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Yumang M, Yee C, Passo RM, Skalet AH. Increased Number and Severity of Open Globe Injuries during COVID-19 Stay-at-home Orders. Ophthalmic Epidemiol 2023; 30:532-536. [PMID: 36748947 DOI: 10.1080/09286586.2023.2174558] [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: 05/03/2022] [Revised: 10/11/2022] [Accepted: 01/25/2023] [Indexed: 02/08/2023]
Abstract
PURPOSE To evaluate the occurrence and outcome of open globe injury during state-mandated COVID-19 stay-at-home orders compared to historical averages at a tertiary medical center in Portland, Oregon. METHODS Open globe injury between January 1, 2015 and December 31, 2020 was identified using relevant procedure codes. The number of injuries, mechanism of trauma, and short-term outcomes of globes repaired during the study period of March 23, 2020 to July 6, 2020 when stay-at-home orders were in effect were compared to a cohort from the same 15-week time frame in 2015-2019. We also evaluated injuries occurring throughout 2020 as compared to the prior 5 years. RESULTS 263 consecutive open globe injuries were identified between January 2015 and December 2020. While Oregon's stay-at-home orders were in effect, we observed a significant increase in the number of open globe injuries treated compared to the prior 5 years (p = .004). Twenty-four cases identified during the study period represent a 2-fold increase over the 2015-2019 average of 11.8 globe repairs during the same 15-week time period. Visual acuity < 20/200 at 6 months (p = .008) and secondary enucleation (p < .001) were more frequent during stay-at-home orders, and severity of injury as calculated by the Ocular Trauma Scores (OTS) was higher. Time-to-repair was similar between the two cohorts. CONCLUSION At our center, there was an increased number and severity of open globe injury during the period of mandatory COVID-19 stay-at-home orders. Visual acuity outcomes and risk for secondary enucleation were poorer compared to the reference cohort.Abbreviations: Ocular Trauma Score (OTS), Open globe injury (OGI), Emergency department (ED), Oregon Health and Science University (OHSU).
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Affiliation(s)
- Marika Yumang
- Casey Eye Institute, Department of Ophthalmology, Oregon Health & Science University, Portland, USA
| | - Claudine Yee
- Casey Eye Institute, Department of Ophthalmology, Oregon Health & Science University, Portland, USA
| | - Ross M Passo
- Casey Eye Institute, Department of Ophthalmology, Oregon Health & Science University, Portland, USA
| | - Alison H Skalet
- Casey Eye Institute, Department of Ophthalmology, Oregon Health & Science University, Portland, USA
- Knight Cancer Institute, Oregon Health & Science University, Portland, USA
- Department of Radiation Medicine, Oregon Health & Science University, Portland, USA
- Department of Dermatology, Oregon Health & Science University, Portland, USA
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2
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Yfantopoulos J. Editorial: Health related quality of life inequalities. Front Public Health 2023; 11:1214899. [PMID: 37304088 PMCID: PMC10251305 DOI: 10.3389/fpubh.2023.1214899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 05/12/2023] [Indexed: 06/13/2023] Open
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3
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Alotaibi HM. Incidence, Risk Factors, and Prognosis of Hidradenitis Suppurativa Across the Globe: Insights from the Literature. Clin Cosmet Investig Dermatol 2023; 16:545-552. [PMID: 36891064 PMCID: PMC9987236 DOI: 10.2147/ccid.s402453] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [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: 12/23/2022] [Accepted: 02/22/2023] [Indexed: 03/06/2023]
Abstract
Hidradenitis suppurativa, a chronic inflammatory disease of the skin, affects a patient's quality of life to a greater extent. While the disease burden, including its incidence and prevalence, has been extensively studied in the western population, there is a paucity of data from developing countries on the epidemiology of Hidradenitis suppurativa. Therefore, a general literature review was conducted to shed light on the epidemiology of Hidradenitis suppurativa across the globe. We reviewed the most recently available information on epidemiology, including incidence, prevalence, risk factors, prognosis and quality of life, complications, and associated comorbid among patients with Hidradenitis suppurativa. The estimated global prevalence of Hidradenitis suppurativa is found to be 0.00033-4.1%, with a relatively higher prevalence of 0.7-1.2% in European and US populations. Both genetic and environmental factors are associated with Hidradenitis suppurativa. Patients with Hidradenitis suppurativa have associated comorbid such as cardiovascular disease, type II diabetes mellitus, mental health issues, and sleep and sexual dysfunctions. These patients spend poor quality of life and tend to be less productive. Future studies are needed to assess the burden of Hidradenitis suppurativa in developing countries. Since the disease tends to be underdiagnosed, future studies should rely on clinical diagnosis rather than self-reporting to avoid the potential of recall bias. Attention needs to be diverted to developing countries with less amount of data on Hidradenitis suppurativa.
