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Sanchez PH, Shriver EM, Strampe MR, Diel RJ, Pham CM, Carter KD, Kemp PS, Field MG. Retrospective Optimization of the Hawkeye Orbital Fracture Prioritization and Evaluation Algorithms for Triaging Ophthalmic Care. Ophthalmol Sci 2024; 4:100447. [PMID: 38284103 PMCID: PMC10810741 DOI: 10.1016/j.xops.2023.100447] [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] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 11/14/2023] [Accepted: 12/04/2023] [Indexed: 01/30/2024]
Abstract
Objectives Many orbital fracture patients are transferred to tertiary care centers for immediate ophthalmology consultation, though few require urgent ophthalmic evaluation or intervention. This overutilizes limited resources and overburdens patients and the health care system with travel and emergency department (ED) expenses. A simple, easy-to-use, clinical decision-making tool is needed to aid local EDs and triage services in effectively identifying orbital fracture patients who need urgent ophthalmic evaluation. Design Single center, retrospective cohort study. Subjects Orbital fracture patients aged ≥ 18 years who presented to the study institution's emergency department and received an ophthalmology consultation. Methods Ocular injuries that required close monitoring or an intervention within the first few hours after presentation were termed urgent. Two Hawkeye Orbital Fracture Prioritization and Evaluation (HOPE) algorithms were developed to identify orbital fracture patients needing urgent evaluation; including 1 algorithm incorporating computerized tomography (CT) scans interpreted by ophthalmology (HOPE+CT). Algorithms were compared with 3 previously published protocols: the University of Texas Health Science Center at Houston (UTH), the South Texas Orbital Fracture Protocol (STOP), and Massachusetts Eye and Ear (MEE) algorithms. Main Outcome Measures Correct triage of patients with orbital fractures who have urgent ocular or orbital conditions. Results In the study institution's ED, 134 adult patients (145 orbits) were seen with orbital fractures in 2019. Eighteen (13.4%) had ocular or orbital conditions categorized as urgent. The HOPE tool resulted in 100% sensitivity and 78.4% specificity. The HOPE+CT tool resulted in 100.0% sensitivity and 94.0% specificity. The UTH algorithm was 91.7% sensitive and 76.5% specific. South Texas Orbital Fracture Protocol and MEE were both 100% sensitive but only 35.1% and 32.8% specific, respectively. Conclusions The HOPE and HOPE+CT algorithms were superior or equal to the UTH, STOP, and MEE algorithms in terms of specificity while detecting all urgent cases. Implementation of a triage protocol that uses the HOPE or HOPE+CT algorithms could improve resource utilization and reduce health care costs through identification of orbital fracture patients needing urgent evaluation. An online tool that deploys the HOPE+CT algorithm in a user-friendly interface has been developed and is undergoing prospective validation before public dissemination. Financial Disclosures Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Peter H. Sanchez
- Department of Ophthalmology and Visual Sciences, Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Erin M. Shriver
- Department of Ophthalmology and Visual Sciences, Carver College of Medicine, University of Iowa, Iowa City, Iowa
- Department of Otolaryngology–Head and Neck Surgery, Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Margaret R. Strampe
- Department of Ophthalmology and Visual Sciences, Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Ryan J. Diel
- Department of Ophthalmology and Visual Sciences, Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Chau M. Pham
- Department of Ophthalmology and Visual Sciences, Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Keith D. Carter
- Department of Ophthalmology and Visual Sciences, Carver College of Medicine, University of Iowa, Iowa City, Iowa
- Department of Otolaryngology–Head and Neck Surgery, Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Pavlina S. Kemp
- Department of Ophthalmology and Visual Sciences, Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Matthew G. Field
- Department of Ophthalmology and Visual Sciences, Carver College of Medicine, University of Iowa, Iowa City, Iowa
- Minnesota Eye Consultants, Bloomington, Minnesota
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Poudel S, Kaffash E, Zhao L, Pangeni R, Chow WN, Xu Q. Dexamethasone sodium phosphate loaded nanoparticles for prevention of nitrogen mustard induced corneal injury. Exp Eye Res 2024; 243:109902. [PMID: 38641196 DOI: 10.1016/j.exer.2024.109902] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 03/20/2024] [Accepted: 04/16/2024] [Indexed: 04/21/2024]
Abstract
Nitrogen mustard (NM) is a potent vesicating chemical warfare agent that is primarily absorbed through skin, inhalation, or ocular surface. Ocular exposure of NM can cause acute to chronic keratopathy which can eventually lead to blindness. There is a current lack of effective countermeasures against ocular exposure of NM despite their imperative need. Herein, we aim to explore the sustained effect of Dexamethasone sodium phosphate (DSP)-loaded polymeric nanoparticles (PLGA-DSP-NP) following a single subconjunctival injection in the management and prevention of corneal injury progression upon exposure to NM. DSP is an FDA approved corticosteroid with proven anti-inflammatory properties. We formulated PLGA-DSP-NP with zinc chelation ion bridging method using PLGA polymer, with particles of approximately 250 nm and a drug loading of 6.5 wt%. Under in vitro sink conditions, PLGA-DSP-NP exhibited a sustained drug release for two weeks. Notably, in NM injured cornea, a single subconjunctival (SCT) injection of PLGA-DSP-NP outperformed DSP eyedrops (0.1%), DSP solution, placebo NP, and saline, significantly mitigating corneal neovascularization, ulceration, and opacity for the two weeks study period. Through PLGA-DSP-NP injection, sustained DSP release hindered inflammatory cytokine recruitment, angiogenic factors, and endothelial cell proliferation in the cornea. This strategy presents a promising localized corticosteroid delivery system to effectively combat NM-induced corneal injury, offering insights into managing vesicant exposure.
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Affiliation(s)
- Sagun Poudel
- Department of Pharmaceutics, Virginia Commonwealth University, Richmond, VA 23298, USA
| | - Ehsan Kaffash
- Department of Pharmaceutics, Virginia Commonwealth University, Richmond, VA 23298, USA
| | - Long Zhao
- Department of Pharmaceutics, Virginia Commonwealth University, Richmond, VA 23298, USA
| | - Rudra Pangeni
- Department of Pharmaceutics, Virginia Commonwealth University, Richmond, VA 23298, USA
| | - Woon Nam Chow
- Department of Ophthalmology, Virginia Commonwealth University, Richmond, VA 23298, USA; Department of Pathology, Virginia Commonwealth University, Richmond, VA 23298, USA
| | - Qingguo Xu
- Department of Pharmaceutics, Virginia Commonwealth University, Richmond, VA 23298, USA; Department of Ophthalmology, Virginia Commonwealth University, Richmond, VA 23298, USA; Center for Pharmaceutical Engineering, and Institute for Structural Biology, Drug Discovery & Development (ISB3D), Massey Cancer Center, Virginia Commonwealth University, Richmond, VA 23298, USA.
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Horwitz V, Cohen M, Gore A, Gez R, Gutman H, Kadar T, Dachir S, Kendler S. Predicting clinical outcome of sulfur mustard induced ocular injury using machine learning model. Exp Eye Res 2023; 236:109671. [PMID: 37776992 DOI: 10.1016/j.exer.2023.109671] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 09/23/2023] [Accepted: 09/27/2023] [Indexed: 10/02/2023]
Abstract
The sight-threatening sulfur mustard (SM) induced ocular injury presents specific symptoms in each clinical stage. The acute injury develops in all exposed eyes and may heal or deteriorate into chronic late pathology. Early detection of eyes at risk of developing late pathology may assist in providing unique monitoring and specific treatments only to relevant cases. In this study, we evaluated a machine-learning (ML) model for predicting the development of SM-induced late pathology based on clinical data of the acute phase in the rabbit model. Clinical data from 166 rabbit eyes exposed to SM vapor was used retrospectively. The data included a comprehensive clinical evaluation of the cornea, eyelids and conjunctiva using a semi-quantitative clinical score. A random forest classifier ML model, was trained to predict the development of corneal neovascularization four weeks post-ocular exposure to SM vapor using clinical scores recorded three weeks earlier. The overall accuracy in predicting the clinical outcome of SM-induced ocular injury was 73%. The accuracy in identifying eyes at risk of developing corneal neovascularization and future healed eyes was 75% and 59%, respectively. The most important parameters for accurate prediction were conjunctival secretion and corneal opacity at 1w and corneal erosions at 72 h post-exposure. Predicting the clinical outcome of SM-induced ocular injury based on the acute injury parameters using ML is demonstrated for the first time. Although the prediction accuracy was limited, probably due to the small dataset, it pointed out towards various parameters during the acute injury that are important for predicting SM-induced late pathology and revealing possible pathological mechanisms.
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Affiliation(s)
- Vered Horwitz
- Department of Pharmacology, Israel Institute for Biological Research, Ness Ziona, 74100, Israel.
| | - Maayan Cohen
- Department of Pharmacology, Israel Institute for Biological Research, Ness Ziona, 74100, Israel
| | - Ariel Gore
- Department of Pharmacology, Israel Institute for Biological Research, Ness Ziona, 74100, Israel
| | - Rellie Gez
- Department of Pharmacology, Israel Institute for Biological Research, Ness Ziona, 74100, Israel
| | - Hila Gutman
- Department of Pharmacology, Israel Institute for Biological Research, Ness Ziona, 74100, Israel
| | - Tamar Kadar
- Department of Pharmacology, Israel Institute for Biological Research, Ness Ziona, 74100, Israel
| | - Shlomit Dachir
- Department of Pharmacology, Israel Institute for Biological Research, Ness Ziona, 74100, Israel
| | - Shai Kendler
- Department of Environmental Physics, Israel Institute for Biological Research, Ness Ziona, 74100, Israel; Faculty of Civil & Environmental Engineering, Technion-Israeli Institute of Technology, Haifa, 320000, Israel
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Mishra A, Agrawal M, Bhirud A, Kapoor G, Baranwal VK, Rao B. Prevent, curtail and mitigate ocular injuries: Proposal for designing an eye injury registry model for the Indian Armed Forces. Med J Armed Forces India 2023; 79:487-493. [PMID: 37719900 PMCID: PMC10499631 DOI: 10.1016/j.mjafi.2023.06.001] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 06/04/2023] [Indexed: 09/19/2023] Open
Abstract
This article aims to propose a design for Eye Injury Registry (EIR) model for Indian Armed Forces, to make ophthalmologists and non-ophthalmologists aware about the existence as well as the usefulness of such a registry. This is a perspective study. The EIR model for Armed Forces was designed based on the relevant sources in PubMed, Scopus and Embase including registries of pioneering countries like United States and Canada. A questionnaire based on the model dimensions was developed (Cronbach's alpha>0.7) and filled by 04 senior ophthalmologists in Armed Forces, all of who had a significant experience in dealing with various types of ocular trauma, to give expert opinions, which were then applied to the proposed model to finalize it. In Armed Forces, a registry and reporting on eye injury along with a systematic collection of standard data on eye injuries will help ophthalmologists in the successful prevention. Such a registry and its large database once formed will permit elaborate epidemiologic investigations, highlighting preventable sources of injury, emerging patterns of trauma in our services, and the best possible treatment protocols to be adopted, for successful outcomes. EIR in Armed Forces can help in the collection of eye injury data, thereby improving the quality-of-care and expansion of prevention strategies for ocular injuries. It is a step to make a truly effective data bank, which will be instrumental in combating such preventable ocular injuries and in turn go a very long way in achieving the final goal of preventing up to 90% of such injuries.
