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Sherif NA, Hoyek S, Wai K, Makhoul KG, Bitar R, Teiger M, Lorch AC, Patel NA, Armstrong GW. Recovery of Vision in Open Globe Injury Patients with Initial No Light Perception Vision. Ophthalmol Retina 2024:S2468-6530(24)00185-4. [PMID: 38636901 DOI: 10.1016/j.oret.2024.04.010] [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: 09/18/2023] [Revised: 03/31/2024] [Accepted: 04/08/2024] [Indexed: 04/20/2024]
Abstract
OBJECTIVE OR PURPOSE To identify clinical characteristics of injured eyes associated with visual recovery in patients with open globe injuries (OGI) and presenting with no light perception (NLP) vision. DESIGN Retrospective chart review. SUBJECTS, PARTICIPANTS, AND/OR CONTROLS All patients presenting to Massachusetts Eye and Ear with OGI and NLP vision from January 1999 to March 2022. METHODS, INTERVENTION, OR TESTING Manual data extraction to collect patient demographic characteristics, pre-operative, intraoperative, and post-operative characteristics of OGI injury, laceration versus rupture, history of intraocular surgery, time from injury to repair, timing of vitrectomy, lensectomy, choroidal drainage, and silicone oil placement, visual acuity (VA) at last follow-up, and subsequent B-scan ultrasound findings of retinal detachment, choroidal hemorrhage, vitreous hemorrhage, and disorganized intraocular contents. Patients with more than one week of follow-up and a documented VA at most recent follow-up were included. Exclusion criteria included age less than 10 years. Multivariable regression was performed. MAIN OUTCOMES VA recovery defined as light perception or better in patients with OGI and initial NLP vision. RESULTS 147 eyes with NLP vision after OGI were included. 25 (17%) eyes regained vision at last follow-up. The majority of patients recovered light perception vision (n=15, 60%) followed by 20/500 or better (n=5, 20%), hand motion (n=3, 12%), and count fingers (n=2, 8%). Most injuries were zone III (n=102, 69%) and presented with rupture (n=127, 86%). The mean time from OGI to surgical repair was 0.85 ± 1.7 days. B-scan was obtained in 104 (71%) cases. Pars plana vitrectomy was performed in 9 eyes (6%) with NLP at time of vitrectomy. Disorganized intraocular contents on B-scan (OR=0.170, 95%CI: 0.042-0.681, P=0.012) was the only clinical variable significantly associated with visual recovery, corresponding to a lack of visual improvement. CONCLUSION Recovery of vision in OGI with NLP vision at presentation cannot be predicted based on presenting clinical features. B-scan findings of disorganized intraocular contents after initial OGI repair was the only factor negatively associated with vision recovery in this patient population. Therefore, all eyes presenting with an OGI and NLP vision should undergo primary repair in hopes of subsequent visual recovery.
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Affiliation(s)
- Noha A Sherif
- Department of Ophthalmology, New England Eye Center, Tufts University, Boston, MA, USA
| | - Sandra Hoyek
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Karen Wai
- Department of Ophthalmology, Byers Eye Institute, Stanford University, San Francisco, CA, USA
| | - Kevin G Makhoul
- Department of Ophthalmology, University of Kansas School of Medicine, Prairie Village, KS, USA
| | - Racquel Bitar
- University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Marisa Teiger
- Department of Ophthalmology, New England Eye Center, Tufts University, Boston, MA, USA
| | - Alice C Lorch
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Nimesh A Patel
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Grayson W Armstrong
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA.
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Tieger M, Armstrong GW, Eliott D. Review of Management and Outcomes of Delayed Repair Open Globe Injuries. Semin Ophthalmol 2024; 39:139-142. [PMID: 38069614 DOI: 10.1080/08820538.2023.2286015] [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: 01/27/2022] [Accepted: 01/28/2022] [Indexed: 01/17/2024]
Abstract
The standard of care for open globe injuries is prompt surgical closure, as delay in repair is a reported risk factor for post-traumatic endophthalmitis and is associated with worse visual outcomes. This article serves as a review of the current management and outcomes of open globe injuries repaired greater than 24 hours from the time of injury, specifically evaluating the rates of endophthalmitis in cases with and without intraocular foreign bodies, visual outcomes and rates of primary enucleation or evisceration.
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Affiliation(s)
- Marisa Tieger
- Harvard Medical School Department of Ophthalmology, Massachusetts Eye and Ear, Boston, MA, USA
| | - Grayson W Armstrong
- Harvard Medical School Department of Ophthalmology, Massachusetts Eye and Ear, Boston, MA, USA
| | - Dean Eliott
- Harvard Medical School Department of Ophthalmology, Massachusetts Eye and Ear, Boston, MA, USA
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Tan SI, Hoskin AK, Khatri A, Dave VP, Bhalerao S, Romero J, Agrawal R. Prognostic factors of open-globe injuries: A review. Indian J Ophthalmol 2023; 71:3587-3594. [PMID: 37991288 PMCID: PMC10788744 DOI: 10.4103/ijo.ijo_1496_23] [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: 06/07/2023] [Revised: 10/07/2023] [Accepted: 10/27/2023] [Indexed: 11/23/2023] Open
Abstract
Open-globe injuries (OGI) can lead to significant visual impairment. The Ocular Trauma Score (OTS) is the most widely recognized tool for predicting visual outcomes. This review aimed to identify prognostic factors and assess the effectiveness of the OTS in predicting visual outcomes. Twenty-one articles published on PubMed and Google Scholar were analyzed. Initial visual acuity and the zone of injury were found to be the most significant prognostic factors for OGI. Other significant prognostic factors include retinal detachment/involvement, relative afferent pupillary defect, vitreous hemorrhage, vitreous prolapse, type of injury, hyphema, lens involvement, and duration from incidence of OGI to vitrectomy. Of the 21 studies evaluated, 11 investigated the effectiveness of OTS. Four studies concluded that OTS was effective overall, while six studies suggested that it was only useful in certain OGI categories. Thus, there is a need for further research to develop an optimized ocular trauma prognosticating system.
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Affiliation(s)
- Sze Ing Tan
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Annette K Hoskin
- Save Sight Institute, The University of Sydney, Australia
- Lions Eye Institute, The University of Western Australia, Australia
| | - Anadi Khatri
- Department of Ophthalmology, Birat Aankha Aspatal, Biratnagar, Nepal
- Department of Opthalmology, Byers Eye Institute at Stanford, Stanford University, Palo Alto, USA
| | - Vivek P Dave
- Department of Ocular Immunology, Anant Bajaj Retina Institute, Kallam Anji Reddy Campus, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Sushank Bhalerao
- Shantilal Shanghvi Cornea Institute, Kode Venkatadri Chowdary Campus, L V Prasad Eye Institute, Vijayawada, Andhra Pradesh, India
| | - Jose Romero
- Department of Ocular Trauma, Unidad Nacional de Oftalmologia de Guatemala, Guatemala, USA
| | - Rupesh Agrawal
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
- Singapore Eye Research Institute, Singapore
- Duke‐NUS Medical School, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Jiro M, Kaidonis G, Chiang J, Stewart J, Padmanabhan S. Firework-Related Ocular Trauma at a Level 1 Trauma Center During a City-Wide Pandemic Lockdown: A Case Series. Cureus 2023; 15:e48531. [PMID: 38073915 PMCID: PMC10704063 DOI: 10.7759/cureus.48531] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2023] [Indexed: 02/12/2024] Open
Abstract
Purpose To report six ocular injury cases caused by unlicensed fireworks and subsequent complications at a level 1 trauma center in the setting of coronavirus disease 2019 (COVID-19)-related shelter-in-place orders. Observations All six cases occurred between March 2020 and July 2020 and involved fireworks of non-official use. A majority of subjects were male between the ages of 17 and 53 years old. Ocular trauma presented as the following: Case 1 is a 17-year-old male who sustained a left-sided corneal abrasion and small intraocular foreign body after a firework exploded in his hand. Case 2 is a 47-year-old male who presented with a right globe rupture after being struck with a projectile from a neighborhood fireworks display. Case 3 is a 36-year-old male with corneal abrasion, traumatic iritis, and commotio retinae after a firework injury in the setting of alcohol use. Case 4 is a 35-year-old male who presented with left lid injury, corneal abrasion, and hyphema after being struck by a firework with evidence of penetrating eye trauma on subsequent exams. Case 5 is a 53-year-old male who developed bilateral subconjunctival hemorrhages and a partial-thickness corneal laceration after a firework exploded in his left hand. Case 6 is a 48-year-old woman who sustained bilateral corneal stromal foreign bodies while cooking after a firework exploded near her vicinity. Conclusions and importance Fireworks are a preventable cause of mortality and long-term ocular morbidity. The index of suspicion for open globe injuries related to fireworks should be high given the mechanism of injury. These presenting cases at a level 1 trauma center and safety net hospital may be an unforeseen by-product of COVID-19 lockdowns. Our findings are relevant to trauma centers and safety net hospitals with large cases of firework injuries. Further initiatives to improve awareness of the dangers of fireworks should be prioritized to limit harms for all community members.