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Affiliation(s)
- Hend M Alotaibi
- Dermatology Department, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
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Moreira MVL, Langohr IM, Campos MRDA, Ferreira E, Carvalho B, Blume GR, Montiani-Ferreira F, Ecco R. Canine and feline uveal melanocytic tumours: Histologic and immunohistochemical characteristics of 32 cases. Vet Med Sci 2022; 8:1036-1048. [PMID: 35122675 PMCID: PMC9122463 DOI: 10.1002/vms3.752] [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] [Indexed: 11/21/2022] Open
Abstract
Objective Gross, histopathological, and immunohistochemical characteristics of uveal melanocytic neoplasms in dogs and cats were investigated. Samples Thirty‐two enucleated globes with uveal melanocytic neoplasms, 27 from dogs and 5 from cats, were examined. Procedures Morphological characteristics of uveal melanocytic neoplasms in dogs and cats were evaluated with anti‐PNL2, anti‐Melan‐A, anti‐Ki‐67, anti‐caspase‐3, and anti‐BAP1 immunomarkers. Statistical analysis was performed to compare canine melanocytomas and melanomas. Results The 32 uveal neoplasms were classified as melanocytomas (19/27 in dogs) or melanomas (8/27 in dogs, 5/5 in cats). Most tumours (84%) were located in the anterior uvea. Neoplastic cells were classified as epithelioid, spindle‐shaped, mixed, or special type (balloon and signet ring cells). The percentage of cells with melanin, melanin concentration within cells, anisocytosis and anisokaryosis, mitotic count, lymphocytic inflammation, necrosis, vascular invasion, and glaucoma were also characterized. Anisocytosis, percentage of neoplastic cells with melanin, mitotic count, and indices (proliferation and apoptotic) varied significantly between canine uveal melanomas and melanocytomas; in general, melanomas had greater cell variability, were less pigmented, and had a higher mitotic count. The melanocytic origin of the neoplasms was confirmed by positive anti‐PNL2 immunolabelling (29/32) and positive anti‐Melan‐A immunolabelling (3/32). In canine uveal melanomas, anisocytosis and anisokaryosis correlated with less pigmentation and minimal pigmentation correlated with a high percentage of immunolabelling for caspase‐3. Conclusions Uveal melanocytomas were more common in dogs, and uveal melanomas were more frequent in cats. Anisocytosis, percentage of neoplastic cells with melanin, and mitotic count are important histologic characteristics of malignancy to evaluate in uveal melanocytic neoplasms. The proliferation and apoptotic indices are relevant when comparing malignant tumours with benign tumours.