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Affiliation(s)
- Avinash Mishra
- Professor & Head (Ophthalmology), Military Hospital, Jalandhar, India
| | - Mohini Agrawal
- Assistant Professor (Ophthalmology), Command Hospital (Western Command), Chandimandir, India
| | - Atul Bhirud
- Assistant Professor (Ophthalmology), Command Hospital (Western Command), Chandimandir, India
| | - Gaurav Kapoor
- Professor (Ophthalmology), Command Hospital (Western Command), Chandimandir, India
| | | | - B.V. Rao
- Professor (Ophthalmology), Command Hospital (Eastern Command), Kolkata, India
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Tomaiuolo M, Woreta FA, Li A, Yonekawa Y, Zhang QE, Sharpe JE, Zafar S, Syed ZA, Ramesh S, Lorch AC, Hall NE, Shah AS, Justin GA, Hyman L. Open-Globe Injury Repairs in the American Academy of Ophthalmology IRIS® Registry 2014 - 2018: Incidence, Risk Factors, and Visual Outcomes. Ophthalmology 2023; 130:812-821. [PMID: 36924850 PMCID: PMC10502180 DOI: 10.1016/j.ophtha.2023.03.002] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 02/15/2023] [Accepted: 03/08/2023] [Indexed: 03/17/2023] Open
Abstract
PURPOSE To estimate incidence and evaluate demographic risk factors and visual acuity (VA) outcomes of open-globe injuries requiring surgical repair in the IRIS® Registry (Intelligent Research in Sight). DESIGN Retrospective cohort study. PARTICIPANTS Patients with open-globe injury repairs (OGRs) were identified by Current Procedural Terminology codes (65275, 65280, 65285, 65286, 65235, 65260, and 65265) from 2014 through 2018 in the IRIS Registry. METHODS Logistic regression models adjusting for age, sex, race, ethnicity, United States region, concurrent and subsequent surgeries, and baseline VA. MAIN OUTCOME MEASURES Outcomes included annual and 5-year incidence rates per 100 000 people and factors associated with OGR, VA better than 20/40, and VA of 20/200 or worse at final follow-up (3-12 months after OGR). RESULTS Thirteen thousand seven hundred sixty-six OGRs were identified; 5-year cumulative incidence was 28.0 per 100 000 patients. Open-globe repair was associated with age 21 to 40 years compared with younger than 21 years (odds ratio [OR], 1.6; 95% confidence interval [CI], 1.5-1.7]), male sex (OR, 2.8; 95% CI, 2.7-2.9), Black versus White race (OR, 1.3; 95% CI, 1.2-1.4), Hispanic versus non-Hispanic ethnicity (OR, 1.7; 95% CI, 1.6-1.8), and South (OR, 1.4; 95% CI, 1.3-1.5) and West (OR, 1.3; 95% CI, 1.2-1.4) versus Midwest regions and associated inversely with Asian versus White race (OR, 0.6; 95% CI, 0.6-0.7). Visual acuity outcomes, analyzed in a subset of 2966 patients with VA data available, showed vision impairment (VA < 20/40) at final follow-up was associated with VA of 20/200 or worse at presentation (20/200 better than 20/40; OR, 11.1; 95% CI, 8.0-15.7), older age (e.g., > 80 years vs. < 21 years; OR, 5.8; 95% CI, 3.2-10.7), and Black versus White race (OR, 1.8; 95% CI, 1.3-2.6). Risk factors were similar for VA of 20/200 or worse after OGR. Among the 1063 patients undergoing OGR with VA of 20/200 or worse at presentation, VA did not improve to better than 20/200 at follow-up in 35% of patients (1063/2996). CONCLUSIONS Our findings bring to light racial disparities in risk of OGR and poor visual outcomes that warrant further exploration. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found after the references.
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Affiliation(s)
- Maurizio Tomaiuolo
- The Vickie and Jack Farber Vision Research Center at Wills Eye, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Fasika A Woreta
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Alexander Li
- The Vickie and Jack Farber Vision Research Center at Wills Eye, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Yoshihiro Yonekawa
- The Vickie and Jack Farber Vision Research Center at Wills Eye, Wills Eye Hospital, Philadelphia, Pennsylvania; Retina Service, Wills Eye Hospital, Mid Atlantic Retina, Philadelphia, Pennsylvania
| | - Qiang Ed Zhang
- The Vickie and Jack Farber Vision Research Center at Wills Eye, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - James E Sharpe
- The Vickie and Jack Farber Vision Research Center at Wills Eye, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Sidra Zafar
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Zeba A Syed
- The Vickie and Jack Farber Vision Research Center at Wills Eye, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Sathyadeepak Ramesh
- The Vickie and Jack Farber Vision Research Center at Wills Eye, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Alice C Lorch
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Nathan E Hall
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Ankoor S Shah
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts; Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Grant A Justin
- Department of Ophthalmology, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Leslie Hyman
- The Vickie and Jack Farber Vision Research Center at Wills Eye, Wills Eye Hospital, Philadelphia, Pennsylvania.
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Nalukenge C, Sebabi FO, Okello B, Ntende J, Nakiyingi L, Nakanjako D, Nakubulwa F, Kalinaki A, Mulinde B, Musika AA. Factors associated with ocular injuries among adult road traffic accident patients presenting at Mulago National Referral Hospital, Uganda. Afr Health Sci 2023; 23:451-458. [PMID: 38223584 PMCID: PMC10782362 DOI: 10.4314/ahs.v23i2.52] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2024] Open
Abstract
Background Ocular trauma is the leading cause of unilateral blindness globally. Road traffic accidents are among the top risk factors for ocular trauma. Objectives This study aimed to evaluate factors associated with ocular injuries among adult road traffic accident patients at Mulago Hospital, Uganda. Methods A cross-sectional study was conducted among adult road traffic accident patients. History taking and ophthalmological examination were performed on consenting participants. Data was analysed using STATA version 14.0. Results Overall, 428 road traffic accident cases were enrolled, of which majority (84.3%) were male. Age 30-39years (aOR = 0.58, 0.36 - 0.94, p = 0.027), being male (aOR = 2.64, 1.21 - 5.13, p = 0.004) and being a passenger of motor vehicle/cycle (aOR = 3.85, 1.49 - 9.93, p = 0.005) were the factors associated with ocular injuries among the participants. Conclusions Age 30-39 years, male gender and being a passenger of motor vehicle/cycle were the factors associated with ocular injuries among the adult road traffic accident patients. Ocular injuries were more common among the road users who did not use safety measures. Use of safety measure by passengers of motor vehicles and cycles is recommended.
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Affiliation(s)
- Caroline Nalukenge
- Department of Ophthalmology, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Francis O Sebabi
- Department of Ophthalmology, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Bonny Okello
- Department of Economics and Statistics, Kyambogo University, Kampala, Uganda
| | - Jacob Ntende
- Department of Ophthalmology, Mulago National Referral Hospital, Kampala, Uganda
| | - Lydia Nakiyingi
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Damalie Nakanjako
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Faith Nakubulwa
- Department of Ophthalmology, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Abubakar Kalinaki
- Department of Ophthalmology, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Ben Mulinde
- Department of Ophthalmology, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Anne A Musika
- Department of Ophthalmology, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
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Cohen S, Shiuey EJ, Zur D, Rachmiel R, Kurtz S, Mezad-Koursh D, Waisbourd M. Ocular injury from foam dart (Nerf) blasters: a case series. Eur J Pediatr 2023; 182:1099-1103. [PMID: 36575309 DOI: 10.1007/s00431-022-04782-4] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 12/12/2022] [Accepted: 12/21/2022] [Indexed: 12/29/2022]
Abstract
To report clinical outcomes following ocular injury from foam dart (nerf) blasters - a spring-loaded toy guns that fire foam-coated darts or bullets at a relatively low velocity. These guns gained popularity in recent years among children and adolescents. Eleven patients with ocular injuries from foam dart blasters were included in this retrospective, single-center study. Visual acuity (VA), intraocular pressure (IOP), and anterior segment, glaucoma-related, and vitreoretinal complications were recorded at each visit. The average age at presentation was 13.4 years and 82% were male. Mean initial VA was 6/12 (range 6/6 - 1/18); On initial examination, nine patients (82%) had hyphema, three (27%) had corneal abrasions, three (27%) had vitreous hemorrhage, and two (18%) had traumatic mydriasis. Four patients (36%) experienced glaucoma-related complications, including three (27%) with angle recession and three (27%) with increased IOP. Three patients (27%) were diagnosed with posterior segment injuries, including three (27%) with commotio retinae and one (9%) with severe retinal photoreceptor damage. No patients required surgical intervention. CONCLUSION Foam dart blasters can cause severe blunt ocular trauma and permanent visual loss, illustrating the need for eye protection when handling these toys. WHAT IS KNOWN • Foam dart blasters, a blanket term for spring-loaded toy guns that fire foam-coated darts or bullets at a relatively low velocity, have gained popularity in recent years among pediatric populations, with an increase in associated ocular injuries. • To date, scattered case reporting provides insufficient insight into the full clinical spectrum of injury and prognosis of foam dart blasters related ocular injury. WHAT IS NEW • This case series characterizes the myriad foam dart blasters injuries that may afflict the eye, most of which are self-limiting, but some of which may result in poor visual outcomes and lifelong disability in pediatric patients. • We strongly recommend that all users wear eye protection while using foam dart blasters.
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Affiliation(s)
- Shai Cohen
- Department of Ophthalmology, Affiliated to the Sackler Faculty of Medicine, Tel Aviv Medical Center, Tel Aviv University, 6 Weizmann Street, 64239, Tel-Aviv, Israel
| | - Eric J Shiuey
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, 19107, USA
| | - Dinah Zur
- Department of Ophthalmology, Affiliated to the Sackler Faculty of Medicine, Tel Aviv Medical Center, Tel Aviv University, 6 Weizmann Street, 64239, Tel-Aviv, Israel
| | - Rony Rachmiel
- Department of Ophthalmology, Affiliated to the Sackler Faculty of Medicine, Tel Aviv Medical Center, Tel Aviv University, 6 Weizmann Street, 64239, Tel-Aviv, Israel
| | - Shimon Kurtz
- Department of Ophthalmology, Affiliated to the Sackler Faculty of Medicine, Tel Aviv Medical Center, Tel Aviv University, 6 Weizmann Street, 64239, Tel-Aviv, Israel
| | - Daphna Mezad-Koursh
- Department of Ophthalmology, Affiliated to the Sackler Faculty of Medicine, Tel Aviv Medical Center, Tel Aviv University, 6 Weizmann Street, 64239, Tel-Aviv, Israel
| | - Michael Waisbourd
- Department of Ophthalmology, Affiliated to the Sackler Faculty of Medicine, Tel Aviv Medical Center, Tel Aviv University, 6 Weizmann Street, 64239, Tel-Aviv, Israel.
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Sanjay S, Durgalaxmi M. Snowball-associated ocular injury - An unusual presentation. Indian J Ophthalmol 2022; 70:4470. [PMID: 36453380 PMCID: PMC9940546 DOI: 10.4103/ijo.ijo_1805_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: 12/12/2022] Open
Abstract
Background Snow ball associated ocular injuries are rare. We present the 1st case of a snow ball injury reported in India with symptoms occurring after 10 days. Purpose To highlight the fact that symptoms can occur many days after the injury. The injuries can cause structural damage to ocular structures and can be permanent. Synopsis A 25-year-old Asian Indian female presented with increased redness and blurring of vision of a day's duration. She had been playing in the snow and had an apparent injury to the right eye 10 days earlier. She had no symptoms at that point of time. Her uncorrected visual acuity by Snellen's chart was 20/20 in both the eyes. Intraocular pressure was normal in both the eyes. On evaluation of the right eye she had traumatic anterior uveitis and mydriasis and the left eye was normal. There was no evidence of posterior segment involvement. She was treated with topical steroids and her anterior chamber inflammation improved but she had persistent mydriasis with no effect on her near vision. She was subsequently lost to follow after a month. Highlights Rare case of ocular injury caused by a hurtling snow ball. Demonstration of anterior chamber inflammation with a video Infrared video imaging of the pupil in bright and dark showing anisocoria worse in bright light. Protective goggles are a must while indulging in these activities. Video link https://youtu.be/FpLbPTVg5Rk.