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Affiliation(s)
- Marycon Jiro
- School of Medicine, University of California San Francisco, San Francisco, USA
| | - Georgia Kaidonis
- Department of Ophthalmology, West Coast Retina Medical Group, San Francisco, USA
| | - Joey Chiang
- Department of Medicine, University of Washington, Seattle, USA
| | - Jay Stewart
- Department of Ophthalmology, University of California San Francisco, San Francisco, USA
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Alawi A, AlHaimi F. Unusual Penetrating Orbital and Globe Injury With a Veterinary Needle. Cureus 2023; 15:e48076. [PMID: 37937023 PMCID: PMC10626050 DOI: 10.7759/cureus.48076] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2023] [Indexed: 11/09/2023] Open
Abstract
We present a rare case of a penetrating injury to the globe and orbit by a veterinary needle. The patient underwent globe exploration and retinal detachment repair under general anesthesia after receiving medical treatment for orbital cellulitis. The case was managed by a multidisciplinary team consisting of a pediatric ophthalmologist, an oculoplastic surgeon, and a retina surgeon. The orbital cellulitis resolved gradually, after which the site of globe penetration was found to be self-sealed, and the retinal detachment was repaired. B-scan ultrasonography and magnetic resonance imaging (MRI) were performed to assess the extent of the injury and evaluate the integrity of the globe. Exploration of presumed Self-sealing globe wounds by a needle should be deferred until the treatment of life-threatening complications like orbital cellulitis and optic nerve infiltration is complete. Prompt judicious care was necessary in this case. It is crucial to implement preventive measures to address the risks involved in children manipulating dangerous objects to avoid preventable accidents and mitigate the potential visual outcomes that may arise as a result.
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Affiliation(s)
- Abeer Alawi
- Pediatric Ophthalmology and Strabismus Division, King Khaled Eye Specialist Hospital, Riyadh, SAU
| | - Fawzia AlHaimi
- Pediatric Ophthalmology and Strabismus Division, King Khaled Eye Specialist Hospital, Riyadh, SAU
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Motamed Shariati M, Hosseini SM, Hashemi Javaheri Z. Traumatic subconjunctival lens dislocation. Clin Case Rep 2023; 11:e8098. [PMID: 37867547 PMCID: PMC10587644 DOI: 10.1002/ccr3.8098] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 09/02/2023] [Accepted: 10/09/2023] [Indexed: 10/24/2023] Open
Abstract
Traumatic crystallin lens dislocation is a common complication following open globe injuries. Wound repair, lensectomy, and prophylactic antibiotic administration are essentials in the management.
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Shetty PA, Natarajan R, Bhalerao SA, Vuyyuru S, Thigale UY, Tara D. Prognostic factors for visual outcome after surgical repair of limbal corneal laceration at a tertiary eye care center in South India. Indian J Ophthalmol 2023; 71:3198-3202. [PMID: 37602608 PMCID: PMC10565948 DOI: 10.4103/ijo.ijo_156_23] [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: 01/16/2023] [Revised: 05/01/2023] [Accepted: 06/03/2023] [Indexed: 08/22/2023] Open
Abstract
Purpose To determine the factors affecting the visual outcome after surgical repair of limbal corneal lacerations at a tertiary eye care center in South India. Methods A retrospective analysis of patients diagnosed with limbal tears between 2011 and 2021 was conducted. Demographic information such as age, gender, cause of injury, and size of the laceration was recorded. Comprehensive ocular examination was performed, including gentle B scan evaluation whenever not contraindicated for detailed posterior segment evaluation. Only those cases with a minimum follow-up of one year were included. Postoperative best-corrected visual acuity, intraocular pressure (IOP), cornea clarity, and integrity of the wound at last follow-up were noted. Results Out of the 20 patients, 15 (75%) were males and 5 (25%) were females. The mean age was 42.6 ± 22.4 years. All 20 patients had a penetrating injury, with four (20%) injured by a stick, two (10%) by an iron rod, three (15%) due to road traffic accident (RTA), three (15%) by glass, and eight (40%) with other nonspecific objects [two (10%) with needle, two (10%) with elastic rope, two (10%) with bangle, and two (10%) with metal]. The average time between the injury and the surgery was 48 hours (2 days). Four (20%) patients underwent a second surgery within a week of repair. After limbal tear repair, at final follow-up at 3 years, 7 (35%) had VA worse than 20/800, 3 (15%) had VA between 20/100 and 20/800, and 10 (50%) achieved VA better than 20/80. Conclusion Preoperative visual acuity (VA), mode of injury, and size of wound affect the final visual outcome after surgical repair of limbal corneal laceration. Preoperative VA and mode of injury were statistically significant even in the multivariate analysis.
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Affiliation(s)
- Prerana A Shetty
- Shantilal Shanghvi Cornea Institute (SSCI), KVC Campus, L. V. Prasad Eye Institute, Vijayawada, Andhra Pradesh, India
| | - Ramya Natarajan
- Department of Ophthalmic Biophysics, KAR Campus, L. V. Prasad Eye Institute, Hyderabad, Telangana, India
| | - Sushank A Bhalerao
- Shantilal Shanghvi Cornea Institute (SSCI), KVC Campus, L. V. Prasad Eye Institute, Vijayawada, Andhra Pradesh, India
| | - Sowjanya Vuyyuru
- Shantilal Shanghvi Cornea Institute (SSCI), KVC Campus, L. V. Prasad Eye Institute, Vijayawada, Andhra Pradesh, India
| | - Uma Yogesh Thigale
- Shantilal Shanghvi Cornea Institute (SSCI), KVC Campus, L. V. Prasad Eye Institute, Vijayawada, Andhra Pradesh, India
| | - Divya Tara
- Shantilal Shanghvi Cornea Institute (SSCI), KVC Campus, L. V. Prasad Eye Institute, Vijayawada, Andhra Pradesh, India
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Lee J, Che Hamzah J, Mohd Khialdin S, Naffi AA. Bilateral Open Globe Injury Secondary to the King of Fruits: Durian Fall. Cureus 2023; 15:e39153. [PMID: 37332448 PMCID: PMC10275641 DOI: 10.7759/cureus.39153] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2023] [Indexed: 06/20/2023] Open
Abstract
We report a case of bilateral open globe injury that resulted from a durian fruit falling on a 62-year-old woman's unprotected face during durian picking in her orchard. On presentation, the bilateral vision was light perception. The right eye sustained a curvilinear corneal laceration with expelled intraocular content. Meanwhile, the left eye sustained a corneoscleral laceration with expelled uvea and retina. Additionally, the right upper lid margin was lacerated. Emergency wound exploration, primary toilet, and suturing were performed on bilateral eyes. Preoperatively, she received intramuscular anti-tetanus toxoid and intravenous ciprofloxacin. Intravitreal ceftazidime and vancomycin were given intraoperatively as endophthalmitis prophylaxis. Postoperatively, the vision remained as light perception. There were no signs of endophthalmitis in both eyes. Although traumatic globe injury due to durian is uncommon, individuals should wear protective gear while in a durian orchard to avoid such unprecedented accidents. Prompt yet scrupulous action should be taken to save the globe and further possible complications.