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Affiliation(s)
- Matheus Vilardo Lóes Moreira
- Section of Pathology, Department of Clinics and Surgery, Veterinary School, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Ingeborg Maria Langohr
- Department of Pathobiological Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Marina Rios de Araújo Campos
- Department of General Pathology, Biological Sciences Institute, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Enio Ferreira
- Department of General Pathology, Biological Sciences Institute, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Bárbara Carvalho
- Department of General Pathology, Biological Sciences Institute, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | | - Fabiano Montiani-Ferreira
- Departament of Veterinary Medicine, Setor de Ciências Agrárias, Universidade Federal do Paraná, Curitiba, Paraná, Brazil
| | - Roselene Ecco
- Section of Pathology, Department of Clinics and Surgery, Veterinary School, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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5
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Dhingra S, Rahman NAA, Peile E, Rahman M, Sartelli M, Hassali MA, Islam T, Islam S, Haque M. Microbial Resistance Movements: An Overview of Global Public Health Threats Posed by Antimicrobial Resistance, and How Best to Counter. Front Public Health 2020; 8:535668. [PMID: 33251170 PMCID: PMC7672122 DOI: 10.3389/fpubh.2020.535668] [Citation(s) in RCA: 113] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 08/14/2020] [Indexed: 12/11/2022] Open
Abstract
Antibiotics changed medical practice by significantly decreasing the morbidity and mortality associated with bacterial infection. However, infectious diseases remain the leading cause of death in the world. There is global concern about the rise in antimicrobial resistance (AMR), which affects both developed and developing countries. AMR is a public health challenge with extensive health, economic, and societal implications. This paper sets AMR in context, starting with the history of antibiotics, including the discovery of penicillin and the golden era of antibiotics, before exploring the problems and challenges we now face due to AMR. Among the factors discussed is the low level of development of new antimicrobials and the irrational prescribing of antibiotics in developed and developing countries. A fundamental problem is the knowledge, attitude, and practice (KAP) regarding antibiotics among medical practitioners, and we explore this aspect in some depth, including a discussion on the KAP among medical students. We conclude with suggestions on how to address this public health threat, including recommendations on training medical students about antibiotics, and strategies to overcome the problems of irrational antibiotic prescribing and AMR.
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Affiliation(s)
- Sameer Dhingra
- School of Pharmacy, Faculty of Medical Sciences, The University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Nor Azlina A. Rahman
- Department of Physical Rehabilitation Sciences, Kulliyyah of Allied Health Sciences, International Islamic University Malaysia, Kuantan, Malaysia
| | - Ed Peile
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Motiur Rahman
- Oxford University Clinical Research Unit, Wellcome Trust Asia Programme, The Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Oxford University, Oxford, United Kingdom
| | - Massimo Sartelli
- Department of General and Emergency Surgery, Macerata Hospital, Macerata, Italy
| | - Mohamed Azmi Hassali
- The Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Minden, Malaysia
| | | | - Salequl Islam
- Department of Microbiology, Jahangirnagar University, Dhaka, Bangladesh
| | - Mainul Haque
- The Unit of Pharmacology, Faculty of Medicine and Defence Health, National Defence University of Malaysia, Kuala Lumpur, Malaysia
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6
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Derakhshan JJ, Parvin N, Loevner LA, Wehrli FW, McKinstry RC. Effects of motion and b-value on apparent temperature measurement by diffusion-based thermometry MRI: eye vitreous study. Med Phys 2020; 47:5006-5019. [PMID: 32757301 DOI: 10.1002/mp.14435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 07/03/2020] [Accepted: 07/21/2020] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To make noninvasive measurements of temperature in the posterior chamber (vitreous) of the eye using diffusion-based thermometry (DBT) magnetic resonance imaging (MRI) and to explain variability in these measurements due to choice of b-value and the effects of motion. METHODS Phantom studies of human vitreous and distilled water were performed using b-values from 0 to 1500 s/mm2 to determine the liquid-specific calibration factor for vitreous as well as to determine the temperature offsets due to sampling the diffusion curve using three higher routine clinical b-values (b = 0, 500, 1000 s/mm2 ) or four lower b-values (b = 0, 200, 400, 600 s/mm2 ), thought to be optimized for fluids. Retrospective ROI-based measurements of apparent diffusion coefficient on single slices as well as multi-slice histograms of the eyes were made in six patients with peri-orbital cellulitis and 11 age-matched controls, to assess for temperature changes in the presence of