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Affiliation(s)
- Srinivasan Sanjay
- Department of Uveitis and Ocular Immunology, Narayana Nethralaya, Bengaluru, Karnataka, India,Correspondence to: Dr. Srinivasan Sanjay, Department of Uveitis and Ocular Immunology, Narayana Nethralaya, Bengaluru, Karnataka, India. E-mail:
| | - Modak Durgalaxmi
- Cornea and Refractive Services, Narayana Nethralaya, Bengaluru, Karnataka, India
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Batchelor A, Lacy M, Hunt M, Lu R, Lee AY, Lee CS, Saraf SS, Chee YE. Predictors of Long-term Ophthalmic Complications after Closed Globe Injuries Using the Intelligent Research in Sight (IRIS®) Registry. Ophthalmol Sci 2022; 3:100237. [PMID: 36561352 PMCID: PMC9764252 DOI: 10.1016/j.xops.2022.100237] [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] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 09/08/2022] [Accepted: 10/18/2022] [Indexed: 11/06/2022]
Abstract
Purpose To identify clinical factors associated with the need for future surgical intervention following closed globe ocular trauma. Design Retrospective cohort study. Subjects Participants and/or Controls Patients in the American Academy of Ophthalmology Intelligent Research in Sight (IRIS®) Registry with a diagnosis of closed globe ocular trauma occurring between 2013 and 2019, identified using International Classification of Disease, 10th Revision and Systematized Nomenclature of Medicine codes. Methods Diagnosis codes were used to identify multiple concomitant diagnoses present on the date of closed globe ocular trauma. Survival analyses were performed for each outcome of interest, and linear regression was used to identify clinical factors associated with the risk of surgical intervention. Main Outcome Measures Outcomes included retinal break treatment, retinal detachment (RD) repair, retinal break treatment or RD repair, glaucoma surgery, and cataract surgery. Results Of the 206 807 patients with closed globe ocular trauma, 9648 underwent surgical intervention during the follow-up period (mean, 444 days): 1697 (0.8%) had RD repair, 1658 (0.8%) had retinal break treatment, 600 (0.3%) had glaucoma surgery, and 5693 (2.8%) had cataract surgery. Traumatic cataract was the strongest risk factor for cataract surgery (hazard ratio, 13.0; 95% confidence interval, 10.8-15.6), traumatic hyphema showed highest risk for glaucoma surgery (7.24; 4.60-11.4), and vitreous hemorrhage was the strongest risk factor for retinal break treatment and detachment repair (11.01; 9.18-13.2 and 14.2; 11.5-17.6, respectively) during the first 60 days after trauma date. Vitreous hemorrhage was a risk factor for cataract surgery at > 60 days after trauma date only. Iris-angle injury was the strongest risk factor for glaucoma surgery > 60 days after trauma, while vitreous hemorrhage remained the strongest factor for retinal break treatment and detachment repair at > 60 days. Traumatic hyphema was a risk factor for all surgical outcomes during all follow-up intervals. Conclusions Diagnosis of concomitant traumatic cataract, vitreous hemorrhage, traumatic hyphema, and other risk factors may increase the likelihood of requiring surgical intervention after closed globe ocular trauma.
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Affiliation(s)
- Ashley Batchelor
- Department of Ophthalmology, University of Washington, Seattle, Washington
| | - Megan Lacy
- Department of Ophthalmology, University of Washington, Seattle, Washington
| | - Matthew Hunt
- Department of Ophthalmology, University of Washington, Seattle, Washington,Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, Iowa
| | - Randy Lu
- Department of Ophthalmology, University of Washington, Seattle, Washington
| | - Aaron Y. Lee
- Department of Ophthalmology, University of Washington, Seattle, Washington,Roger and Angie Karalis Johnson Retina Center, Seattle, Washington
| | - Cecilia S. Lee
- Department of Ophthalmology, University of Washington, Seattle, Washington,Roger and Angie Karalis Johnson Retina Center, Seattle, Washington,Correspondence: Cecilia S. Lee, MD, MS, Department of Ophthalmology, University of Washington, 325 Ninth Avenue, Box 359608, Seattle, WA 98104.
| | - Steven S. Saraf
- Department of Ophthalmology, University of Washington, Seattle, Washington,Roger and Angie Karalis Johnson Retina Center, Seattle, Washington
| | - Yewlin E. Chee
- Department of Ophthalmology, University of Washington, Seattle, Washington,Roger and Angie Karalis Johnson Retina Center, Seattle, Washington
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10
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Patel PS, Uppuluri A, Oydanich M, Langer PD, Zarbin MA, Bhagat N. Epidemiology of United States tennis-related ocular injuries from 2000 to 2019. Int Ophthalmol 2022. [PMID: 36057008 DOI: 10.1007/s10792-022-02502-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 08/26/2022] [Indexed: 10/14/2022]
Abstract
PURPOSE To characterize trends in ocular tennis injuries over the last 20 years. METHODS The National Electronic Injury Surveillance System was utilized to characterize tennis-related eye injuries in a nationally representative sample of emergency department visits. Data were divided into 5 age groups, and various demographic information was obtained. RESULTS Approximately 16,000 tennis-related ocular injuries were identified with males being affected nearly 2:1 compared to females. The youngest age group (0-20) had the greatest proportion of injuries, with most injuries in boys 11-15 years old. Injuries occurred most often during the spring season. Most patients were treated and released from the ED. Of those patients who were hospitalized, one-third had an open globe injury. CONCLUSIONS The overall number of injuries trended downward during the timespan of the study. Although most patients did not experience serious visual consequences, the greatest proportion of ocular tennis injuries occurred in the pediatric age group in whom the risk of amblyopia is high. Primary care providers and tennis regulatory bodies should consider recommending eye safety sports goggles in children to mitigate the potential for significant visual morbidity.
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11
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Honig MG, Del Mar NA, Henderson DL, O'Neal D, Yammanur M, Cox R, Li C, Perry AM, Moore BM, Reiner A. Raloxifene, a cannabinoid type-2 receptor inverse agonist, mitigates visual deficits and pathology and modulates microglia after ocular blast. Exp Eye Res 2022; 218:108966. [PMID: 35143834 DOI: 10.1016/j.exer.2022.108966] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 01/04/2022] [Accepted: 01/24/2022] [Indexed: 11/19/2022]
Abstract
Visual deficits after ocular blast injury (OBI) are common, but pharmacological approaches to improve long-term outcomes have not been identified. Blast forces frequently damage the retina and optic nerves, and work on experimental animals has shown the pro-inflammatory actions of microglia can further exacerbate such injuries. Cannabinoid type-2 receptor (CB2) inverse agonists specifically target activated microglia, biasing them away from the harmful pro-inflammatory M1 state toward the helpful reparative M2 state. We previously found that treating mice with CB2 inverse agonists after traumatic brain injury, produced by either focal cranial air blast or dorsal cranial impact, greatly attenuated the visual deficits and pathology that otherwise resulted. Here we examined the consequences of single and repeat OBI and the benefit provided by raloxifene, an FDA-approved estrogen receptor drug that possesses noteworthy CB2 inverse agonism. After single OBI, although the amplitudes of the A- and B-waves of the electroretinogram and pupil light response appeared to be normal, the mice showed hints of deficits in contrast sensitivity and visual acuity, a trend toward optic nerve axon loss, and significantly increased light aversion, which were reversed by 2 weeks of daily treatment with raloxifene. Mice subjected to repeat OBI (5 blasts spaced 1 min apart), exhibited more severe visual deficits, including decreases in contrast sensitivity, visual acuity, the amplitudes of the A- and B-waves of the electroretinogram, light aversion, and resting pupil diameter (i.e. hyperconstriction), accompanied by the loss of photoreceptor cells and optic nerve axons, nearly all of which were mitigated by raloxifene. Interestingly, optic nerve axon abundance was strongly correlated with contrast sensitivity and visual acuity across all groups of experimental mice in the repeat OBI study, suggesting optic nerve axon loss with rOBI and its attenuation with raloxifene are associated with the extent of these two deficits while photoreceptor abundance was highly correlated with A-wave amplitude and resting pupil size, suggesting a prominent role for photoreceptors in these two deficits. Quantitative PCR (qPCR) showed levels of M1-type microglial markers (e.g. iNOS, IL1β, TNFα, and CD32) in retina, optic nerve, and thalamus were increased 3 days after repeat OBI. With raloxifene treatment, the overall expression of M1 markers was more similar to that in sham mice. Raloxifene treatment was also associated with the elevation of IL10 transcripts in all three tissues compared to repeat OBI alone, but the results for the three other M2 microglial markers we examined were more varied. Taken together, the qPCR results suggest that raloxifene benefit for visual function and pathology was associated with a lessening of the pro-inflammatory actions of microglia. The benefit we find for raloxifene following OBI provides a strong basis for phase-2 efficacy testing in human clinical trials for treating ocular injury.
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Affiliation(s)
- Marcia G Honig
- Department of Anatomy and Neurobiology(,) the University of Tennessee Health Science Center, Memphis, TN, 38163, USA
| | - Nobel A Del Mar
- Department of Anatomy and Neurobiology(,) the University of Tennessee Health Science Center, Memphis, TN, 38163, USA
| | - Desmond L Henderson
- Department of Anatomy and Neurobiology(,) the University of Tennessee Health Science Center, Memphis, TN, 38163, USA
| | - Dylan O'Neal
- Department of Anatomy and Neurobiology(,) the University of Tennessee Health Science Center, Memphis, TN, 38163, USA
| | - Meghna Yammanur
- Department of Anatomy and Neurobiology(,) the University of Tennessee Health Science Center, Memphis, TN, 38163, USA
| | - Rachel Cox
- Department of Anatomy and Neurobiology(,) the University of Tennessee Health Science Center, Memphis, TN, 38163, USA
| | - Chunyan Li
- Department of Anatomy and Neurobiology(,) the University of Tennessee Health Science Center, Memphis, TN, 38163, USA
| | - Aaron M Perry
- Department of Anatomy and Neurobiology(,) the University of Tennessee Health Science Center, Memphis, TN, 38163, USA
| | - Bob M Moore
- Department of Pharmaceutical Sciences, The University of Tennessee Health Science Center, Memphis, TN, 38163, USA
| | - Anton Reiner
- Department of Anatomy and Neurobiology(,) the University of Tennessee Health Science Center, Memphis, TN, 38163, USA; Department of Ophthalmology, The University of Tennessee Health Science Center, Memphis, TN, 38163, USA.
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12
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LIU YU. Comment on: Ocular Injury Associated With Prone Positioning in Adult Critical Care: A Systematic Review and Meta-Analysis. Am J Ophthalmol 2022; 234:335-338. [PMID: 34634235 DOI: 10.1016/j.ajo.2021.09.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 09/27/2021] [Indexed: 11/01/2022]
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13
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Ono T, Takahashi S, Mori Y, Nejima R, Iwasaki T, Kataoka Y, Miyai T, Miyata K. Severe fishhook-related ocular injury: A case series. Trauma Case Rep 2021; 37:100574. [PMID: 34917740 PMCID: PMC8666537 DOI: 10.1016/j.tcr.2021.100574] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2021] [Indexed: 12/01/2022] Open
Abstract
This study examined the treatment, clinical course, and prognosis of two patients who visited our institution with severe ocular fishhook-related injuries with complications. The first patient was a 57-year-old man injured in the right eye by a fishhook lacerating the right upper eyelid. Although no aqueous humor leakage was observed, intraocular hemorrhage was severe, and the best-corrected visual acuity (BCVA) was “counting fingers” at 15 cm. The eyelid was sutured and vitreous surgery with cataract surgery was performed for traumatic cataract, vitreous hemorrhage, and retinal detachment. The patient experienced recurring iritis and the BCVA recovered to 20/100 eight months postoperatively. The second patient was a 62-year-old man who incurred a penetrating right-eye fishhook injury on a ship with BCVA of “hand motion.” The sclera and iris were ruptured with severe hemorrhage and a shallow anterior chamber without leakage of aqueous humor. A damaged lens and vitreous hemorrhage were observed with intraocular pressure of 38 mmHg. The ruptured sclera was sutured and vitreous surgery with lensectomy was performed. After 16 months, the BCVA improved to 20/40; however, glaucoma control was maintained by topical medication. Therefore, ocular fishhook-related injury could result in irreversible visual impairment. It is important to pay attention and protect the eyes from moving fishhooks during fishing. Plain language summary There are few reports on fishhook injury of the eye with resulting complications such as retinal detachment. We present the characteristics of the injury, treatment, clinical course, and prognosis of two patients with severe fishhook-related injuries of the eye with complications. Following treatment, most complications, including vitreous hemorrhage, detached lens, and retinal detachment, safely resolved in these cases; however, both patients required further treatment for recurring inflammation of the iris or glaucoma. The visual acuity of both patients improved over several months. Fishhook-related injuries of the eyes might result in irreversible visual impairment. It is important to pay attention and protect the eyes from moving fishhooks during fishing.