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Affiliation(s)
- Jing Lee
- Department of Ophthalmology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, MYS
| | - Jemaima Che Hamzah
- Department of Ophthalmology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, MYS
| | - Safinaz Mohd Khialdin
- Department of Ophthalmology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, MYS
| | - Ainal Adlin Naffi
- Department of Ophthalmology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, MYS
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De Niear MA, Tang VD, Nguyen M, Lin LK. Utilization of Ophthalmic Management in Patients with Head-and-Neck Trauma Secondary to Firearms. J Emerg Trauma Shock 2023; 16:43-47. [PMID: 37583378 PMCID: PMC10424738 DOI: 10.4103/jets.jets_165_21] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 02/02/2023] [Accepted: 04/06/2023] [Indexed: 08/17/2023] Open
Abstract
Introduction This retrospective cohort study presents the epidemiology of severe firearm-related ophthalmic injury and the level of ophthalmology involvement in the multidisciplinary management of head-and-neck gunshot injuries. Methods A retrospective study identified 207 patients with firearm-related injuries involving the head and neck treated at an Academic Tertiary Care Institution from 2010 to 2020. Results Ophthalmology consulted on 29% of patients with head-and-neck firearm injuries. At least one of the services managing facial trauma (plastic surgery and otolaryngology) consulted on 71.5% of cases (P < 0.001). Of patients evaluated by ophthalmology, 93.3% survived to discharge; 78.2% of patients who were not evaluated survived to discharge (P = 0.009). Ophthalmology consulted on all patients with open globe injury (10.6%) (P < 0.001), all of which were evaluated by the facial trauma service (P = 0.002), 77.3% by otolaryngology (P = 0.42), 50% by neurosurgery, 36.4% by plastic surgery, 13.6% by orthopedic surgery, and 4.5% by vascular surgery. Ophthalmology consulted on 76.5% of patients with orbital fracture (32.9%) (P < 0.001); 83.8% were evaluated by the facial trauma service (P = 0.006), 69.1% by otolaryngology (P = 0.014), 54.4% by neurosurgery, 27.9% by plastic surgery, 10.3% by orthopedic surgery, and 2.9% by vascular surgery. For patients with orbital fractures, 92.3% survived when ophthalmology was consulted (P = 0.698); 43.8% survived when not consulted (P = 0.001). Conclusions Firearm-related injuries of the head and neck frequently involve ocular and orbital structures, often causing serious vision-threatening injuries. Multispecialty management is common and early ophthalmology specialist evaluation and co-management are indicated to best identify ophthalmic injuries.
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Affiliation(s)
- Matthew Allen De Niear
- Department of Ophthalmology and Vision Science, University of California Davis Health, Sacramento, CA, USA
| | - Vincent Duong Tang
- Department of Ophthalmology and Vision Science, University of California Davis Health, Sacramento, CA, USA
| | - Michael Nguyen
- Department of Ophthalmology and Vision Science, University of California Davis Health, Sacramento, CA, USA
| | - Lily Koo Lin
- Department of Ophthalmology and Vision Science, University of California Davis Health, Sacramento, CA, USA
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Porapaktham T, Choovuthayakorn J, Nanegrungsunk O, Phinyo P, Tanasombatkul K, Watanachai N, Kunavisarut P, Chaikitmongkol V, Patikulsila D. Open Globe Injury in a Tertiary Hospital of Northern Thailand: No Vision Survival and Ocular Trauma Score. Clin Ophthalmol 2023; 17:365-373. [PMID: 36721667 PMCID: PMC9884457 DOI: 10.2147/opth.s401643] [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: 12/15/2022] [Accepted: 01/19/2023] [Indexed: 01/26/2023] Open
Abstract
Purpose To determine characteristics and factors associated with no vision survival (included no light perception, enucleation, and evisceration) following open globe injury (OGI) and to correlate the proportion of final vision to predictive values of ocular trauma score (OTS). Patients and Methods The medical records of consecutive patients diagnosed as OGI between January 2015 and December 2020 were retrospectively reviewed. Data collected included demographics, mechanisms and modes of injuries, ophthalmic presentations, managements, and visual outcomes at the final visit. Results Three hundred and seventy-one patients with a mean (standard deviation, SD) age of 44.0 (17.4) years were included. Male with workplace injury was the most frequent scenario. High-velocity metallic objects were the predominant causative materials. Following treatments, fifty-six eyes (14.9%) obtained no vision survival. Factors associated with no vision survival following OGI were low presenting vision, globe perforation, larger wound, presence of relative afferent pupillary defect, retinal detachment, and vitreous hemorrhage. Compared to OTS predictive values, eyes in OTS categories 1 and 2 had a lower proportion of no vision survival. Conclusion This study identified the importance of workplace injuries. Overall, there were comparable final visions between OTS and this study. However, a reduced proportion of no vision survival among severely injured eyes signifies the challenges of OGI management.
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Affiliation(s)
- Tuangprot Porapaktham
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Janejit Choovuthayakorn
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand,Correspondence: Janejit Choovuthayakorn, Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, 110 Intavaroros Road, Maung, Chiang Mai, 50200, Thailand, Tel +66 53 935512, Fax +66 53 936121, Email
| | - Onnisa Nanegrungsunk
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Phichayut Phinyo
- Clinical Epidemiology and Clinical Statistics Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand,Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand,Musculoskeletal Science and Translational Research (MSTR), Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Krittai Tanasombatkul
- Clinical Epidemiology and Clinical Statistics Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand,Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Nawat Watanachai
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Paradee Kunavisarut
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Voraporn Chaikitmongkol
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Direk Patikulsila
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Jabłoński M, Winiarczyk M, Biela K, Bieliński P, Jasielska M, Batalia J, Mackiewicz J. Open Globe Injury (OGI) with a Presence of an Intraocular Foreign Body (IOFB)-Epidemiology, Management, and Risk Factors in Long Term Follow-Up. J Clin Med 2022; 12. [PMID: 36614991 DOI: 10.3390/jcm12010190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 12/09/2022] [Accepted: 12/23/2022] [Indexed: 12/28/2022] Open
Abstract
The purpose of the study was to evaluate visual outcomes and consider management strategies in the eyes with an intraocular foreign body (IOFB). In a single-center, retrospective case-control study, 36 eyes of 36 patients who suffered from open globe injury (OGI) with IOFB were admitted to the Department of Vitreoretinal Surgery of Medical University of Lublin, Poland from January 2015 to December 2020. Most frequent primary procedure was the pars plana vitrectomy (PPV) with IOFB removal (n = 28). Retinal detachment (RD) developed in nine eyes soon after injury or as a further complication. Recurrent retinal detachment occurred in eight of these nine cases. Final VA 0.1 or better was observed in 21 eyes (58%). Fifteen patients had BCVA of less than 0.1. One eye was not included in the final VA assessment due to the short follow-up period. In 25 out of 28 patients who underwent any kind of pars plana vitrectomy (ppV) a BCVA of <0.4 was observed. The prognosis after an IOFB injury is uncertain due to multiple factors in a peri- and postoperative period. Factors predisposing to poor visual outcomes are: IOFB localization in the posterior segment, retinal detachment, vitreous hemorrhage and prolonged silicone oil tamponade.