peri-orbital inflammation. A prospective study of ten repeated measurements of eye temperature using both high and lower b-value sampling was performed in ten asymptomatic volunteers to determine the reproducibility of eye temperature measurements in-vivo as well as to estimate vitreous temperature in the absence of motion. RESULTS The diffusion coefficient of vitreous (2,088 ± 13 × 10-6 mm2 /s) was significantly lower (-1.9%, P < 0.001) compared to distilled water (2,128 ± 12 × 10-6 mm2 /s). The calibration factor for temperature measurements of vitreous using DBT is +0.74 ± 0.06°C. Temperature offsets were smaller (<-0.2°C, P < 0.01) when using larger routine clinical b-values to estimate the diffusion coefficient compared to using a series of lower b-values (<-1.0°C, P < 0.001). Two-dimensional single-slice ROI-based measurement showed significant temperature differences (ΔTI-C = 2.5 ± 1.2°C, P < 0.001) between the eyes of patient with peri-orbital cellulitis, higher on the side of inflammation. There was no significant difference in eye temperature when using the 3D histogram (which is likely due to motion averaging as significant slice-to-slice variation was present). However, significant differences in the 3D temperature histograms between the two eyes was observed in one out of six patients. Prospective eye temperature measurements in healthy volunteers showed significant intra- and inter-subject variability (33.8-41.6°C), which was caused by eye motion. This resulted in +2.4°C cohort-wide elevation in temperature when three b-values were used and +4.7°C when four b-values were used. Using a pattern of elevated temperature at the periphery of the eye to detect motion, eye temperature is the absence of motion was estimated to be 34.5 ± 0.4°C with three higher b-values and 34.6 ± 1.9°C with four lower b-values; this temperature corresponds with prior mathematical simulations of eye temperature as well as boundary conditions. CONCLUSIONS Globe vitreous temperature has been measured noninvasively using DBT MRI. Using routine clinical b-values of b = 0, 500 and 1000 s/mm2 produces acceptable (<-0.2°C) temperature offsets. Although DBT measurements are highly susceptible to motion, methods such as temperature differences or regression can be used to reduce or eliminate the effects of motion. Using a single clinical diffusion-weighted MRI, globe temperature difference of 1.6°C is pathological. Using a series of ten measurements, globe temperature differences larger than 0.6°C are abnormal. This study suggests CSF flow likely artifactually increases core brain temperature measured by DBT MRI.
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Affiliation(s)
- Jamal J Derakhshan
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, 63110, USA.,Department of Radiology, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Neda Parvin
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Laurie A Loevner
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Felix W Wehrli
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Robert C McKinstry
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, 63110, USA
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7
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Takahashi R, Okamura K, Tsukahara-Kawamura T, Harada K, Saeki Y, Ozaki H, Uchio E. Finite Element Analysis of Changes in Tensile Strain by Airsoft Gun Impact on Eye and Deformation Rate in Eyes of Various Axial Lengths. Clin Ophthalmol 2020; 14:1445-1450. [PMID: 32546952 PMCID: PMC7266397 DOI: 10.2147/opth.s249483] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose We have carried out three-dimensional finite element analysis (FEA) to determine the physical and mechanical response in several ocular injuries. We applied this FEA model to evaluate an airsoft gun impact on an eye and the deformation rate of eyes of various axial lengths at various velocities. Methods This study was carried out on a human eye model using an FEA program created by Nihon, ESI Group. The airsoft gun pellet was set to impact the eye at initial velocities of 45, 60 and 75 m/s with the addition of variation in axial length of 20 mm (hyperopia), 22 mm (emmetropia), 24 mm (myopia) and 26 mm (high myopia). Deformation of the eye was calculated as the decrease rate of the volume of the eyeball and the decrease rate of the axial length. Results In all emmetropic cases, the cornea reached its strain threshold during the impact, and scleral strain showed a patchy strength distribution in the simulation. The deformation was most evident in the anterior segment, while deformation of the posterior segment was less. The decrease rate of the volume of the eyeball and decrease rate of the axial length were highest in the hyperopic eye, followed by the emmetropic eye and myopic eye, and the high myopic eye showed the lowest decrease rates among the four axial lengths in all impact velocity simulations. Conclusion These results suggest that hyperopic eyes are most susceptible to deformation by an airsoft gun impact compared with other axial length eye models in this simulation. The considerable deformation by an airsoft gun impact shown in this study might indicate the necessity of ocular protection to avoid permanent eye injury. FEA using a human eyeball model might be a useful method to analyze and predict the mechanical features of ocular injury by an airsoft gun.