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Affiliation(s)
- Takashi Ono
- Department of Ophthalmology, Miyata Eye Hospital, Miyakonojo, 6-3, Kuraharacho, Miyakonojo, Miyazaki 885-0051, Japan.,Department of Ophthalmology, the University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Shigefumi Takahashi
- Department of Ophthalmology, Miyata Eye Hospital, Miyakonojo, 6-3, Kuraharacho, Miyakonojo, Miyazaki 885-0051, Japan
| | - Yosai Mori
- Department of Ophthalmology, Miyata Eye Hospital, Miyakonojo, 6-3, Kuraharacho, Miyakonojo, Miyazaki 885-0051, Japan
| | - Ryohei Nejima
- Department of Ophthalmology, Miyata Eye Hospital, Miyakonojo, 6-3, Kuraharacho, Miyakonojo, Miyazaki 885-0051, Japan
| | - Takuya Iwasaki
- Department of Ophthalmology, Miyata Eye Hospital, Miyakonojo, 6-3, Kuraharacho, Miyakonojo, Miyazaki 885-0051, Japan
| | - Yasushi Kataoka
- Department of Ophthalmology, Miyata Eye Hospital, Miyakonojo, 6-3, Kuraharacho, Miyakonojo, Miyazaki 885-0051, Japan
| | - Takashi Miyai
- Department of Ophthalmology, the University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Kazunori Miyata
- Department of Ophthalmology, Miyata Eye Hospital, Miyakonojo, 6-3, Kuraharacho, Miyakonojo, Miyazaki 885-0051, Japan
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14
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Khatri A, Shrestha SM, Kuhn F, Subramanian P, Hoskin AK, Pradhan E, Agrawal R. Ophthalmic Trauma Correlation Matrix (OTCM): a potential novel tool for evaluation of concomitant ocular tissue damage in open globe injuries. Graefes Arch Clin Exp Ophthalmol 2021; 260:1773-1778. [PMID: 34792638 DOI: 10.1007/s00417-021-05491-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 08/25/2021] [Revised: 10/29/2021] [Accepted: 11/04/2021] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To introduce a novel tool to investigate the correlation between concomitant injuries and primary open globe injury (OGI) in the setting of ophthalmic trauma, the "Ophthalmic Trauma Correlation Matrix" (OTCM). METHODS Retrospective cohort review, performed at a tertiary referral eye care center in Eastern Nepal, involving all eyes with OGI meeting the inclusion criteria from 2015-2018. Clinical data including details of primary injury, concurrent injuries, and clinical course were noted from hospital medical records. A correlation matrix chart was devised using matrix correlation and Pearson's correlation coefficient. This chart was then used to evaluate the association of the various injuries in the setting of OGI. RESULTS A total of 109 eyes with OGI were included. Majority of the eyes (78, 71.6%) had zone I injuries, while most of the eyes (66, 60.6%) had penetrating injury. The most frequent concomitant injuries in all zones of OGI were traumatic lens injury (77, 70.64%), followed by hyphema (48, 44.03%), and vitreous hemorrhage (35, 32.11%). The most common concomitant injury associated with zone I was hyphema (0.873), while traumatic subluxation/cataract (0.894) and vitreous hemorrhage (0.972) were commonly associated with zone II and III, respectively. CONCLUSIONS OTCM could be a useful tool to manage injuries related to the primary ocular injury. This additional information will aid in the prognostication, planning, and management of OGI and potentially prevent repeat surgeries and inadequate treatments.
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Affiliation(s)
- Anadi Khatri
- Department of Vitreoretinal Services, Birat Eye Hospital, Biratnagar, Nepal. .,Department of Ophthalmology, Birat Medical College and Teaching Hospital, Biratnagar, Nepal.
| | | | - Ferenc Kuhn
- Helen Keller Foundation for Research and Education, Birmingham, USA.,Department of Ophthalmology, University of Pécs Medical School, Pécs, Hungary.,International Society of Ocular Trauma, Birmingham, USA
| | - Prem Subramanian
- Colorado School of Medicine, Aurora, CO, USA.,Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Annette K Hoskin
- Save Sight Institute, University of Sydney, Sydney, Australia.,Lions Eye Institute, University of Western Australia, Perth, Australia
| | - Eli Pradhan
- Tilganga Institute of Ophthalmology, Kathmandu, Nepal
| | - 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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15
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Irawati Y, Fitri MAR, Natalia MER, Atmodiwirjo P, Ramadan MR, Triatmoko SE. A case report of reconstruction of ocular and complete upper eyelid avulsion with severe facial soft tissue injuries using anterolateral thigh free flap. Int J Surg Case Rep 2021; 82:105856. [PMID: 33838486 PMCID: PMC8056434 DOI: 10.1016/j.ijscr.2021.105856] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 03/27/2021] [Accepted: 03/28/2021] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION AND IMPORTANCE Ocular injury is second mostly caused by motor vehicle accident (MVA) and often leads to severe ocular injury even to visual loss and various aesthetic problems. The outcome is determined by the magnitude of the initial damage and treatment availability. Treating ocular and facial injury due to MVA is challenging given the scope of the damage and may result in various outcomes. CASE PRESENTATION This case presented a 22-years old woman with a history of car accident assessed with total upper eyelid avulsion with corneal perforation and involvement of multiple facial fractures on the left side. The visual function is irreparable due to the extensive corneal defect from exposure and secondary infection, and possible optic nerve damage. CLINICAL DISCUSSION This case presented a complete upper eyelid avulsion with severe facial tissue injury. Therefore, the reconstructive procedure main objectives are to maintain appropriate prosthetic position and to improve cosmetic function. This case used anterolateral thigh free flap as the reconstructive surgery method because it is convenient for large defects and the donor scar is not visible. After completing the surgery and several follow-up procedures, the patient recovered without any significant complications. CONCLUSION Despite visual loss due to the extent damage of the eye, it is important to restore the facial damages. Visual function is as crucial as cosmetic function in determining the patient's quality of life.
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Affiliation(s)
- Yunia Irawati
- Plastic Reconstructive Surgery Division, Ophthalmology Department, Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo National Hospital, Jakarta, Indonesia.
| | - Marsha Alyssa Razief Fitri
- Ophthalmology Department, Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo National Hospital, Jakarta, Indonesia
| | - Michelle Eva Rebeca Natalia
- Ophthalmology Department, Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo National Hospital, Jakarta, Indonesia
| | - Parintosa Atmodiwirjo
- Reconstructive Microsurgery Section, Division of Plastic Surgery, Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo National Hospital, Jakarta, Indonesia
| | - Mohamad Rachadian Ramadan
- Reconstructive Microsurgery Section, Division of Plastic Surgery, Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo National Hospital, Jakarta, Indonesia
| | - Sara Ester Triatmoko
- Reconstructive Microsurgery Section, Division of Plastic Surgery, Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo National Hospital, Jakarta, Indonesia
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16
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Gore A, Kadar T, Dachir S, Horwitz V. Therapeutic measures for sulfur mustard-induced ocular injury. Toxicol Lett 2021; 340:58-66. [PMID: 33440228 DOI: 10.1016/j.toxlet.2021.01.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 10/07/2020] [Revised: 12/28/2020] [Accepted: 01/04/2021] [Indexed: 02/07/2023]
Abstract
The use of sulfur mustard (SM) in global terrorism is still a relevant threat to both civilian population and military personnel. Casualties exposed to SM may present mild, moderate or severe acute ocular lesions followed by a complete ocular resolution, chronic lesions or re-emerged ocular pathologies after a latent period. Current treatment for SM-induced ocular injury is based mainly on the clinical manifestation at the different stages of the injury and includes pharmaceutical and surgical interventions. These therapeutic measures are beneficial but not sufficient, and the ocular injury remains a continuous challenge for medical professionals. This review focuses on treatment experience carried out in humans and studied in animal models, for both SM-induced ocular acute injury and late pathology. In general, therapeutic measures are based on clinical features of the ocular injury or on the involvement of specific factors during the ocular injury that point out towards potential treatments. Anti-inflammatory treatments and limbal stem cell transplantation techniques were developed based on the clinical manifestation of the ocular injury. Optional therapies for impaired corneal innervation and endothelium are suggested for future research. Additionally, studies on potential treatments with anti-matrix metalloproteinase (MMP), anti-vascular endothelial growth factor (VEGF) and anti-IL-6 agents are discussed. Consequently, future studies may reveal the potential of additional pharmacological and biological treatments or advanced cellular and molecular biology methods to serve as novel therapeutic measures and techniques for this complicated ocular injury.
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Affiliation(s)
- Ariel Gore
- Department of Pharmacology, Israel Institute for Biological Research, Ness Ziona, 74100, Israel.
| | - Tamar Kadar
- Department of Pharmacology, Israel Institute for Biological Research, Ness Ziona, 74100, Israel
| | - Shlomit Dachir
- Department of Pharmacology, Israel Institute for Biological Research, Ness Ziona, 74100, Israel
| | - Vered Horwitz
- Department of Pharmacology, Israel Institute for Biological Research, Ness Ziona, 74100, Israel.
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17
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Hirano K, Tanikawa A. Ocular Injury Caused by the Sprayed Venom of the Asian Giant Hornet ( Vespa mandarinia). Case Rep Ophthalmol 2020; 11:430-435. [PMID: 32999672 PMCID: PMC7506230 DOI: 10.1159/000508911] [Citation(s) in RCA: 4] [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: 02/07/2020] [Accepted: 05/21/2020] [Indexed: 11/19/2022] Open
Abstract
This report presents the details of a case of sight-threatening injury in the right eye of a 77-year-old man which was caused by the venom of the Asian giant hornet (Vespa mandarinia). The patient was not stung, rather the venom was sprayed into his eye. Although the injured eye was washed as a first aid treatment, persistent corneal defect, corneal endothelial decompensation, iris atrophy, pupil dilation, and mature cataract were observed and a hand movement visual acuity was recorded 8 weeks after the injury. Since a slight a-wave was detected in his electroretinogram (ERG) result after the corneal epithelial defect had healed, we performed cataract surgery and Descemet stripping automated endothelial keratoplasty (DSAEK). After the DSAEK, the cornea of the right eye became clearer; however, the visual acuity of his right eye did not improve. Fundus examination revealed branch retinal artery occlusion but no optic disc atrophy. ERG showed that the a-wave amplitude of the injured eye recorded after the surgery was almost half of that of the fellow eye. The iris atrophy and mature cataract show that the sprayed Vespa venom of the Asian giant hornet can permeate into the intraocular area even without stinging. Whether the venom directly affects retinal function is unclear, but the decreased a-wave of the injured eye shows that the venom caused damage of retinal function in some way. Irrigation of the anterior chamber as well as eye washing is needed as a first aid treatment in similar cases.
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Affiliation(s)
- Koji Hirano
- Department of Ophthalmology, Fujita Health University Bantane Hospital, Nagoya, Japan
| | - Atsuhiro Tanikawa
- Department of Ophthalmology, School of Medicine, Fujita Health University, Toyoake, Japan
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18
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Aydil BA, Benlidayi ME, Kocaelli H, Dogancali GE, Genc A. Ocular injuries among oral and maxillofacial surgeons: Have high risk or not? An overview of a two-centered experience. J Stomatol Oral Maxillofac Surg 2020; 122:289-292. [PMID: 32535253 DOI: 10.1016/j.jormas.2020.06.001] [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] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 06/03/2020] [Accepted: 06/04/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Oral and maxillofacial surgeons are occupationally exposed to ocular injuries via bodily fluid (ie, blood or saliva), which can carry substantial latent risks, both bacterial and viral. The aim of this study was to determine the prevalence of ocular injury and infection among oral and maxillofacial surgeons during outpatient procedures. METHODS Data were collected from a consecutive series of 500 surgeries conducted by 26 resident surgeons via a questionnaire. Responses were categorized into two groups: Group I did not indicate an eye injury, and Group II did indicate an eye injury. RESULTS Of 500 procedures, 161 resulted in ocular injuries, a rate of 32.2 injuries per 100 person-procedures. Educated participants experienced eye injuries at a significantly higher rate than those who were uneducated (23.33% vs. 15.11%; P=0.022). Those not using eye protection experienced eye injuries at a significantly higher rate than those using eye protection (23.32% vs. 2.33%; P<0.001). Of all eye injuries, 14.28% required medical management. Incidents were reported at a rate of 10.56%, higher in those with multiple injuries. CONCLUSION These findings demonstrate major inadequacies and breaches of the present eye/face protection protocols. Because the number of clinical studies on ocular injuries during oral and maxillofacial surgerical procedures is limited in the literature, each additional study can be important for promoting awareness among professionals, so that serious morbidity can be prevented.
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Affiliation(s)
- B A Aydil
- Istanbul University, Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Istanbul
| | - M E Benlidayi
- Cukurova University, Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Istanbul
| | - H Kocaelli
- Istanbul University, Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Istanbul
| | - G E Dogancali
- Istanbul University, Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Istanbul
| | - A Genc
- Istanbul University, Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Istanbul.