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Sen P, Kohli GM, Shah C, Mohan A, Tiwari A, Ingale R, Shenoy P, Sen A. Risk Factors for Development of Endophthalmitis after Open Globe Injury in Children: A Case-Control Study. Ocul Immunol Inflamm 2022; 30:1633-1638. [PMID: 34241557 DOI: 10.1080/09273948.2021.1928237] [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] [Indexed: 12/16/2022]
Abstract
AIM To identify risk-factors for developing endophthalmitis following open globe injury (OGI) in children. METHODS Retrospective, single-center, case-control study of children aged <18 years who sustained OGI. RESULTS Our cohort of 93 eyes consisted of 30 cases (Group A- endophthalmitis) and 63 controls (Group B- no endophthalmitis). Twenty-four eyes (80%) diagnosed with endophthalmitis presented after 24 hours of injury. The presence of central corneal zone-1 injuries (Odd ratio [OR]: 6.64, p= 0.001) and vitreous in wound (OR: 3.53) were associated with the risk of developing endophthalmitis. (p= < 0.05) Additionally the presence of iris prolapse (OR: 4.76) and posterior capsular rupture (PCR) (OR: 5.80) increased the risk of developing endophthalmitis.(p <0.05) . Streptococci was isolated in 15 eyes, Pseudomonas in 3 eyes, and Candida in 1 eye. The visual outcomes at three months were significantly worse in Group A (LogMAR 1.77±1.06) compared to Group B (LogMAR 0.65±0.68)(p<0.05). CONCLUSION Central corneal involvement, vitreous/ iris incarceration and PCR were important risk factors for development of PTE in children.
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Affiliation(s)
- Pradhnya Sen
- Department of Pediatric Ophthalmology and Strabismus, Sadguru Netra Chikitsalaya, Chitrakoot, India
| | - Gaurav Mohan Kohli
- Department of Vitre-retina and Uvea, Sadguru Netra Chikitsalaya, Chitrakoot, India
| | - Chintan Shah
- Department of Pediatric Ophthalmology and Strabismus, Sadguru Netra Chikitsalaya, Chitrakoot, India
| | - Amit Mohan
- Department of Pediatric Ophthalmology and Strabismus, Sadguru Netra Chikitsalaya, Chitrakoot, India
| | - Amrita Tiwari
- Department of Pediatric Ophthalmology and Strabismus, Sadguru Netra Chikitsalaya, Chitrakoot, India
| | - Rashmi Ingale
- Department of Pediatric Ophthalmology and Strabismus, Sadguru Netra Chikitsalaya, Chitrakoot, India
| | - Pratik Shenoy
- Department of Vitre-retina and Uvea, Sadguru Netra Chikitsalaya, Chitrakoot, India
| | - Alok Sen
- Department of Vitre-retina and Uvea, Sadguru Netra Chikitsalaya, Chitrakoot, India
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13
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Wei X, Ang BCH, Nazir A, Shah FQ, Qureshi T, Jain A, Natarajan S. A series of 777 pellet gun ocular injuries over a 4-month period in Kashmir. Indian J Ophthalmol 2022; 70:3465-3469. [PMID: 36190028 PMCID: PMC9789860 DOI: 10.4103/ijo.ijo_721_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 11/05/2022] Open
Abstract
Purpose To examine the incidence, clinical findings and management of pellet gun-related ocular injuries that occurred during protests in Kashmir region. Methods This retrospective study included records from 777 patients diagnosed with pellet gun-related ocular injuries admitted to a tertiary hospital in Srinagar, India, between July and November 2016. By reviewing the clinical records, the following data were collected: demographics, clinical information pertaining to the injury, imaging reports including computer tomography and ultrasonography B-scan, management in the emergency setting, and follow-up treatment. Results Mean age was 22.3 ± 7.2 years and majority patients were male (97.7%). In terms of laterality, 94.3% and 5.7% of the patients sustained monocular and binocular injuries, respectively. In terms of the nature of injury, 76.3% of the eyes had open globe injury while 23.7% of the eyes had closed eye injury. Emergency surgical exploration was performed in 67.7% of closed globe injuries while emergency primary repair was done in 91.1% of open globe injuries. The vast majority of patients (98.7%) who required surgery underwent surgical intervention on the day of admission or the next day. Final best-corrected visual acuity (BCVA) after treatment was counting fingers or worse in 82.4% of the eyes. Conclusion Pellet gun-related ocular injuries resulted in significant ocular morbidity, mostly manifesting as open globe injuries. Treatment often required surgical interventions, but despite expeditious management, visual prognosis remained poor for most of the patients.
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Affiliation(s)
- Xin Wei
- Department of Ophthalmology and Visual Sciences, Khoo Teck Puat Hospital, Singapore,Department of Ophthalmology, Tan Tock Seng Hospital, National Healthcare Group Eye Institute, Singapore
| | - Bryan Chin Hou Ang
- Department of Ophthalmology, Tan Tock Seng Hospital, National Healthcare Group Eye Institute, Singapore
| | - Arshi Nazir
- Department of Ophthalmology, Government Medical College, Srinagar, Jammu and Kashmir, India
| | - Faisal Qayoom Shah
- Department of Ophthalmology, Government Medical College, Srinagar, Jammu and Kashmir, India
| | - Tariq Qureshi
- Department of Ophthalmology, Government Medical College, Srinagar, Jammu and Kashmir, India
| | - Astha Jain
- Vitreo Retinal Service, Kamala Sundaram Foundation, Aditya Jyot Fundation for Twinkling Little Eyes, Mumbai, Maharashtra, India
| | - Sundaram Natarajan
- Vitreo Retinal Service, Aditya Jyot Eye Hospital, Mumbai, Maharashtra, India,Correspondence to: Prof. Sundaram Natarajan, Aditya Jyot Eye Hospital Pvt Ltd, Plot No. 153, Road No. 9, Major Parmeshwaran Road, Opp S.I.W.S. College Gate No. 3, Wadala, Mumbai, Maharashtra - 400 031, India. E-mail:
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14
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Fernandez EO, Miller HM, Pham VQ, Fleischman D. Comparison of Time-to-Surgery and Outcomes in Transferred Vs Non-Transferred Open Globe Injuries. Clin Ophthalmol 2022; 16:2733-2742. [PMID: 36035239 PMCID: PMC9416327 DOI: 10.2147/opth.s378049] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 08/01/2022] [Indexed: 12/02/2022] Open
Abstract
Purpose It is widely accepted in the field of ophthalmology that closure of open globes within 24 hours of the injury results in the best visual outcomes. This study investigates the time-to-surgery and visual outcomes of open globe injury patients in North Carolina that were transferred to our institution before receiving surgical intervention as compared to those that were not transferred. Patients and methods This is a retrospective cohort study using data from UNC Hospitals trauma registry. Demographics, time of injury, final clinical outcomes, time to surgical intervention, and transfer history were extracted and analyzed. The study population includes open globe injury patients of all ages that were seen and treated at our institution from 2005 to 2020. Patients were divided based on transfer history. The transfer group consisted of patients who were transferred from an outside hospital to our tertiary care facility for surgical treatment. The non-transfer group consisted of patients who arrived at our tertiary care facility directly after injury. Results In total, 238 open globe injuries were evaluated. Of those, 197 were transferred and 41 were not transferred. Compared to non-transfer patients, transfer patients had longer delays between injury and surgery, between presentation at the initial ED and surgery, and between injury and arrival at the tertiary care center. On average, the delay between injury and surgical intervention was 3 hours and 51 minutes longer for transfer patients compared to non-transfer patients. Eight patients in the transfer group were delayed >24 hours due to inter-hospital transfer. Additionally, transfer patients on average suffered from poorer final visual acuities, with an average final visual acuity of 1.84 logMAR in the transfer group and 1.35 logMAR in the non-transfer group. Conclusion Our study found that inter-hospital transfer leads to significant delays in primary closure of open globe injuries. Injuries that were transferred to a tertiary care center before receiving surgical intervention on average resulted in worse final visual acuities.