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Affiliation(s)
- Rie Takahashi
- Department of Ophthalmology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Kanno Okamura
- Department of Ophthalmology, Fukuoka University School of Medicine, Fukuoka, Japan
| | | | - Kazuhiro Harada
- Department of Ophthalmology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Yusuke Saeki
- Department of Ophthalmology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Hiroaki Ozaki
- Department of Ophthalmology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Eiichi Uchio
- Department of Ophthalmology, Fukuoka University School of Medicine, Fukuoka, Japan
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8
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Ababneh LT, Mohidat H, Abdelnabi H, Kana'an MF, Tashtush NA, El-Mulki OS, Aleshawi AJ. Hospital-Based Ocular Trauma: Factors, Treatment, And Impact Outcome. Clin Ophthalmol 2019; 13:2119-2126. [PMID: 31802841 PMCID: PMC6827522 DOI: 10.2147/opth.s223379] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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] [Received: 07/16/2019] [Accepted: 10/09/2019] [Indexed: 11/23/2022] Open
Abstract
Background Specific morbidities as blindness is a serious complication that commonly results from patients with ocular traumas and can significantly impair the patient's social and occupational abilities. This study is conducted due to the current lack of data on ocular injuries in developing countries and places near war regions and aims to investigate and evaluate the impact of ocular trauma. Material and methods After Institutional Review Board approval was obtained, we retrospectively identified 112 patients who were admitted due to eye trauma from January 2015 until October 2018. Information about demographics, diagnostic modalities, prognostic impact, and treatment interventions were retrieved, analyzed. Results One-hundred and twelve patients were included in the study. The majority of patients were males. The mean age for patients was 22.2. Road traffic accident (RTA) constituted the most common cause of trauma (60.7%). Gunshots and blast injuries were observed in 12.5% of patients. Workplace injuries were infrequent (8.1%). The gunshot was significantly associated with injury to two or more eyeball structures while the RTA was significantly related to one eyeball structure injury. RTA was associated with intact globe while gunshot was significantly associated with ruptured globes. The mean duration of admission was 8.1 days. Associated truncal injury is the most important independent factor affecting the duration of admission. Conclusion Majority of trauma cases occurred in young males involved in RTAs. The location of Jordan near the Syrian war increases the appearance of gunshot ocular trauma in specific and ocular trauma in general. Educating the public is essential if we wish to prevent eye injuries.
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Affiliation(s)
- Laila T Ababneh
- Department of Special Surgery, Division of Ophthalmology, Faculty of Medicine, Jordan University of Science & Technology, Irbid 22110, Jordan
| | - Hasan Mohidat
- Department of Special Surgery, Division of Ophthalmology, Faculty of Medicine, Jordan University of Science & Technology, Irbid 22110, Jordan
| | - Heba Abdelnabi
- Department of Special Surgery, Division of Ophthalmology, Faculty of Medicine, Jordan University of Science & Technology, Irbid 22110, Jordan
| | - Mohammed F Kana'an
- Faculty of Medicine, Jordan University of Science & Technology, Irbid 22110, Jordan
| | - Nour A Tashtush
- Faculty of Medicine, Jordan University of Science & Technology, Irbid 22110, Jordan
| | - Omar S El-Mulki
- Department of Special Surgery, Division of Ophthalmology, Faculty of Medicine, Jordan University of Science & Technology, Irbid 22110, Jordan
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Abstract
Background Orbital reconstruction following oncologic midface resection is uniquely challenging, and makes critical contributions to patient aesthetics, function, and identity. Approach is largely dependent on surgeon and patient preferences, and there exists no consensus on defect characterization. Objective The goal of the study is to provide a mental framework for the reconstructive oncologic surgeon to use as a foundation during his or her approach to the orbit. Design The design of the study is based on the review of current literature and expert opinion. Conclusions Critical versus optimal objectives must be set in orbital reconstruction, and a systematic approach should be followed. We approach orbital reconstruction by first deciding whether globe-sparing surgery is possible, or if orbital exenteration will be necessary. We then set critical and optimal objectives for our chosen pathway. Critical goals in globe-sparing reconstruction include maintaining orbital volume and preserving visual function, and an optimal goal includes preservation of the nasolacrimal system. Critical goals in orbital exenteration include obliterating the defect, sealing the skull base and nasal cavities, and allowing eye protection to be worn over the contralateral eye postoperatively. Optimal goals in exenteration include preparation for prosthetics, volume and bony replacement, eyelid-sparing technique, and consideration of postoperative radiation.