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Noh H, Chung JK, Woo KI, Kim YD. Occurrence of ocular injury and orbital fracture in orbital blunt trauma patients at tertiary care center emergency room. Graefes Arch Clin Exp Ophthalmol 2020; 259:165-171. [PMID: 32514771 DOI: 10.1007/s00417-020-04786-6] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 05/19/2020] [Accepted: 06/01/2020] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To analyze the prevalence and association of ocular injury and orbital fracture in orbital trauma patients METHODS: Patients with periocular trauma who visited the emergency room at the referral center from 2014 to 2016 were screened. Patients examined by ophthalmologists and evaluated by CT scan were included. Patients' age, gender, cause of trauma, and injury patterns were retrieved. The location of the fracture and morphologic parameters were reviewed. The patients were divided into groups based on the presence of orbital fracture and/or the presence of ocular injury and clinical data were compared. RESULTS Two hundred patients were included and 158 presented with fracture. Ocular injuries occurred in 129 of 158 (81.6%) in the fracture group, and in 40 of 42 (95.2%) in the no fracture group; ocular injuries were found more often in the no fracture group (p = 0.031). Open globe injuries occurred in 5 of 158 (3.2%) in the fracture group and in 6 of 42 (14.3%) in the no fracture group; open globe injuries were found more often in the no fracture group (p = 0.012). Patients with ocular injuries showed shorter depth of the orbit (41.9 vs. 44.1 mm; p = 0.003) compared to the patients without ocular injuries. Logistic regression revealed that short orbit was associated with the presence of ocular injury (p = 0.004). CONCLUSION The incidence of ocular injuries was significantly higher in patients without orbital fracture than in those with fractures of the orbit. The orbital fracture may play a protective role against ocular injury by providing a decompressive effect on the orbital tissue.
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Affiliation(s)
- Hoon Noh
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-gu, Seoul, 06351, Korea
| | - Joon Kyo Chung
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-gu, Seoul, 06351, Korea
| | - Kyung In Woo
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-gu, Seoul, 06351, Korea.
| | - Yoon-Duck Kim
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-gu, Seoul, 06351, Korea
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20
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Andrade WM, da Silva ACG, Moreira LC, Gomes TRLES, Batista AC, Valadares MC. Innovative strategy based on mechanisms to substitute animal testing for ocular toxicity assessment of agrochemical formulations market in Brazil. Toxicol In Vitro 2020; 66:104851. [PMID: 32259559 DOI: 10.1016/j.tiv.2020.104851] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 02/27/2020] [Accepted: 04/03/2020] [Indexed: 12/14/2022]
Abstract
Considering the successful employment of alternative methods for eye toxicity assessment of products for regulatory purposes, and the recent advances in Brazilian legislative scenario, which adopted the UN GHS classification system for agrochemical formulations toxicity assessment, there is an emerging demand for strategies that allow the evaluation of such products. Based on this, the present study aimed to address the applicability of a mechanistic-based defined approach for eye toxicity assessment of agrochemical formulations. It was investigated the opacity/permeability, depth and location of corneal injury in bovine cornea, and vascular events in chorioallantoic membrane induced for different Brazilian agrochemicals using a Sequential Testing Strategy (STS). Cytotoxicity induced by the agrochemical formulations was evaluated by Short Time exposure (STE) (OECD TG 491) assay (step 1), corneal injury was investigated by standard Bovine Corneal Opacity and Permeability (BCOP) (OECD TG 437) followed by histopathological evaluation (step 2), and Hen Chorionic-allantoic Membrane test (HET-CAM) was used to evaluate vascular injury (step 3). The results demonstrated that the proposed defined approach enabled a classification corresponding UN GHS classification of agrochemical formulations while minimizing the use of live animals. Therefore, this approach may be useful for categorization of agrochemicals in Brazil according to the new regulatory scenario.
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Affiliation(s)
- Wanessa Machado Andrade
- Laboratory of Education and Research in In Vitro Toxicology, Tox In, Faculty of Pharmacy, Federal University of Goiás, Goiânia, GO, Brazil
| | - Artur Christian Garcia da Silva
- Laboratory of Education and Research in In Vitro Toxicology, Tox In, Faculty of Pharmacy, Federal University of Goiás, Goiânia, GO, Brazil
| | - Larissa Cleres Moreira
- Laboratory of Education and Research in In Vitro Toxicology, Tox In, Faculty of Pharmacy, Federal University of Goiás, Goiânia, GO, Brazil
| | | | - Aline Carvalho Batista
- Laboratory of Oral Pathology, Dental School, Federal University of Goiás, Goiânia, GO, Brazil
| | - Marize Campos Valadares
- Laboratory of Education and Research in In Vitro Toxicology, Tox In, Faculty of Pharmacy, Federal University of Goiás, Goiânia, GO, Brazil.
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Kaluzhny Y, Kinuthia MW, Lapointe AM, Truong T, Klausner M, Hayden P. Oxidative stress in corneal injuries of different origin: Utilization of 3D human corneal epithelial tissue model. Exp Eye Res 2019; 190:107867. [PMID: 31705899 DOI: 10.1016/j.exer.2019.107867] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [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: 07/10/2019] [Revised: 10/10/2019] [Accepted: 11/04/2019] [Indexed: 12/17/2022]
Abstract
The purpose of the current work was to utilize a three dimensional (3D) corneal epithelial tissue model to study dry eye disease and oxidative stress-related corneal epithelial injuries for the advancement of ocular therapeutics. Air-liquid interface cultures of normal human corneal epithelial cells were used to produce 3D corneal epithelial tissues appropriate for physiologically relevant exposure to environmental factors. Oxidative stress was generated by exposing the tissues to non-toxic doses of ultraviolet radiation (UV), hydrogen peroxide, vesicating agent nitrogen mustard, or desiccating conditions that stimulated morphological, cellular, and molecular changes relevant to dry eye disease. Corneal specific responses, including barrier function, tissue viability, reactive oxygen species (ROS) accumulation, lipid peroxidation, cytokine release, histology, and gene expression were evaluated. 3D corneal epithelial tissue model structurally and functionally reproduced key features of molecular responses of various types of oxidative stress-induced ocular damage. The most pronounced effects for different treatments were: UV irradiation - intracellular ROS accumulation; hydrogen peroxide exposure - barrier impairment and IL-8 release; nitrogen mustard exposure - lipid peroxidation and IL-8 release; desiccating conditions - tissue thinning, a decline in mucin expression, increased lipid peroxidation and IL-8 release. Utilizing a PCR gene array, we compared the effects of corneal epithelial damage on the expression of 84 oxidative stress-responsive genes and found specific molecular responses for each type of damage. The topical application of lubricant eye drops improved tissue morphology while decreasing lipid peroxidation and IL-8 release from tissues incubated at desiccating conditions. This model is anticipated to be a valuable tool to study molecular mechanisms of corneal epithelial damage and aid in the development of therapies against dry eye disease, oxidative stress- and vesicant-induced ocular injuries.
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Affiliation(s)
- Yulia Kaluzhny
- MatTek Corporation, 200 Homer Avenue, Ashland, MA, 01721, USA.
| | | | | | - Thoa Truong
- MatTek Corporation, 200 Homer Avenue, Ashland, MA, 01721, USA.
| | | | - Patrick Hayden
- MatTek Corporation, 200 Homer Avenue, Ashland, MA, 01721, USA.
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Ghazanfari T, Ghasemi H, Yaraee R, Mahmoudi M, Javadi MA, Soroush MR, Faghihzadeh S, Majd AMM, Shakeri R, Babaei M, Heidary F, Hassan ZM. Tear and serum interleukin-8 and serum CX3CL1, CCL2 and CCL5 in sulfur mustard eye-exposed patients. Int Immunopharmacol 2019; 77:105844. [PMID: 31669888 DOI: 10.1016/j.intimp.2019.105844] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 05/20/2019] [Revised: 08/17/2019] [Accepted: 08/19/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND The serum and tear levels of four inflammatory chemokines were evaluated in sulfur mustard (SM)-exposed with serious ocular problems. MATERIALS AND METHODS In this study, 128 SM-exposed patients and 31 healthy control participants participated. Tear and serum levels of chemokines were assessed by ELISA method. RESULTS There was no significant difference in the serum level of IL-8/CXCL8, CX3CL1/fractalkine, CCL2/MCP-1, and CCL5/RANTES between all SM-exposed subjects and control groups. The tear level of IL-8 in the SM-exposed group was lower than the control group, but the difference was not significant. In the SM-exposed group with the abnormalities in tear breakup time (TBUT) test, fundus and pannus formation were significantly higher than SM-exposed patients without these problems. CX3CL1 levels have significantly increased in SM-exposed group with blepharitis, pterygium, and conjunctival pigmentation as compared with the control group. Besides, significantly higher levels of CX3CL1 were observed in SM-exposed group with or without bulbar conjunctival hyperemia and abnormal vessels a well as with fundus abnormality compared to the control group. Only, SM-exposed group with subconjunctival fibrosis had significantly lower levels of CCL5 than SM-exposed group without this problem. CONCLUSION The higher level of CX3CL1 and consistent levels of IL-8/CXCL8, MCP-1/CCL2, and RANTES/CCL5 in SM-exposed individuals may indicate an anti-inflammatory response against the destructive effects of SM gas. High tear level of IL-8/CXCL8 reflects the severity of ocular surface abnormalities, yet significantly low tear level found in mild SM-exposed subgroup compared with the control group. The lower levels of CX3CL1 and RANTES/CCL5 may represent the different pathophysiology which requires further studies.
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Affiliation(s)
- Tooba Ghazanfari
- Immunoregulation Research Center, Shahed University, Tehran, Iran.
| | - Hassan Ghasemi
- Department of Ophthalmology, Shahed University, 3319118651 Tehran, Iran
| | - Roya Yaraee
- Department of Immunology and Immunoregulation Research Center, Shahed University, Tehran, Iran
| | - Mahmoud Mahmoudi
- Immunology Research Center, Mashhad University of Medical Sciences, 9138813944 Mashhad, Iran.
| | - Mohammad Ali Javadi
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, 1983969411 Tehran, Iran
| | - Mohammad Reza Soroush
- Janbazan Medical and Engineering Research Center (JMERC), NO.17, Farrokh St., Moghaddas Ardebily Ave., Chamran Highway, 1985946531 Tehran, Iran
| | - Soghrat Faghihzadeh
- Department of Biostatistics and Social Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | | | - Raheleh Shakeri
- Department of Biological Science and Biotechnology, Faculty of Science, 6617715175, University of Kurdistan, Sanandaj, Iran
| | - Mahmoud Babaei
- Department of Ophthalmology, Baqiyatallah University of Medical Sciences, 1435916471 Tehran, Iran; Trauma Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran.
| | - Fatemeh Heidary
- Immunoregulation Research Center, Shahed University, Tehran, Iran
| | - Zuhair Mohammad Hassan
- Department of Immunology, School of Medical Sciences, Tarbiat Modares University, 14115111 Tehran, Iran.
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Ghasemi H, Javadi MA, Ardestani SK, Mahmoudi M, Pourfarzam S, Mahdavi MRV, Yarmohammadi ME, Baradaran-Rafii A, Jadidi K, Shariatpanahi S, Rastin M, Heidary F, Safavi M, Mirsharif ES, Nasiri Z, Ghazanfari T. Alteration in inflammatory mediators in seriously eye-injured war veterans, long-term after sulfur mustard exposure. Int Immunopharmacol 2019; 80:105897. [PMID: 31685435 DOI: 10.1016/j.intimp.2019.105897] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 06/02/2019] [Revised: 08/26/2019] [Accepted: 09/06/2019] [Indexed: 01/12/2023]
Abstract
BACKGROUND Sulfur mustard (SM) exposure produces extensive systemic and ocular adverse effects on the victims. One of the most important effects is immunological insults that can lead to other organ damages, including the eyes. METHODS In this descriptive study, 128 SM-exposed veterans with severe eye injury were compared with 31 healthy controls. Tear levels of tumor necrosis factor (TNF)-α and serum concentrations of interleukin (IL)-1α, IL-1β, IL1Ra, IL-6, TNF-α, granulocyte-macrophage colony-stimulating factor (GM-CSF), and Fas Ligand (FasL) were compared between the two groups. RESULTS Meibomian gland dysfunction (MGD); tear breakup time (TBUT < 10″); and conjunctival, limbal, and corneal abnormalities were more frequent among the cases (MS-exposed veterans) than the controls. Ocular involvement was mild in 14.8%, moderate in 24.2%, and severe in 60.9% of the cases. Serum levels of IL-1α and FasL were significantly higher among the cases than among the controls (P < 0.001 and P = 0.037, respectively). Also, a significant decrease was observed in serum and tear levels of TNF-α in the cases as compared with controls (P < 0.001, P < 0.001, respectively). Serum levels of FasL were significantly higher in cases with severe ocular involvement than in the controls (P = 0.03). Nonetheless, serum levels of IL-1β, IL-1Ra, IL-1α/IL-1Ra, and IL-6 were not significantly different between the two groups. CONCLUSION Serum levels of IL-1α and FasL may cause different ocular surface abnormalities in SM-exposed patients. Lower tear TNF-α concentration may be due to lower serum levels of this cytokine in these patients.