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Affiliation(s)
- Elise O Fernandez
- School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Hannah M Miller
- Department of Ophthalmology, University of North Carolina, Chapel Hill, NC, USA
| | - Vincent Q Pham
- College of Medicine, Northeast Ohio Medical University, Rootstown, OH, USA
| | - David Fleischman
- Department of Ophthalmology, University of North Carolina, Chapel Hill, NC, USA
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15
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Affiliation(s)
- Haoyu Chen
- Joint Shantou International Eye Center, Shantou University & the Chinese University of Hong Kong, Shantou, China
| | - Vishal Jhanji
- University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Rupesh Agrawal
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore.,Department of Ophthalmology, Singapore Eye Research Institute, Singapore, Singapore.,Lee Kong Chian School of Medicine, Singapore, Singapore.,Duke National University of Singapore (NUS) Medical School, Singapore, Singapore
| | - Hua Yan
- Department of Ophthalmology, Tianjin Medical University General Hospital, Tianjin, China
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16
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Ramachandran NO, Kohli P, Babu N, Mishra C, Chakrabarti A. Frosted branch angiitis following corneal tear repair. Taiwan J Ophthalmol 2022; 12:491-494. [PMID: 36660112 PMCID: PMC9843579 DOI: 10.4103/tjo.tjo_52_21] [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: 08/19/2021] [Accepted: 10/30/2021] [Indexed: 01/22/2023] Open
Abstract
We report a patient who developed frosted branch angiitis (FBA) and was diagnosed 1 month after the penetrating eye injury (PEI) repair. A 31-year-old male with no systemic comorbidities presented with defective vision following trauma to his left eye while cutting wood. His best-corrected visual acuity (BCVA) was 20/200. Anterior segment examinations showed a zone I full-thickness corneal tear with iris tissue incarceration. There was no clinical evidence of intraocular foreign body (IOFB) or endophthalmitis. He underwent PEI repair with iris abscission on the same day with intracameral moxifloxacin injection. His BCVA on postoperative day 45 was 20/200. Examination showed a resolving vitreous hemorrhage, venous tortuosity, and retinal perivascular infiltration affecting the venules from the posterior pole up to the periphery. He was treated with oral and topical steroids. The clinical signs resolved completely and BCVA improved to 20/20 after 1 month of treatment. FBA can complicate the recovery of eyes after PEI repair, even in the absence of endophthalmitis or sympathetic ophthalmia. A thorough search for IOFB or its tell-tale signs should be done in such eyes.
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Affiliation(s)
- N. Obuli Ramachandran
- Department of Vitreo-Retinal Services, Aravind Eye Hospital, Madurai, Tamil Nadu, India
| | - Piyush Kohli
- Department of Vitreo-Retinal Services, Aravind Eye Hospital, Madurai, Tamil Nadu, India,Address for correspondence: Dr. Piyush Kohli, Department of Vitero-Retinal Services, Aravind Eye Hospital, 1, Anna Nagar, Madurai - 625 020, Tamil Nadu, India. E-mail:
| | - Naresh Babu
- Department of Vitreo-Retinal Services, Aravind Eye Hospital, Madurai, Tamil Nadu, India
| | - Chitaranjan Mishra
- Department of Vitreo-Retinal Services, Aravind Eye Hospital, Madurai, Tamil Nadu, India
| | - Anirban Chakrabarti
- Department of Vitreo-Retinal Services, Aravind Eye Hospital, Madurai, Tamil Nadu, India
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17
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Choi S, Park J, Park S, Byon I, Choi HY. Establishment of a prediction tool for ocular trauma patients with machine learning algorithm. Int J Ophthalmol 2021; 14:1941-1949. [PMID: 34926212 DOI: 10.18240/ijo.2021.12.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 10/22/2021] [Indexed: 11/23/2022] Open
Abstract
AIM To predict final visual acuity and analyze significant factors influencing open globe injury prognosis. METHODS Prediction models were built using a supervised classification algorithm from Microsoft Azure Machine Learning Studio. The best algorithm was selected to analyze the predicted final visual acuity. We retrospectively reviewed the data of 171 patients with open globe injury who visited the Pusan National University Hospital between January 2010 and July 2020. We then applied cross-validation, the permutation feature importance method, and the synthetic minority over-sampling technique to enhance tool performance. RESULTS The two-class boosted decision tree model showed the best predictive performance. The accuracy, precision, recall, F1 score, and area under the receiver operating characteristic curve were 0.925, 0.962, 0.833, 0.893, and 0.971, respectively. To increase the efficiency and efficacy of the prognostic tool, the top 14 features were finally selected using the permutation feature importance method: (listed in the order of importance) retinal detachment, location of laceration, initial visual acuity, iris damage, surgeon, past history, size of the scleral laceration, vitreous hemorrhage, trauma characteristics, age, corneal injury, primary diagnosis, wound location, and lid laceration. CONCLUSION Here we devise a highly accurate model to predict the final visual acuity of patients with open globe injury. This tool is useful and easily accessible to doctors and patients, reducing the socioeconomic burden. With further multicenter verification using larger datasets and external validation, we expect this model to become useful worldwide.
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Affiliation(s)
- Seungkwon Choi
- Department of Ophthalmology, Pusan National University Hospital, Busan 49241, Republic of Korea.,Biomedical Research Institute of Pusan National University Hospital, Busan 49241, Republic of Korea
| | - Jungyul Park
- Department of Ophthalmology, Pusan National University Hospital, Busan 49241, Republic of Korea.,Biomedical Research Institute of Pusan National University Hospital, Busan 49241, Republic of Korea
| | - Sungwho Park
- Department of Ophthalmology, Pusan National University Hospital, Busan 49241, Republic of Korea.,Biomedical Research Institute of Pusan National University Hospital, Busan 49241, Republic of Korea
| | - Iksoo Byon
- Department of Ophthalmology, Pusan National University Hospital, Busan 49241, Republic of Korea.,Biomedical Research Institute of Pusan National University Hospital, Busan 49241, Republic of Korea
| | - Hee-Young Choi
- Department of Ophthalmology, Pusan National University Hospital, Busan 49241, Republic of Korea.,Biomedical Research Institute of Pusan National University Hospital, Busan 49241, Republic of Korea.,Department of Ophthalmology, School of Medicine, Pusan National University, Busan 49241, Republic of Korea
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Saksiriwutto P, Charuchinda P, Atchaneeyasakul LO, Surachatkumtonekul T, Phamonvaechavan P. Epidemiology of Pediatric Open Globe Injuries in a University Hospital in Thailand. Cureus 2021; 13:e19366. [PMID: 34925976 PMCID: PMC8654118 DOI: 10.7759/cureus.19366] [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] [Accepted: 11/08/2021] [Indexed: 12/02/2022] Open
Abstract
Objective: To describe the epidemiology, clinical characteristics, and clinical outcomes of pediatric traumatic open globe injuries and to determine the risk factors for poor visual outcome. Methods: The medical records of patients aged younger than 15 years of age who were diagnosed with open globe injuries from January 2005 to December 2015 were retrospectively reviewed. The patients’ demographic data were collected, including age, sex, injury date, place of injury, mechanism of injury, cause of injury, and the activity related to the injury. Clinical data were recorded, including initial visual acuity (VA), wound size, wound location, associated ocular findings at presentation, and complications. The prognostic factors for a poor visual outcome were assessed. Results: In total, 46 pediatric patients were included in this study. The mean age was 6.8 years old. Most patients were male (65.2%). The most common type of injury was penetrating injury (60.9%) and mostly occurred during playing (60.9%). Household appliances/furniture and scissors/knives were common causes of injuries (17.4%, 15.2%, respectively). Poor final VA worse than 6/60 was found in 17 patients (37%). Wound location and retinal detachment (RD) at the time of presentation were significant prognostic factors for a poor visual outcome according to the univariate analysis (p = 0.008, <0.001). Only wound location at zone II and III was found to be significantly correlated with poor final VA in the multivariate analysis (adjusted risk ratio (RR) = 2.87, 95% confidence interval (CI), 1.26-6.55, p = 0.012). Traumatic cataract was the most common associated injury (45.7%). Conclusions: One-third of pediatric patients with open globe injuries had a poor visual outcome. Wound location at zone II and III significantly correlated with a poor visual outcome in pediatric open globe injuries. The parents and caregivers should be made aware of the seriousness of open globe injuries in order to prevent children from possible injuries.