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Affiliation(s)
- Alex T Legocki
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine, Mount Sinai Health System, New York, United States
| | - Brett A Miles
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine, Mount Sinai Health System, New York, United States
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Erickson BP, Feng PW, Ko MJ, Modi YS, Johnson TE. Gun-related eye injuries: A primer. Surv Ophthalmol 2019; 65:67-78. [PMID: 31229522 DOI: 10.1016/j.survophthal.2019.06.003] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 06/01/2019] [Accepted: 06/07/2019] [Indexed: 02/03/2023]
Abstract
Gun-related eye injuries are relatively common in the context of gunshot wounds to the head and neck. Many of the fundamental principles of gunshot wound management apply to the care of these patients, but the complex anatomy and functional relationships of the periocular region do pose special challenges. We provide a focused primer for physicians seeking a more in-depth understanding of gun-related eye injuries and present 3 representative cases outlining the spectrum of pathology, provide a focused review of the relevant ballistics concepts, and discuss the management of injuries to the periocular soft tissues, orbital structures, and globe. We found that good cosmetic and functional results can often be achieved with appropriate early intervention, but visual prognosis may remain guarded despite optimal treatment.
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Affiliation(s)
- Benjamin P Erickson
- Stanford Health Care, Byers Eye Institute at Stanford, Palo Alto, California, USA.
| | - Paula W Feng
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut, USA
| | - Marcus J Ko
- Nevada Centre for Eye Plastic Surgery, Reno, Nevada, USA
| | - Yasha S Modi
- Department of Ophthalmology, New York University School of Medicine, New York, New York, USA
| | - Thomas E Johnson
- Oculofacial Plastic Surgery, Bascom Palmer Eye Institute, Miami, Florida, USA
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11
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Abstract
In this article, the anatomy of the orbit is reviewed, with a specific emphasis on surgical anatomy. A brief discussion of the ocular globe is also included. The orbits are pyramidal structures separating the upper and middle facial skeletons. The walls, apex, and base harbor several foramina and fissures as well as bony irregularities where various ligaments, muscles, and capsules attach. There are a variety of surgical approaches to the orbit, including the traditional transcutaneous and neurosurgical techniques and, more recently, minimally invasive, endoscopic approaches.
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Affiliation(s)
- Shirley Hu
- Department of Otolaryngology, Mount Sinai Medical Center, New York, New York.,Department of Otolaryngology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York
| | - Patrick Colley
- Department of Otolaryngology, Mount Sinai Medical Center, New York, New York.,Department of Otolaryngology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York
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12
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Hollis AR, Dixon JJ, Berlato D, Murray R, Weller R. Computed tomographic dimensions of the normal adult equine eye. Vet Ophthalmol 2019; 22:651-659. [PMID: 30716192 DOI: 10.1111/vop.12636] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 11/14/2018] [Accepted: 11/15/2018] [Indexed: 11/30/2022]
Abstract
There are limited data on whether the dimensions of the equine eye and its internal structures change with bodyweight in horses. The aim of this study was to identify whether the size of the equine eye and its individual structures varied in a predictable manner with bodyweight, and to examine the reliability of computed tomography (CT) scans in the measurement of the equine eye. Ninety horses which had undergone CT examination of the head for non-ocular disease were included. All measurements of the eye were performed twice on all eyes by the same operator to quantify intra-operator agreement, and in 10 cases were also performed by a second operator to quantify inter-operator agreement. Agreement was excellent for all but the rostrocaudal measurement of the anterior chamber, which was fair. The following variables correlated significantly with bodyweight: anterior-posterior size of the globe (correlation coefficient: 0.586) and posterior segment (correlation coefficient: 0.554); the latero-medial size of the globe (correlation coefficient: 0.452), anterior chamber (correlation coefficient: 0.504) and posterior segment (correlation coefficient: 0.455); and the orbital fossa diameter (correlation coefficient: 0.219). The lens size and anterior-posterior distance of the anterior chamber did not correlate significantly with bodyweight. These results suggest that overall eye size and the size of the orbital fossa change with the bodyweight of the horse, but lens size remains consistent, and that CT measurements of the internal structures of the eye are repeatable and reproducible. This information aids in interventional procedures for ocular pathology and assessment of normal anatomy.