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Affiliation(s)
- Hassan Ghasemi
- Department of Ophthalmology, Shahed University, Tehran 3319118651, Iran
| | - Mohammad Ali Javadi
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran 1983969411, Iran
| | - Sussan K Ardestani
- Department of Immunology, Institute of Biochemistry and Biophysics, University of Tehran, Tehran 1417614335, Iran.
| | - Mahmoud Mahmoudi
- Immunology Research Center, Department of Immunology and Allergy, School of Medicine, Mashhad University of Medical Sciences, Mashhad 9138813944, Iran.
| | | | | | | | - Alireza Baradaran-Rafii
- Ocular Tissue Engineering Research Center, Shahid Beheshti University of Medical Sciences, No 23, Paydarfard-9th Boostan St., Pasdaran Ave, Tehran 1666673111, Iran
| | - Khosro Jadidi
- Department of Ophthalmology, Baqiyatallah University of Medical Sciences, Tehran 1435915371, Iran
| | | | - Maryam Rastin
- Immunology Research Center, Department of Immunology and Allergy, School of Medicine, Mashhad University of Medical Sciences, Mashhad 9138813944, Iran.
| | - Fatemeh Heidary
- Immunoregulation Research Center, Shahed University, Tehran 3319118651, Iran
| | - Maliheh Safavi
- Department of Biotechnology, Iranian Research Organization for Science and Technology, Sh. Ehsani Rad St., Enqelab St., Parsa Sq., Ahmadabad Mostoufi Rd., Azadegan Highway, Tehran 3313193685, Iran
| | | | - Zahra Nasiri
- Immunoregulation Research Center, Shahed University, Tehran 3319118651, Iran
| | - Tooba Ghazanfari
- Immunoregulation Research Center, Shahed University, Tehran 3319118651, Iran; Department of Immunology, Shahed University, Tehran 3319118651, Iran.
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Klyuchareva SV, Ponomarev IV, Topchiy SB, Pushkareva AE, Andrusenko YN. Treatment of Basal Cell Cancer With a Pulsed Copper Vapor Laser: A Case Series. J Lasers Med Sci 2019; 10:350-354. [PMID: 31875131 PMCID: PMC6885912 DOI: 10.15171/jlms.2019.57] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Introduction: Basal cell carcinoma (BCC) is the most prevalent form of non-melanoma skin cancer commonly arising in elderly patients. Currently, many laser systems are applied for the treatment of BCC. However, up to the present, there have been several reports concerning ocular side effects due to the laser procedure in the borders of the periorbital area. This determines the feasibility of testing new laser surgical modes for the management of periorbital BCC. This stuay aimed to estimate both the efficacy, the early post-radiated side effects and long-term outcomes of the CVL treatment of periorbital BCC. Patients and Methods: Two men and 6 women aged 50 to 77 years were diagnosed with periorbital BCC according to the data of both the clinical evaluation and histological examination of the tissue samples taken from the involved area. Six months after the laser treatment, the histological examination of skin samples from the borderline of the irradiated area was made again. All patients were followed for 24 months after the laser treatment of BCC. The laser treatment was administered during one session of copper vapor laser (CVL) (Yakhroma-Med model). The treatment included CVL radiation with a wavelength of 511 nm and 578 nm, in the ratio of 3:2. The power level was set up to 3 W, and the exposure time was equal from 200 to 600 ms. The pulse duration accounted for 15 ns. The diameter of the light spot on the skin surface amounted to 1 mm. Results: Dual-wavelengths CVL treatment of periorbital BCC provided a complete elimination of malignant cells and dysplastic vessels during one procedure. The duration of skin healing amounted to 2-4 weeks. There were neither ocular injuries or pronounced skin side effects nor relapses within 24 months after the laser procedure. Conclusion: CVL treatment of periorbital BCC provides relevant cosmetic results without ocular injuries and relapses.
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Affiliation(s)
- Svetlana V. Klyuchareva
- Department of Dermatovenereology, I.I. Mechnikov North-Western State Medical University, 47, Piskarevkiy Prospect, St. Petersburg, 195067, Russian Federation
| | - Igor V. Ponomarev
- P.N. Lebedev Physical Institute of the Russian Academy of Sciences, 53, Leninskiy Prospect, Moscow, 119991, Russian Federation
| | - Sergey B. Topchiy
- P.N. Lebedev Physical Institute of the Russian Academy of Sciences, 53, Leninskiy Prospect, Moscow, 119991, Russian Federation
| | - Alexandra E. Pushkareva
- Saint Petersburg National Research University of Information Technologies, Mechanics and Optics, 49, Kronverkskiy Prospect, St. Petersburg, 197101, Russian Federation
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Heidary F, Ardestani SK, Ghasemi H, Javadi MA, Mahmoudi M, Yaraee R, Shams J, Falahi F, Sedighi Moghadam MR, Shariatpanahi S, Shakeri R, Naghizadeh MM, Ghazanfari T. Alteration in serum levels of ICAM-1 and P-, E- and L-selectins in seriously eye-injured long-term following sulfur-mustard exposure. Int Immunopharmacol 2019; 76:105820. [PMID: 31480003 DOI: 10.1016/j.intimp.2019.105820] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 08/05/2019] [Accepted: 08/09/2019] [Indexed: 11/27/2022]
Abstract
INTRODUCTION In this study, the serum levels of soluble intercellular adhesion molecule 1 (ICAM-1), P-, E-, and L-selectins were investigated in seriously eye-injured patients exposed to sulfur mustard (SM). MATERIAL AND METHODS A total of 128 individuals with SM-induced serious eye injuries and 31 healthy male controls were included in this study. The serum concentration of soluble forms of adhesion molecules was measured by enzyme-linked immunosorbent assay (ELISA) method. RESULT The serum level of soluble ICAM-1 was significantly higher in the SM-exposed individuals with an abnormality in tear meniscus height, corneal verticillata, and pannus compared with SM-exposed individuals without these abnormalities. There were no significant differences in the level of all three measured selectins between the SM-exposed group and the control groups. SM-exposed individuals with corneal defect had a significantly higher level of soluble E-selectin than SM-exposed individuals without this abnormality. The serum level of soluble P-selectin in the SM-exposed group with limbal abnormality was significantly lower than that in the SM-exposed without this abnormality; also it was significantly higher in SM-exposed group with fundus abnormality compared to that in the control group or SM-exposed group without this abnormality. CONCLUSION The changes in the levels of selectins and ICAM-1 in the SM-exposed group with various ocular abnormalities is a defense mechanism against the toxicity of SM. Further analysis is required to understand the molecular mechanisms of the relationship between adhesion molecules with ocular complications in SM-exposed individuals.
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Affiliation(s)
- Fatemeh Heidary
- Immunoregulation Research Center, Shahed University, Tehran, Iran
| | - Sussan K Ardestani
- Department of Immunology, Institute of Biochemistry and Biophysics, University of Tehran, Tehran, Iran.
| | - Hassan Ghasemi
- Department of Ophthalmology, Shahed University, Tehran, Iran
| | - Mohammad Ali Javadi
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahmoud Mahmoudi
- Immunology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Roya Yaraee
- Department of Immunology and Immunoregulation Research Center, Shahed University, Tehran, Iran
| | - Jalaledin Shams
- Hematology-oncology Unit, Internal Medicine Department, Shahed University, Tehran, Iran
| | | | | | | | - Raheleh Shakeri
- Department of Biological Science and Biotechnology, Faculty of Science, University of Kurdistan, Sanandaj, Iran
| | - Mohammad Mehdi Naghizadeh
- Immunoregulation Research Center, Shahed University, Tehran, Iran; Non communicable diseases Research Center, Fasa University of Medical Science, Fasa, Iran
| | - Tooba Ghazanfari
- Immunoregulation Research Center, Shahed University, Tehran, Iran; Department of Immunology, Shahed University, Tehran, Iran.
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Kaye AD, Renschler JS, Cramer KD, Anyama BO, Anyama EC, Gayle JA, Armstead-Williams CM, Mosieri CN, Saus JA, Cornett EM. Postoperative Management of Corneal Abrasions and Clinical Implications: a Comprehensive Review. Curr Pain Headache Rep 2019; 23:48. [PMID: 31147838 DOI: 10.1007/s11916-019-0784-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE OF REVIEW Total patient care is of extreme importance during the administration of anesthesia. Proper care of the eye is necessary during all anesthetic administrations, especially during the administration of general anesthesia or monitored anesthesia care. By paying attention to details, the likelihood of an occurrence of eye injuries is reduced. RECENT FINDINGS Though perioperative eye injuries are rare during general anesthesia, they do account for 2-3% of claims against anesthesiologists. Ocular injuries may occur during general anesthesia even when tape has been utilized for eye closure. Corneal abrasions are the most common injuries that have been attributed to direct trauma to the eye, exposure keratopathy, or chemical injury. Using a hydrogel patch during general anesthesia is also associated with more frequent corneal injury than previously thought. Prevention of anesthesia-related eye injuries assumes a high priority since the eye is one of the major sense organs of the body. The eye can be damaged during anesthesia for both non-ophthalmic and ophthalmic surgeries.
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Goswami DG, Kant R, Tewari-Singh N, Agarwal R. Efficacy of anti-inflammatory, antibiotic and pleiotropic agents in reversing nitrogen mustard-induced injury in ex vivo cultured rabbit cornea. Toxicol Lett 2018; 293:127-132. [PMID: 29174984 DOI: 10.1016/j.toxlet.2017.11.026] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Revised: 11/13/2017] [Accepted: 11/22/2017] [Indexed: 01/01/2023]
Abstract
Vesicating agent, Sulfur mustard (SM), causes devastating eye injury; however, there are no effective antidotes available. Using nitrogen mustard (NM), a bi-functional analog of SM, we have earlier reported that NM-induced corneal injury in ex vivo rabbit cornea organ culture model parallels corneal injury reported with SM. Using this model, we have demonstrated the therapeutic efficacy of dexamethasone (DEX), doxycycline (DOX) and silibinin (SB) in reversing NM (2h exposure)-induced corneal injuries when added immediately after washing NM. In the present study, we further examined the efficacy of similar/higher doses of these agents when added immediately, 2, or 4h after washing NM following its 2h exposure. All three treatment agents caused a reversal in established NM-induced injury biomarkers when added immediately or 2h after washing NM following its 2h exposure; however, when treatments were carried out 4h after washing NM, there was no significant effect. Together, our results further show the beneficial effect of these agents in reversing NM-induced corneal injury and indicate the time window for effective treatment. This could be useful towards future development of targeted therapeutics against vesicant-induced ocular injury.
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Affiliation(s)
- Dinesh G Goswami
- Department of Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Rama Kant
- Department of Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Neera Tewari-Singh
- Department of Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Rajesh Agarwal
- Department of Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
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Abstract
Purpose We report a rare case of ocular injury due to potassium permanganate (KMnO4) granules in a child. Methods This is a retrospective case report. Results A 2-year-old boy was transferred to our emergency room with severe pain in his right eye, inflamed eyelids, and brownish stains on his fingers. Chemical injury was suspected. Copious eye irrigation was immediately performed. Diffuse brownish splotches were then observed at the inferior bulbar conjunctiva. Otherwise, systemic organs were intact. Complete eye exam under general anesthesia revealed a 5-mm epithelial defect at the central cornea, along with generalized conjunctival injection and limbal ischemia, inferiorly. Multiple semi-dissolved granules of KMnO4 trapped in the inferior fornix were identified. The chemical particles were gradually washed out and removed; however, the brownish stains remained. The patient received preservative-free steroid, antibiotic eye drops, and lubricants as regular management for mild to moderate degree of ocular burn. Pseudomembrane developed early and transformed into symblepharon within a few days after the injury. Membrane adhesion was lysed, and more aggressive medications were then substituted. Commercial amniotic membrane (PROKERA®) was also applied to promote wound healing and to prevent recurrence of symblepharon. The ocular surface was eventually restored, and corneal transparency was preserved. Conclusion Ocular injury with the granular form of KMnO4 is rare. Its toxicity is comparable to concentrated KMnO4 solution. However, the dissolved particles that had been absorbed in the stained conjunctiva were continuously released and damaged the ocular surface more than we primarily anticipated. Awareness of this condition and prompt management yield a good treatment outcome.