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Paulbuddhe V, Addya S, Gurnani B, Singh D, Tripathy K, Chawla R. Sympathetic Ophthalmia: Where Do We Currently Stand on Treatment Strategies? Clin Ophthalmol 2021; 15:4201-4218. [PMID: 34707340 PMCID: PMC8542579 DOI: 10.2147/opth.s289688] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 08/16/2021] [Accepted: 09/30/2021] [Indexed: 01/05/2023] Open
Abstract
Sympathetic ophthalmia is a rare bilateral diffuse granulomatous panuveitis that usually results from surgical or penetrating trauma to one eye. The symptoms range from impaired near vision to pain, photophobia, and loss of visual acuity. Anterior segment manifestations include bilateral acute uveitis with mutton-fat keratic precipitates and posterior segment findings include vitritis, multifocal neurosensory retinal detachment, choroiditis, optic nerve edema, and Dalen-Fuchs nodules. The diagnosis is clinical. Ancillary investigations include fundus fluorescein angiography, indocyanine green angiography, optical coherence tomography (OCT), ultrasound B scan, and autofluorescence imaging. The management options include corticosteroids (topical and systemic) as the first line along with immunomodulatory therapy started at the presentation of the disease. Recent advances include imaging with OCT-angiography, enhanced depth imaging-OCT (EDI-OCT, choroidal vascular index/CVI), targeting IL-23/IL-17 pathway, and use of biologics for the management of this rare entity. Recent advances in early diagnosis and prompt treatment has led to improved final visual outcomes in both the sympathizing and exciting eye. This review is aimed at giving a comprehensive overview of sympathetic ophthalmia along with a special emphasis on current treatment strategies and recent advances.
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Affiliation(s)
- Vivek Paulbuddhe
- Department of Vitreoretina, ASG Eye Hospital, Guwahati, 781006, Assam, India
| | - Sujit Addya
- Department of Vitreoretina, ASG Eye Hospital, Guwahati, 781006, Assam, India
| | - Bharat Gurnani
- Department of Cornea, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Pondicherry, 605007, Puducherry, India
| | - Dheerendra Singh
- Department of Retina, ASG Eye Hospital, Bhopal, 462016, Madhya Pradesh, India
| | - Koushik Tripathy
- Department of Vitreoretina, ASG Eye Hospital, Kolkata, 700058, West Bengal, India
| | - Rohan Chawla
- Department of Ophthalmology, All India Institute of Medical Sciences, New Delhi, 110029, India
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20
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Dulz S, Dimopoulos V, Katz T, Kromer R, Bigdon E, Spitzer MS, Skevas C. Reliability of the ocular trauma score for the predictability of traumatic and post-traumatic retinal detachment after open globe injury. Int J Ophthalmol 2021; 14:1589-1594. [PMID: 34667737 DOI: 10.18240/ijo.2021.10.17] [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: 12/16/2020] [Accepted: 04/30/2021] [Indexed: 11/23/2022] Open
Abstract
AIM To elucidate the question of whether the ocular trauma score (OTS) and the zones of injury could be used as a predictive model of traumatic and post traumatic retinal detachment (RD) in patients with open globe injury (OGI). METHODS A retrospective observational chart analysis of OGI patients was performed. The collected variables consisted of age, date, gender, time of injury, time until repair, mechanism of injury, zone of injury, injury associated vitreous hemorrhage, trauma associated RD, post traumatic RD, aphakia at injury, periocular trauma and OTS in cases of OGI. RESULTS Totally 102 patients with traumatic OGI with a minimum of 12mo follow-up and a median age at of 48.6y (range: 3-104y) were identified. Final best corrected visual acuity (BCVA) was independent from the time of repair, yet a statistically significant difference was present between the final BCVA and the zone of injury. Severe trauma presenting with an OTS score I (P<0.0001) or II (P<0.0001) revealed a significantly worse BCVA at last follow up when compared to the cohort with an OTS score >III. OGI associated RD was observed in 36/102 patients (35.3%), whereas post traumatic RD (defined as RD following 14d after OGI) occurred in 37 patients (36.3%). OGI associated RD did not correlate with the OTS and the zone of injury (P=0.193), yet post traumatic RD correlated significantly with zone III injuries (P=0.013). CONCLUSION The study shows a significant association between lower OTS score and zone III injury with lower final BCVA and a higher number of surgeries, but only zone III could be significantly associated with a higher rate of RD.
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Affiliation(s)
- Simon Dulz
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Vasilis Dimopoulos
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
| | | | - Robert Kromer
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Eileen Bigdon
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Martin Stephan Spitzer
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Christos Skevas
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
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21
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Parchand S, Shenoy P, Muralidhar A, Kohli G, Gangwe A, Agrawal D, Varshney A, Mittal R, Saha I, Madharia A, Singh S, Sen A, Trehan H, Agarwal M. Changing patterns of posterior segment trauma during the COVID-19 pandemic: A regional analysis from the Bodhya Eye Consortium. Indian J Ophthalmol 2021; 69:2828-2835. [PMID: 34571643 PMCID: PMC8597502 DOI: 10.4103/ijo.ijo_1395_21] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 07/14/2021] [Accepted: 08/25/2021] [Indexed: 11/29/2022] Open
Abstract
Purpose To assess changes in the presentation patterns of posterior segment trauma during the COVID-19 pandemic from six tertiary eye care institutes of North and Central India. Methods A multicenter, hospital-based, retrospective comparative analysis of patients presenting with posterior segment trauma was done during the COVID-19 (Group A) (March 25, 2020 - September 30, 2020) period and the pre-COVID-19 (Group B) (March 25, 2019 - September 30, 2019) period. Results A total of 405 patients were diagnosed with posterior segment trauma (Group A: 206, Group B: 199). The time interval between onset of trauma and presentation was higher in Group A (16.59 ± 29.87 days) as compared to Group B (9.41 ± 19.19 days) (P = 0.004). A majority of patients in Group A had a history of prior consultation before presentation (P = 0.049). In Group A, 120 (58.2%) patients sustained ocular trauma at home as compared to 80 (40.2%) patients in Group B (P < 0.0001). Patients presenting with light perception were significantly more in Group A (43.7%) as compared to Group B (30.2%) (P = 0.004). In Group B, 37.6% patients had presenting visual acuity of counting finger or better as compared to 27.6% patients in Group A (P = 0.07). Patients in Group A had a significantly higher proportion of post-traumatic endophthalmitis with delayed presentation (P = 0.011) and retinal detachment (P = 0.041). Patients undergoing surgery for foreign-body removal were significantly fewer in Group A (P = 0.05). Conclusion Although the number of patients presenting with posterior segment trauma was comparable in Groups A and B, a greater number of patients sustained home injuries during the COVID-19 pandemic. A majority of these patients had delayed presentation with poor presenting visual acuity and a higher tendency of retinal detachment.
