/22/2016] [Revised: 12/22/2016] [Accepted: 02/08/2017] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE To introduce and validate the pediatric ocular trauma score (POTS) - a mathematical model to predict visual outcome trauma in children with traumatic cataract METHODS: In this retrospective cohort study, medical records of consecutive children with traumatic cataracts aged 18 and below were retrieved and analysed. Data collected included age, gender, visual acuity, anterior segment and posterior segment findings, nature of surgery, treatment for amblyopia, follow-up, and final outcome was recorded on a precoded data information sheet. POTS was derived based on the ocular trauma score (OTS), adjusting for age of patient and location of the injury. Visual outcome was predicted using the OTS and the POTS and using receiver operating characteristic (ROC) curves. RESULTS POTS predicted outcomes were more accurate compared to that of OTS (p = 0.014). CONCLUSION POTS is a more sensitive and specific score with more accurate predicted outcomes compared to OTS, and is a viable tool to predict visual outcomes of pediatric ocular trauma with traumatic cataract.
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Affiliation(s)
- Mehul A Shah
- Drashti Netralaya, Nr. GIDC, Chakalia Road, Dahod, 389151, Gujarat, India.
| | - Rupesh Agrawal
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Tan Tock Seng, Singapore
| | - Ryan Teoh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore
| | - Shreya M Shah
- Drashti Netralaya, Nr. GIDC, Chakalia Road, Dahod, 389151, Gujarat, India
| | - Kashyap Patel
- Drashti Netralaya, Nr. GIDC, Chakalia Road, Dahod, 389151, Gujarat, India
| | - Satyam Gupta
- Drashti Netralaya, Nr. GIDC, Chakalia Road, Dahod, 389151, Gujarat, India
| | - Siddharth Gosai
- Drashti Netralaya, Nr. GIDC, Chakalia Road, Dahod, 389151, Gujarat, India
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