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Affiliation(s)
- Chareenun Chirapapaisan
- Department of Ophthalmology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Pinnita Prabhasawat
- Department of Ophthalmology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sabong Srivannaboon
- Department of Ophthalmology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Puodžiuvienė E, Jokūbauskienė G, Vieversytė M, Asselineau K. A five-year retrospective study of the epidemiological characteristics and visual outcomes of pediatric ocular trauma. BMC Ophthalmol 2018; 18:10. [PMID: 29347941 PMCID: PMC5774107 DOI: 10.1186/s12886-018-0676-7] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 01/10/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pediatric trauma can lead to serious visual impairment as a result of the trauma itself or secondary to amblyopia. Precise data on epidemiological characteristics and visual outcomes of pediatric ocular injuries are valuable for the prevention of monocular blindness. METHODS A total of 268 cases of pediatric ocular trauma admitted to the Department of Ophthalmology of the Lithuanian University of Health Sciences Hospital from January 2008 to December 2013 were retrospectively reviewed. Data analysed included age, sex, cause, type and treatment of injury, initial and final visual acuity (VA) and tissues involvement. Eye injuries were classified by Birmingham Eye Trauma Terminology (BETT) and Ocular Trauma Classification System (OTCS). RESULTS The age of children ranged from 6 months to 17.5 years. Boys were more likely to suffer ocular injury than girls. Home was the leading place of eye injury (60.4%), followed by outdoors (31.7%), school (5.2%) and sporting area (2.2%). The highest percentage of eye injuries in children were caused by blunt (40.3%) and sharp objects (29.9%), followed by burns (9.3%), falls (6.7%), explosions (4.5%), fireworks (4.1%), gunshots (1.9%) and traffic accidents (0.7%). Closed globe injury (CGI) was the most common type of eye injury (53.4%). CGI were noted to be higher in children aged 13-18 years, while open globe injury (OGI) were higher in the pre-school age group. Injury of grade 4 and grade 5 were more common in OGI, while grade 1 and grade 2 predominated in cases of CGI. Hypotony, traumatic cataract, iris laceration, vitreous prolapse and uveitis were the most common presentations of OGI, while hyphema, secondary glaucoma and retinal edema were significantly related with CGI. Final diagnoses contributing to poor final visual outcome such as corneal scar corneal opacity, hypotony, aphakia, and retinal detachment were statistically significant related only with OGI. Overall, 65.63% of children regained good visual acuity (VA ≥ 0.5), but for 18.4% of them, the trauma resulted in severe visual impairment (VA ≤ 0.1). CONCLUSION Ocular trauma in children still remains an important preventable cause of ocular morbidity. This study provides data indicating that ophthalmological injuries are a significant cause of visual impairment in children.
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Affiliation(s)
- Edita Puodžiuvienė
- Eye clinic, Lithuanian University of Health Sciences, Eivenių 2, Kaunas, Lithuania
| | - Giedrė Jokūbauskienė
- Eye clinic, Lithuanian University of Health Sciences, Eivenių 2, Kaunas, Lithuania
| | - Monika Vieversytė
- Eye clinic, Lithuanian University of Health Sciences, Eivenių 2, Kaunas, Lithuania
| | - Kirwan Asselineau
- Ophthalmology department, Centre Hospitalier Universitaire de Limoges, 2, avenue Martin Luther King, Limoges, France
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Keel S, Xie J, Foreman J, Taylor HR, Dirani M. The prevalence of vision loss due to ocular trauma in the Australian National Eye Health Survey. Injury 2017; 48:2466-2469. [PMID: 28964509 DOI: 10.1016/j.injury.2017.09.020] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [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: 09/06/2017] [Accepted: 09/19/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND To determine the prevalence of vision loss due to ocular trauma in Australia. METHODS The National Eye Health Survey (NEHS) is a population-based cross-sectional study that examined 3098 non-Indigenous Australians (aged 50-98 years) and 1738 Indigenous Australians (aged 40-92 years) living in 30 randomly selected sites, stratified by remoteness. An eye was considered to have vision loss due to trauma if the best-corrected visual acuity was worse than 6/12 and the main cause was attributed to ocular trauma. This determination was made by two independent ophthalmologists and any disagreements were adjudicated by a third senior ophthalmologist. RESULTS The sampling weight adjusted prevalence of vision loss due to ocular trauma in non-Indigenous Australians aged 50 years and older and Indigenous Australians aged 40 years and over was 0.24% (95%CI: 0.10, 0.52) and 0.79% (95%CI: 0.56, 1.13), respectively. Trauma was attributed as an underlying cause of bilateral vision loss in one Indigenous participant, with all other cases being monocular. Males displayed a higher prevalence of vision loss from ocular trauma than females in both the non-Indigenous (0.47% vs. 1.25%, p=0.03) and Indigenous populations (0.12% vs. 0.38%, p=0.02). After multivariate adjustments, residing in Very Remote geographical areas was associated with higher odds of vision loss from ocular trauma. CONCLUSIONS We estimate that 2.4 per 1000 non-Indigenous and 7.9 per 1000 Indigenous Australian adults have monocular vision loss due to a previous severe ocular trauma. Our findings indicate that males, Indigenous Australians and those residing in Very Remote communities may benefit from targeted health promotion to improve awareness of trauma prevention strategies.
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Affiliation(s)
- Stuart Keel
- Centre for Eye Research Australia, Royal Victorian Eye & Ear Hospital, Melbourne, Australia.
| | - Jing Xie
- Centre for Eye Research Australia, Royal Victorian Eye & Ear Hospital, Melbourne, Australia
| | - Joshua Foreman
- Centre for Eye Research Australia, Royal Victorian Eye & Ear Hospital, Melbourne, Australia; Ophthalmology, University of Melbourne, Department of Surgery, Melbourne, Australia
| | - Hugh R Taylor
- Indigenous Eye Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Mohamed Dirani
- Centre for Eye Research Australia, Royal Victorian Eye & Ear Hospital, Melbourne, Australia
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Abstract
This article reviews the unique challenges presented by chemical, electrical, and radiation injuries. The authors discuss pathophysiology and diagnosis of these injuries and provide recommendations for management.
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Affiliation(s)
| | - David A Brown
- Duke University School of Medicine, 8 Duke University Medical Center Greenspace, Durham, NC 27703, USA
| | - Benjamin Levi
- Division of Plastic Surgery, University of Michigan School of Medicine, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA.
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Alexander V, Sindhu KNC, Zechariah P, Resu AV, Nair SR, Kattula D, Mohan VR, Alex T RG. Occupational safety measures and morbidity among welders in Vellore, Southern India. Int J Occup Environ Health 2016; 22:300-306. [PMID: 27682579 DOI: 10.1080/10773525.2016.1228287] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Welders in the unorganized occupational sector in the economically developing world are exposed to respiratory, skin, eye, ear, and neurological problems exacerbated by non-usage of personal protective equipment (PPE). OBJECTIVE To study the frequency of health problems and the usage of PPE among welders in unorganized welding units in Vellore, India. METHODS A cross-sectional survey was conducted among 150 welders to determine the frequency of skin, ear, eye, and respiratory morbidity and the usage of PPE. A group of 150 non-welders were chosen for comparison. RESULTS Significant differences in the frequency of skin burns, redness, hyper pigmentation, itching, eye injuries, and sensorineural deafness were observed among the welders and non-welders (P < 0.001). Hypertension was noted in 12.6% of the welders as compared to 0.7% among the non-welders. None of the welders used appropriate PPE. For welders, low educational attainment was associated with an increased risk of eye injury (P < 0.05, OR = 0.29). There was also a significant difference between sensorineural deafness and a welder having less than 10 years of welding work experience (P < 0.001, OR = 18.18) which could probably be accounted for by the healthy worker effect. CONCLUSION Welders in this sample experienced a significant skin, eye, and ear morbidity accentuated by the non-usage of PPE. All worked without formal training and were unaware of the safe working guidelines that exist, but are not implemented for the welders in India.
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Affiliation(s)
- Vijay Alexander
- a Department of Community Health , Christian Medical College , Vellore , India
| | | | - Pradeep Zechariah
- a Department of Community Health , Christian Medical College , Vellore , India
| | | | | | - Deepthi Kattula
- b Division of GI Sciences , Christian Medical College , Vellore , India
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Gendler S, Nadler R, Erlich T, Fogel O, Shushan G, Glassberg E. Eye injury in the Israeli Defense Force: "an ounce of prevention is worth a pound of cure". Injury 2015; 46:1241-4. [PMID: 25682313 DOI: 10.1016/j.injury.2015.01.035] [Citation(s) in RCA: 12] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Revised: 01/07/2015] [Accepted: 01/22/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND The eye occupies 0.1% of the total body surface yet it accounts for 8-13% of battle injuries in modern warfare worldwide. Protective eyewear can prevent over 90% of these eye injuries in both military and civilian settings. This study presents an analysis of a military casualty database and describes the proportion and distribution of eye injuries among Israel Defense Force (IDF) Soldiers. METHODS All trauma patients recorded in the IDF Trauma Registry (ITR) in whom ocular injury related to combat or to training was documented were reviewed. RESULTS There were 129 patients with documented eye injury sustained during combat or training between 1997 and 2013: 75% of injuries were related to combat and the remainder occurred during training. Penetrating fragmental injuries accounted for 74% of combat related injuries and 28% of training related injuries. Sixty-six percent (66%) of these casualties were subsequently re-classified as no longer fit for combat duties. Combat related injuries resulted in a higher incidence of severe injuries compared to training related injuries (P<0.05). CONCLUSIONS Despite optimal medical care, the majority of soldiers who sustain eye injuries during military service suffer from substantial disability and most are no longer fit for combat service. A majority are discharged from military service. Protective eyewear could potentially prevent penetrating fragmental wounds which are the most common cause of injury. Further research on optimal orbital protection is critical for both the military and the civilian sectors.
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Affiliation(s)
- Sami Gendler
- Surgeon General's HQ, Israel Defense Force, Ramat Gan, Israel; Department of Military Medicine, Hebrew University, Jerusalem, Israel.
| | - Roy Nadler
- Surgeon General's HQ, Israel Defense Force, Ramat Gan, Israel; Department of Military Medicine, Hebrew University, Jerusalem, Israel
| | - Tomer Erlich
- Surgeon General's HQ, Israel Defense Force, Ramat Gan, Israel; Department of Military Medicine, Hebrew University, Jerusalem, Israel
| | - Ofir Fogel
- Department of Military Medicine, Hebrew University, Jerusalem, Israel
| | - Guy Shushan
- Technology and Logistics Branch, Personal Protection Equipment Section, Israel Defense Force, Ramat Gan, Israel
| | - Elon Glassberg
- Surgeon General's HQ, Israel Defense Force, Ramat Gan, Israel; Department of Military Medicine, Hebrew University, Jerusalem, Israel
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Baba A, Zbiba W, Korbi M, Mrabet A. [Epidemiology of open globe injuries in the Tunisian region of Cap Bon: Retrospective study of 100 cases]. J Fr Ophtalmol 2015; 38:403-8. [PMID: 25913659 DOI: 10.1016/j.jfo.2014.11.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 04/19/2014] [Revised: 10/28/2014] [Accepted: 11/11/2014] [Indexed: 11/27/2022]
Abstract
PURPOSE The goal of our study was to assess the epidemiological characteristics of ocular injuries in the Cap Bon region. PATIENTS AND METHODS We retrospectively reviewed the records of 100 patients, hospitalized and treated in the department of ophthalmology at the Mohamed Taher Maamouri university medical center in Nabeul, Tunisia for an open globe injury between January 2006 and November 2013. The mean duration of follow-up was 15.9 months. RESULTS The average age of the patients was 31.9 years. Domestic accidents accounted for 30% of cases of trauma, followed by violence (29%). The trauma was sharp in most cases (54%). The injury was penetrating in most cases (65.7%). The initial visual acuity was ≤ 1/10 in 69.8% of cases. The wound was isolated to the cornea in 59.7% of cases and scleral in 25% of cases. The most common associated ocular lesions were traumatic cataract (35%), followed by hyphema (32%). An intraocular foreign body was present in 4% of cases. At the final examination, 41.8% had a final visual acuity ≤ 1/10. CONCLUSION Open globe injuries represent a real public health problem given their psychological and functional repercussions. The best treatment is preventative, involving better awareness in the family, school and work environment.