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Affiliation(s)
- Swapnil Parchand
- Department of Vitreo-retina, MGM Eye Institute, Raipur, Chattisgarh, India
- The Bodhya Eye Consortium
| | - Pratik Shenoy
- Department of Vitreo-retina Services, Sadguru Netra Chikitsalaya, Chitrakoot, Madhya Pradesh, India
- The Bodhya Eye Consortium
| | - Alankrita Muralidhar
- Department of Vitreo-retina Services, Dr Shroff’s Charity Eye Hospital, New Delhi, India
- The Bodhya Eye Consortium
| | - Gaurav Kohli
- Department of Vitreo-retina Services, Sadguru Netra Chikitsalaya, Chitrakoot, Madhya Pradesh, India
- The Bodhya Eye Consortium
| | - Anil Gangwe
- Department of Vitreo-retina, MGM Eye Institute, Raipur, Chattisgarh, India
- The Bodhya Eye Consortium
| | - Deepanshu Agrawal
- Department of Vitreo-retina, MGM Eye Institute, Raipur, Chattisgarh, India
- The Bodhya Eye Consortium
| | - Abhishek Varshney
- Department of Vitreo-retina Services, CL Gupta Eye Institute, Moradabad, Uttar Pradesh, India
- The Bodhya Eye Consortium
| | - Ruchi Mittal
- Department of Vitreo-retina Services, LJ Eye Institute, Ambala, Haryana, India
- The Bodhya Eye Consortium
| | - Indranil Saha
- Department of Vitreo-retina Services, Regional Institute of Ophthalmology, Sitapur Eye Hospital, Sitapur, Uttar Pradesh, India
- The Bodhya Eye Consortium
| | - Aishwarya Madharia
- Department of Vitreo-retina Services, Sadguru Netra Chikitsalaya, Chitrakoot, Madhya Pradesh, India
- The Bodhya Eye Consortium
| | - Shalini Singh
- Department of Vitreo-retina Services, Dr Shroff’s Charity Eye Hospital, New Delhi, India
- The Bodhya Eye Consortium
| | - Alok Sen
- Department of Vitreo-retina Services, Sadguru Netra Chikitsalaya, Chitrakoot, Madhya Pradesh, India
- The Bodhya Eye Consortium
| | - Hemant Trehan
- Department of Vitreo-retina Services, Command Hospital Air Force, Bengaluru, Karnataka, India
| | - Manisha Agarwal
- Department of Vitreo-retina Services, Dr Shroff’s Charity Eye Hospital, New Delhi, India
- The Bodhya Eye Consortium
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22
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Gondchawar A, Ravishankar HN, Sagar P, Tekade P, Biswal SK, Mahesha S. Ocular Injury due to Arecanut: A Unique Occupational Hazard in Central Karnataka. Indian J Occup Environ Med 2021; 25:111-113. [PMID: 34421248 PMCID: PMC8341410 DOI: 10.4103/ijoem.ijoem_174_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 05/29/2020] [Accepted: 06/13/2020] [Indexed: 11/30/2022] Open
Abstract
Purpose: To evaluate the ocular manifestations and visual outcomes of ocular injury by arecanut. Methods: We analysed cases with ocular injury by arecanut from August 2018 to December 2019, retrospectively. Mode of injury, visual acuity and ocular manifestations of trauma were recorded. Results: Out of the 40 cases, closed globe injuries were seen in 97.5% of cases. All the injuries were due to the direct impact of arecanut during harvesting. The mean age was 45.15 ± 12.84 years. The mean best-corrected visual acuity (BCVA) at presentation was 20/40. A significant number of cases (35%) required surgical intervention. Mean BCVA at final follow-up was 20/30 but 16.66% of cases had BCVA of <20/60 even after definitive therapy. Conclusion: Ocular trauma due to arecanut is an important and preventable cause of visual impairment in central Karnataka. Modifications in harvesting technique would prevent ocular injuries.
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Affiliation(s)
- Ankush Gondchawar
- Department of Vitreo-Retina, Sankara Eye Hospital, Shimoga, Karnataka, India
| | - H N Ravishankar
- Department of Vitreo-Retina, Sankara Eye Hospital, Shimoga, Karnataka, India
| | - Pradeep Sagar
- Department of Vitreo-Retina, Sankara Eye Hospital, Shimoga, Karnataka, India
| | - Pradeep Tekade
- Department of Vitreo-Retina, Sankara Eye Hospital, Shimoga, Karnataka, India
| | - Suchitra K Biswal
- Department of Vitreo-Retina, Sankara Eye Hospital, Shimoga, Karnataka, India
| | - S Mahesha
- Department of Vitreo-Retina, Sankara Eye Hospital, Shimoga, Karnataka, India
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23
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Zamani M, Tabatabaei SA, Fotouhi A, Naderan M, Soleimani M. Open globe injuries in geriatric population in Iran: characteristics and outcomes. Int J Ophthalmol 2021; 14:1237-1240. [PMID: 34414090 DOI: 10.18240/ijo.2021.08.16] [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: 10/16/2020] [Accepted: 03/22/2021] [Indexed: 11/23/2022] Open
Abstract
AIM To investigate the patterns and outcomes of open globe injuries in the elderly population in Iran. METHODS In this retrospective cross-sectional chart review, medical records of 248 patients (aged 60y and more) with the diagnosis of open globe injury from 2006 to 2016 were reviewed. Demographic features, type, and mechanism of open globe injury, ocular trauma score (OTS), visual acuity before and after treatment, the zone of injuries, and the associated injuries found at the presentation or thereafter were documented. RESULTS A total of 248 eyes of 248 patients were included. The mean age was 69.2±5.8y (range: 60-90y). Male/ female ratio was about 3:1 (187 vs 61). The three most common causes of injury were falling (25.2%), sharp objects (18.9%), and tree branches (13.9%). Penetrating injury accounted for most of the geriatric ocular trauma (50.4%), followed by globe rupture (40.3%), intraocular foreign body (IOFB; 7.3%), and perforating injury (2.0%). The median raw OTS for the population was 60.5 and the most common OTS class was 3. The injuries tend to affect zone I more than zone II and zone III. The only predictor of final visual acuity was the class of OTS (P<0.001). CONCLUSION Geriatric open globe injury should be valued specifically. The most common type of open globe injury in Iran is penetrating injuries but falling remain the main cause. The OTS class must be considered as an important predictor of final visual acuity.
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Affiliation(s)
- Maryam Zamani
- Ocular Trauma and Emergency Department, Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran 1336616351, Iran
| | - Seyed Ali Tabatabaei
- Ocular Trauma and Emergency Department, Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran 1336616351, Iran
| | - Akbar Fotouhi
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran 1336616351, Iran
| | - Morteza Naderan
- Ocular Trauma and Emergency Department, Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran 1336616351, Iran
| | - Mohammad Soleimani
- Ocular Trauma and Emergency Department, Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran 1336616351, Iran
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Besek NK, Nacaroglu SA, Er MO, Kirgiz A, Yilmaz FO, Yildiz BK, Ocal MC. The Effect of Secondary Intraocular Lens Implantation Time on Visual Prognosis in Aphakia Cases After Open Globe Injury. ACTA ACUST UNITED AC 2021; 35:368-375. [PMID: 34344135 PMCID: PMC8521333 DOI: 10.3341/kjo.2020.0004] [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: 11/16/2020] [Accepted: 07/09/2021] [Indexed: 11/23/2022]
Abstract
Purpose We investigated the effect of the time of secondary intraocular lens (IOL) implantation on final visual acuity and other causes affecting visual prognosis in cases left aphakic after open globe injury. Methods The study included 62 eyes of 62 patients left aphakic after the repair of open globe injury between 2012-2019. Demographic characteristics, trauma zone, ocular trauma score (OTS), type of injury, time of secondary IOL implantation, final best corrected visual acuity (BCVA), and complications were recorded for each patient. Results The mean follow-up time of 62 patients was 25.05 ± 12.59 months. The preoperative BCVA was found to be 2.40±0.86 LogMAR, while the postoperative final BCVA was found to be 0.53±0.70 LogMAR (p<0.01). The mean interval timing of secondary sulcus foldable IOL implantation was determined to be 3.79 ± 4.04 months. No correlation was observed between secondary IOL implantation time and final BCVA (r= 0.140, p=0.319). Furthermore, when only pediatric patients were taken, an excellent positive correlation was found between the secondary IOL implantation time and final BCVA LogMAR (r=0.895, p<0.01). Multiple linear regression on final BCVA with age, revealed a significant model explaining 48.0% of the variability with younger age and better final BCVA with as significant coefficients (p= 0.007). Conclusion Although time interval between primary repair and secondary IOL implantation to correct aphakia does not effect final BCVA in adult patients, earlier surgery should be considered for amblyopia management in pediatric patients.