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Abstract
We report the clinical presentation, radiography, and management outcomes of autoenucleations (AE). Charts of 7 patients evaluated at 4 institutions with AE were reviewed. Four males and three females had a mean age of 50 years (range 26-72 years). The etiologies were psychosis secondary to underlying mental illness (6, 88%) and substance use (1, 12%), and the mechanism was largely blunt digital injury (6, 88%). Three (43%) AE patients suffered bilateral enucleations. Common concomitant injuries included eyelid lacerations (5, 71%) and optic nerve avulsion (3, 43%). Radiography was utilized for all of the study patients with computed tomography as the most common (5, 71%), followed by ultrasound (1, 14%), and magnetic resonance imaging with CT angiography (1, 14). Orbital exploration was performed in the management of all patients. Orbital implants were placed in 4 (57%) patients. Patients were followed for a mean of 1.9 months (range 1-4 months). Autoenucleation affects both genders and is commonly associated with eyelid lacerations, optic nerve avulsion, and intracranial hemorrhage. The association with intracranial hemorrhage is consistent with prior reports of internal carotid artery injury following shearing of the optic nerve. Autoenucleation cases were seen secondary to mental or substance induced psychosis, and these patients may be at risk for future injuries such as AE of the contralateral globe. The common causes for psychosis reported our patient group include schizophrenia, depression, schizoaffective disorder, and methamphetamine-induced psychosis, which corroborates with similar cases in the literature. Two of three cases of bilateral AE suffered sequential AE where the contralateral globe was enucleated days apart. All patients suffering AE should have full medical, psychiatric, neurologic, and radiologic evaluation and monitoring while under care. When evaluating patients with obvious ocular injury, accompanying intracranial injuries should be ruled out in a timely fashion before pursuing surgical intervention.
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Affiliation(s)
- Mamta Shah
- a Department of Ophthalmology , SUNY Downstate Medical Center , Brooklyn , New York , USA
| | - Lucy Sun
- a Department of Ophthalmology , SUNY Downstate Medical Center , Brooklyn , New York , USA
| | - Solly Elmann
- a Department of Ophthalmology , SUNY Downstate Medical Center , Brooklyn , New York , USA
| | - Ivan Vrcek
- b Department of Ophthalmology , UT Southwestern Medical Center , Dallas , Texas , USA
| | - Ronald Mancini
- b Department of Ophthalmology , UT Southwestern Medical Center , Dallas , Texas , USA
| | | | | | - Roman Shinder
- a Department of Ophthalmology , SUNY Downstate Medical Center , Brooklyn , New York , USA
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14
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Gross FJ, DiSandro G. Bleb incarceration following Ahmed valve surgery. Int Med Case Rep J 2016; 9:329-331. [PMID: 27799829 PMCID: PMC5077236 DOI: 10.2147/imcrj.s119899] [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] [Indexed: 11/23/2022] Open
Abstract
Globe luxation is a painful and potentially vision-threatening condition in which the globe becomes trapped behind the eyelids requiring physician intervention in the emergency department or eye clinic. On presentation, the patient typically complains of an inability to close their eye, severe foreign body sensation, decreased vision, and significant eye pain. Although most visual symptoms are reversible and primarily result from exposure keratopathy, optic nerve damage, and permanent vision loss can occur from repeat or prolonged episodes of globe luxation. Risk factors include any congenital or acquired conditions that displace the globe anteriorly in the orbit and increased eyelid laxity that allows the globe to prolapse through the lid aperture. Typically, the precipitating event involves eyelid retraction during ophthalmic examination or an event that increases intraorbital pressure such as coughing or sneezing. Once the globe has luxated, the condition is typically worsened by blepharospasm and patients' attempts to close the eye that worsen the entrapment. In the current case, the patient had a large superotemporal filtering bleb following Ahmed valve surgery for uncontrolled glaucoma. While instilling her glaucoma medication, she retracted her eyelids sufficiently to pull the upper lid over her filtering bleb where it became entrapped causing a similar presentation to globe luxation. Traditional methods of repositioning the globe were unsuccessful. Bleb needling was ultimately required to return the globe to a normal position.