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Affiliation(s)
- A Baba
- Service d'ophtalmologie, CHU Mohamed Taher Maamouri de Nabeul, 15, rue de Nouak Chutt, 8000 Nabeul, Tunisie.
| | - W Zbiba
- Service d'ophtalmologie, CHU Mohamed Taher Maamouri de Nabeul, 15, rue de Nouak Chutt, 8000 Nabeul, Tunisie
| | - M Korbi
- Service d'ophtalmologie, CHU Mohamed Taher Maamouri de Nabeul, 15, rue de Nouak Chutt, 8000 Nabeul, Tunisie
| | - A Mrabet
- Service d'ophtalmologie, CHU Mohamed Taher Maamouri de Nabeul, 15, rue de Nouak Chutt, 8000 Nabeul, Tunisie
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Omar R, Knight VF, Aziz Mohammed MA. Low vision rehabilitation and ocular problems among industrial workers in a developing country. Malays Fam Physician 2014; 9:27-33. [PMID: 26425302 PMCID: PMC4568723] [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] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
AIM Work-related ocular injuries and illnesses were among the major causes of job absenteeism. This study was conducted to determine if low vision rehabilitation was provided following work-related ocular problems among industrial workers in a developing country. This was a retrospective analysis of case records. METHOD Randomly selected records of all employees from the Social Security Organization (SOCSO) Medical Board for 2004 who suffered from ocular injuries and illnesses were selected. Rates of ocular injuries and illnesses according to age, gender, races, types of injuries, types of industries, visual rehabilitation and types of medical interventions were tabulated and analysed. RESULTS A total of 26 cases of ocular injuries and illnesses were identified where 46.2% suffered from ocular injuries. The remaining 53.8% had ocular and/or systemic diseases. The 40-49-yearold age group suffered the greatest number of injuries (26.92%). Ocular perforating injuries (66.67%) and ocular contusions (33.33%) were the most common types of ocular injury among industrial workers in Kuala Lumpur. Most injuries occurred among workers in the service industry (50%). Almost 60% of these injured workers did not receive any low vision rehabilitation after medical intervention while 25% were given contact lenses or spectacles as rehabilitation and remaining had surgery. CONCLUSION The low vision rehabilitation is still unexplored in the management of ocular injuries and illnesses among industrial workers. Introducing low vision rehabilitation can benefit both workers and employers as it provides care beyond spectacles or contact lens prescriptions.
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Affiliation(s)
- R Omar
- Rokiah Omar BOptom, PhD Optometry & Vision Sciences Programme, Schol of Healthcare Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300 Kuala Lumpur Malaysia
| | - V F Knight
- Victor Feizal Knight MBBS, MHP Faculty of Medicine and Health Defence, National Defence University, Kem Sg Besi, Kuala Lumpur, Malaysia
| | - M A Aziz Mohammed
- NMohammed MBBS (UM), LFOM (Ireland), C.I.M.W (ABIME USA), FFOM (Ireland), MBA (OXEL) Social Security Organisations (SOCSO), Menara PERKESO, Jalan Ampang, Kuala Lumpur, Malaysia
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Fitzgerald O'Connor E, Frew Q, Din A, Pleat J, Ashraff S, Ghazi-Nouri S, El-Muttardi N, Philp B, Dziewulski P. Periorbital burns – a 6 year review of management and outcome. Burns 2014; 41:616-23. [PMID: 25406883 DOI: 10.1016/j.burns.2014.08.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [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: 05/06/2014] [Revised: 07/31/2014] [Accepted: 08/25/2014] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Periorbital burns are an infrequent but potentially devastating injury. This study aimed to elucidate the spectrum of such injuries presenting to a UK burns centre and the outcome achieved in the cases requiring periorbital reconstruction for the restoration of function and form. METHODS Patients admitted to a UK regional burns centre between January 2005 and January 2011 with periorbital burns were identified from the Patient Administration System (PAS), theatre logs and the International Burns Injury database (IBID). Multiple parameters were assessed using patient notes, ITU and hospital image databases. RESULTS Over 6 years, 167 patients with facial burns requiring surgery were treated, including 103 patients with eyelid burns. The mean burn size was 33% total body surface area. The eyelid burn depth varied; 67% superficial partial thickness, 17% deep dermal and 16% full thickness. Two patients lost complete vision in one eye, one patient underwent amniotic membrane grafting. In total 16 patients required periorbital reconstruction to maintain eye closure, with 1.8 operations on average per patient. Acute surgery was required in 11 patients, whilst late intervention (>3 months) was needed in 5, 2 patients had both acute and delayed surgery. Of the 5 late intervention patients 4 were treated with full thickness skin grafts and 1 with a Z plasty. Average time for final reconstruction with delayed surgery was 4.5 months. CONCLUSION The goal in management of periorbital burns is preservation of vision, prevention of future complications and restoration of an acceptable aesthetic outcome. Total visual loss is thankfully rare, but early ophthalmology intervention is vital given the evidence of corneal damage as a brief therapeutic window exists.
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Affiliation(s)
- Edmund Fitzgerald O'Connor
- St. Andrews Centre for Burns & Plastic Surgery, Mid Essex NHS Hospitals Trust, Broomfield, Chelmsford, Essex CM1 7ET, United Kingdom; St Andrew's Anglia Ruskin (StAAR) Research Group.
| | - Q Frew
- St. Andrews Centre for Burns & Plastic Surgery, Mid Essex NHS Hospitals Trust, Broomfield, Chelmsford, Essex CM1 7ET, United Kingdom; St Andrew's Anglia Ruskin (StAAR) Research Group
| | - A Din
- St. Andrews Centre for Burns & Plastic Surgery, Mid Essex NHS Hospitals Trust, Broomfield, Chelmsford, Essex CM1 7ET, United Kingdom
| | - J Pleat
- Frenchay Hospital, Bristol BS16 1LE, United Kingdom
| | - S Ashraff
- St. Andrews Centre for Burns & Plastic Surgery, Mid Essex NHS Hospitals Trust, Broomfield, Chelmsford, Essex CM1 7ET, United Kingdom
| | - S Ghazi-Nouri
- Broomfield Hospital, Court Road, Broomfield, Chelmsford, Essex CM1 7ET, United Kingdom
| | - N El-Muttardi
- St. Andrews Centre for Burns & Plastic Surgery, Mid Essex NHS Hospitals Trust, Broomfield, Chelmsford, Essex CM1 7ET, United Kingdom
| | - B Philp
- St. Andrews Centre for Burns & Plastic Surgery, Mid Essex NHS Hospitals Trust, Broomfield, Chelmsford, Essex CM1 7ET, United Kingdom
| | - P Dziewulski
- St. Andrews Centre for Burns & Plastic Surgery, Mid Essex NHS Hospitals Trust, Broomfield, Chelmsford, Essex CM1 7ET, United Kingdom; St Andrew's Anglia Ruskin (StAAR) Research Group
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Abstract
BACKGROUND The objective of this study is to provide a systematic review on ocular injuries induced by glass bottles containing carbonated drinks in China, which emphasised the injury circumstance and visual function loss. METHODS We performed a literature-based retrospective analysis using predetermined inclusion and exclusion criteria. Demographic characteristics of pressurised bottled drinks-related eye injuries were obtained and vision loss was calculated. RESULTS A total of 26 relevant articles were found suitable for investigation of causative agent and patient demographics, of which 19 articles could be used for calculating vision loss and injury circumstance. Victims were often pertinent workers (46.0%). Most of the trauma was serious and even devastating. Final visual acuity was >10/20 in 29.2%, with severe final vision loss (<10/200) in 30.8%. Visual acuity can improve significantly with treatment (P<0.05). CONCLUSIONS One in three ocular injuries from glass bottles containing carbonated drinks show severe vision loss. Relevant workers are most frequently injured, followed by inappropriate handlers or openers. Besides manufacturing standards being strictly implemented, many ocular traumas related to bottled carbonated drinks should be prevented through health education.
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Affiliation(s)
- Lili Zhu
- Department of Ophthalmology, The First Affiliated Hospital, Medical College, Zhejiang University, Zhejiang 310003, China
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Matsumoto K, Matsumoto CS, Shinoda K, Watanabe E, Mizota A. Tissue plasminogen activator-assisted vitrectomy for ruptured eye with suprachoroidal hemorrhage. Case Rep Ophthalmol 2012; 3:258-61. [PMID: 22949914 PMCID: PMC3433021 DOI: 10.1159/000342136] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [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] [Indexed: 01/03/2023] Open
Abstract
Purpose To report a case of a ruptured eye with a suprachoroidal hemorrhage (SCH) in which tissue plasminogen activator (tPA)-assisted vitrectomy was successful in reconstructing the globe and restoring good vision. Case A 32-year-old man was struck on the right eye by a surfboard. His eye was ruptured and his visual acuity decreased to hand movements. Surgery was immediately performed to successfully close the ruptured globe. Nine days later, a second surgery was performed, and tPA (25 µg/0.1 ml monteplase) was used to liquefy and drain the SCH. This freed enough vitreous space for a more comprehensive vitrectomy. Eighteen months after the injury, the retina remained attached, and the decimal best-corrected visual acuity improved to 0.8. Conclusion tPA was helpful in lysing a massive SCH, thereby contributing to the excellent visual outcome. tPA-assisted drainage should be considered in cases of massive SCH when drainage is difficult due to an incomplete lysis of the clot.
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Affiliation(s)
- Koichi Matsumoto
- Department of Ophthalmology, Teikyo University School of Medicine, University Hospital Itabashi, Tokyo, Japan
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Al-Saikhan F, Amry MA, Al-Othaimeen S, Alwadani S. Severe ocular injury and its management following self induced plant extracts: A case report. Saudi Pharm J 2012; 20:177-9. [PMID: 23960790 DOI: 10.1016/j.jsps.2011.09.006] [Citation(s) in RCA: 3] [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] [Subscribe] [Scholar Register] [Received: 08/14/2011] [Accepted: 09/16/2011] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Homemade and folk remedies' use is widely practiced in under developed countries, of the used materials are plant extracts, lemon juice and some dried insect bodies. CASE PRESENTATION We report a case of severe ocular injury and its management after self administered plants seeds in both the eyes of a 47-year-old man who had bilateral severe ocular damage after he put the seeds of a plant Lepidium Sativum (Rashad) in his eyes. He reported severe ocular pain and redness, conjunctival epithelial defect and symblepharon. A conjunctival biopsy was taken which turned out to be negative for the immunological staining studies for Ocular Cicatricial Pemphegoid (OCP). The patient's visual acuity improved from 20/40 before treatment to 20/25 after treatment with no further sequelae after 3 months follow-up. CONCLUSIONS Self induced plant extracts can cause ocular complications. Public awareness is necessary to help in discouraging the use of these harmful plant extracts in human eyes.
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Affiliation(s)
- Fahad Al-Saikhan
- Department of Pharmacy Services, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
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Alquraini TA, Aggour MA, Zamzam AM. Airbag induced facial and bilateral ocular injuries in a 14-year-old child. Saudi J Ophthalmol 2011; 25:421-5. [PMID: 23960958 DOI: 10.1016/j.sjopt.2010.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 10/20/2010] [Revised: 12/24/2010] [Accepted: 12/25/2010] [Indexed: 10/18/2022] Open
Abstract
Although air bags have reduced the incidence of fatal and severe injuries in automobile collisions, they have been shown to carry a risk of injury themselves. Ocular injury in particular can often be a direct consequence of air bag deployment. We report a 14-year-old child who sustained facial burn and bilateral ocular injuries affecting both the anterior and posterior segments due to an inflated air bag in a low speed motor vehicle accident.
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Affiliation(s)
- D Joshi
- Classified Specialist (Ophthalmology & Vitreo-retinal surgery), 7 Air Force Hospital, Kanpur
| | - P Shingal
- Classified Specialist (Ophthalmology), Command Hospital AF, Bangalore
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