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Affiliation(s)
- Fredric J Gross
- Department of Ophthalmology, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Giovanni DiSandro
- Department of Ophthalmology, Eastern Virginia Medical School, Norfolk, VA, USA
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15
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Grech R, Cornish KS, Galvin PL, Grech S, Looby S, O'Hare A, Mizzi A, Thornton J, Brennan P. Imaging of adult ocular and orbital pathology--a pictorial review. J Radiol Case Rep 2014; 8:1-29. [PMID: 24967016 DOI: 10.3941/jrcr.v8i2.1525] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [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: 11/15/2022] Open
Abstract
Orbital pathology often presents a diagnostic challenge to the reporting radiologist. The aetiology is protean, and clinical input is therefore often necessary to narrow the differential diagnosis. With this manuscript, we provide a pictorial review of adult ocular and orbital pathology.
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Affiliation(s)
- Reuben Grech
- Department of Neuroradiology, Beaumont Hospital, Dublin, Republic of Ireland
| | - Kurt Spiteri Cornish
- Department of Ophthalmology, Aberdeen Royal Infirmary, Foresterhill, United Kingdom
| | - Patrick Leo Galvin
- Department of Neuroradiology, Beaumont Hospital, Dublin, Republic of Ireland
| | | | - Seamus Looby
- Department of Neuroradiology, Beaumont Hospital, Dublin, Republic of Ireland
| | - Alan O'Hare
- Department of Neuroradiology, Beaumont Hospital, Dublin, Republic of Ireland
| | - Adrian Mizzi
- Department of Radiology, Mater Dei Hospital, Malta
| | - John Thornton
- Department of Neuroradiology, Beaumont Hospital, Dublin, Republic of Ireland
| | - Paul Brennan
- Department of Neuroradiology, Beaumont Hospital, Dublin, Republic of Ireland
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16
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Haluk Akar H, Tahan F, Kurt T, Solmaz I. A case of hereditary angioedema who presented with difficulty in urination and globe. Eur Ann Allergy Clin Immunol 2014; 46:60-62. [PMID: 24702880] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Hereditary angioedema (HEA) is a disease characterized by decreased levels or function of C1 esterase inhibitor (C1-INH). The symptoms of HEA in pediatric age group generally consist of recurrent episodes of soft tissue swelling. These symptoms can be transient, subtle, and varied in severity. Genitourinary system is rarely affected in this disease. Here, a three-year-old girl who presented with angioedema on her hands, fingers, and face, and had difficulty in urination and globe is reported. The aim of this case is to focus on this rare disease, hereditary angioedema, which presented with difficulty in urination and urinary globe.
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Affiliation(s)
- H Haluk Akar
- Erciyes University School of Medicine, Department of Pediatric Allergy and Immunology, Kayseri, Turkey.
| | - F Tahan
- Erciyes University School of Medicine, Department of Pediatric Allergy and Immunology, Kayseri, Turkey
| | - T Kurt
- Erciyes University School of Medicine, Department of Pediatrics, Kayseri, Turkey
| | - I Solmaz
- Erciyes University School of Medicine, Department of Pediatrics, Kayseri, Turkey
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17
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Abstract
BACKGROUND The purpose of this study was to examine patient characteristics and outcomes in a group of consecutive patients with ruptured globe eye injuries at Kings County Hospital Center, a large, urban, level 1 trauma center. METHODS A retrospective chart review was performed to identify all patients with ruptured globe eye injuries seen between January 2009 and October 2011. Thirty-eight patients who sustained ruptured globe eye injuries from all causes were investigated for etiology and final visual outcomes. RESULTS Eight eyes in which vision could be assessed were evaluated as having no light perception at presentation and three of these eyes required primary enucleation. Of the 38 eyes, orbit fractures were found in 15 eyes and an intraocular foreign body was found in six eyes. DISCUSSION Our cohort revealed a 37.5% rate of primary enucleation in eyes with no light perception, which we believe to be a reflection of the severity of injury. All three cases were secondary to a gunshot wound. Further, our sample, although small in size, revealed a very high percentage of eyes that were ruptured secondary to violent causes compared with other studies.
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Affiliation(s)
- Eitan S Burstein
- Departments of Ophthalmology, SUNY Downstate Medical Center and Kings County Hospital Center, Brooklyn, NY, USA
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