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Affiliation(s)
- Nilay Kandemir Besek
- University of Health Sciences, Beyoğlu Eye Training and Research Hospital, Istanbul, Turkey
| | - Senay Asik Nacaroglu
- University of Health Sciences, Beyoğlu Eye Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Onur Er
- University of Health Sciences, Beyoğlu Eye Training and Research Hospital, Istanbul, Turkey
| | - Ahmet Kirgiz
- University of Health Sciences, Beyoğlu Eye Training and Research Hospital, Istanbul, Turkey
| | - Fevziye Ondes Yilmaz
- University of Health Sciences, Beyoğlu Eye Training and Research Hospital, Istanbul, Turkey
| | - Burçin Kepez Yildiz
- University of Health Sciences, Beyoğlu Eye Training and Research Hospital, Istanbul, Turkey
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Neerukonda VK, Stagner AM, Wolkow N. Florid sympathetic ophthalmia. Orbit 2021:1. [PMID: 34219581 DOI: 10.1080/01676830.2021.1939733] [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: 04/26/2021] [Accepted: 06/02/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Vamsee K Neerukonda
- David G. Cogan Laboratory of Ophthalmic Pathology, Massachusetts Eye and Ear/Harvard Medical School, Boston, Massachusetts, USA
| | - Anna M Stagner
- David G. Cogan Laboratory of Ophthalmic Pathology, Massachusetts Eye and Ear/Harvard Medical School, Boston, Massachusetts, USA
| | - Natalie Wolkow
- David G. Cogan Laboratory of Ophthalmic Pathology, Massachusetts Eye and Ear/Harvard Medical School, Boston, Massachusetts, USA
- Ophthalmic Plastic Surgery Service, Department of Ophthalmology Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
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26
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Lee BWH, Hunter D, Robaei DS, Samarawickrama C. Open globe injuries: Epidemiology, visual and surgical predictive variables, prognostic models, and economic cost analysis. Clin Exp Ophthalmol 2021; 49:336-346. [PMID: 33982383 DOI: 10.1111/ceo.13944] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 05/03/2021] [Accepted: 05/07/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Open globe injuries (OGI) represent a visually and economically devastating cause of vision loss. We examined the epidemiology, predictive variables, prognostic models, and economic cost of surgically managed OGI. METHODS A retrospective tertiary centre study from 2008 to 2018 of 155 consecutive OGI in individuals aged 16 and older was performed. Medical records review, application of Ocular Trauma Score (OTS) and Classification and Regression Tree Analysis (CART) and cost analysis were undertaken. Key outcomes measured were visual acuity, number of operating theatre visits, prognostication using OTS and CART and estimated costs. RESULTS Younger males at work with inadequate protective eyewear (89.1%) and falls in the elderly were overrepresented. Inferior visual outcomes were associated with a more severe OTS score, a larger injury zone, increasing age, the presence of retinal detachment, extraocular muscle involvement, intraocular foreign body, and globe rupture (R2 = 0.723, p < 0.001). Multiple operating theatre visits were required in the presence of retinal detachment, lens or orbit involvement, work-related injury, globe rupture, and a history of previous intraocular surgery (R2 = 0.0423, p < 0.001). Both OTS and CART prognosticated outcomes (p < 0.001). The OTS predicted for no vision (no light perception/enucleation/evisceration) and profound visual loss (worse than 6/120; specificity: both 100%, sensitivity: 88.2% and 88%) whereas the CART predicted for visual survival (light perception or better) and minimal-to-severe visual loss (6/120 or better; specificity: 88.5% and 81.7% , sensitivity: 97.7% and 100%). Estimated annual OGI cost for Australia was AUD48.1-60.5 million (USD37.3-47.0 million). CONCLUSIONS The total cost of OGI is immense with young males and the elderly being disproportionately affected. Implementation of targeted government legislation and public health preventative measures may be cost-effective in ameliorating the significant burden.
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Affiliation(s)
- Brendon W H Lee
- University of Sydney School of Medicine, Sydney, Australia.,Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Damien Hunter
- Westmead Institute for Medical Research, Sydney, Australia
| | - Dana S Robaei
- University of Sydney School of Medicine, Sydney, Australia
| | - Chameen Samarawickrama
- University of Sydney School of Medicine, Sydney, Australia.,Faculty of Medicine, University of New South Wales, Sydney, Australia.,Westmead Institute for Medical Research, Sydney, Australia
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Durrani AF, Zhao PY, Zhou Y, Huvard M, Azzouz L, Keil JM, Armenti ST, Dedania VS, Musch DC, Zacks DN. Risk Factors for Endophthalmitis Following Open Globe Injuries: A 17-Year Analysis. Clin Ophthalmol 2021; 15:2077-2087. [PMID: 34040343 PMCID: PMC8141272 DOI: 10.2147/opth.s307718] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 04/13/2021] [Indexed: 11/23/2022] Open
Abstract
Background/Aims To determine the rate of endophthalmitis and assess risk factors for development of endophthalmitis following open globe injury (OGI). Methods A retrospective chart review of all patients treated for OGI at the University of Michigan from January 2000 to July 2017 was conducted. Exclusion criteria included intravitreal injection or intraocular surgery in the 30 days prior to injury or less than 30 days of follow-up. A total of 586 out of 993 open globe injuries were included in the study. The main outcome measure was the rate of endophthalmitis. Results In this study, 25/586 eyes (4.3%) had endophthalmitis. Of these, 12/25 eyes (48.0%) presented with endophthalmitis and 13/25 eyes (52.0%) developed endophthalmitis after globe closure. Multivariate analysis identified time to globe repair (OR 4.5, CI 1.9-10.7, p = 0.0008), zone I injury (OR 3.6, CI 1.1-11.0, p = 0.0282), and need for additional surgery (OR 5.5, CI 1.5-19.7, p = 0.0092) as factors associated with increased risk of developing endophthalmitis. Subconjunctival antibiotic injection at the time of globe closure (OR 0.3, CI 0.1-0.7, p = 0.0036) was associated with decreased risk of developing endophthalmitis. Conclusion Prompt globe closure and subconjunctival antibiotics may reduce the risk of endophthalmitis in OGI. Furthermore, our practice of a one-time dose of systemic prophylactic antibiotics, and intravitreal antibiotics if intraocular foreign body (IOFB) removal is delayed, was not found to increase the rate of endophthalmitis.
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Affiliation(s)
- Asad F Durrani
- Department of Ophthalmology and Visual Sciences, W.K. Kellogg Eye Center, University of Michigan, Ann Arbor, MI, USA
| | - Peter Y Zhao
- Department of Ophthalmology and Visual Sciences, W.K. Kellogg Eye Center, University of Michigan, Ann Arbor, MI, USA
| | - Yunshu Zhou
- Department of Ophthalmology and Visual Sciences, W.K. Kellogg Eye Center, University of Michigan, Ann Arbor, MI, USA
| | - Michael Huvard
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Lyna Azzouz
- University of Michigan Medical School, Ann Arbor, MI, USA
| | - Jason M Keil
- University of Michigan Medical School, Ann Arbor, MI, USA
| | - Stephen T Armenti
- Department of Ophthalmology and Visual Sciences, W.K. Kellogg Eye Center, University of Michigan, Ann Arbor, MI, USA
| | - Vaidehi S Dedania
- Department of Ophthalmology, NYU Grossman School of Medicine, New York, NY, USA
| | - David C Musch
- Department of Ophthalmology and Visual Sciences, W.K. Kellogg Eye Center, University of Michigan, Ann Arbor, MI, USA.,Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - David N Zacks
- Department of Ophthalmology and Visual Sciences, W.K. Kellogg Eye Center, University of Michigan, Ann Arbor, MI, USA
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Scanzera AC, Dunbar G, Shah V, Cortina MS, Leiderman YI, Shorter E. Visual Rehabilitation With Contact Lenses Following Open Globe Trauma. Eye Contact Lens 2021; 47:288-291. [PMID: 33181528 PMCID: PMC8272942 DOI: 10.1097/icl.0000000000000756] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To describe visual outcomes with various contact lens modalities in patients with a history of ocular trauma who underwent surgical open globe repair. METHODS Records of all patients with a history of open globe injury and repair at a tertiary care hospital between January 1, 2010, and December 31, 2016, were reviewed. Demographics, type of injury, and visual acuity were assessed before and after contact lens evaluation. RESULTS Of 214 patients who underwent open globe repair, 29 (13.6%) were evaluated with a contact lens. Visual acuity improved in 97% (28 of 29) of patients from 1.47±0.75 to 0.67±0.71 logarithm of the minimal angle of resolution (logMAR) with manifest refraction to 0.28±0.45 logMAR with contact lenses (n=29; P<0.0001). Corneal opacity was the most common clinical indication (20 of 29) for fitting followed by aphakia (13 of 29). A range of contact lens modalities, including corneal rigid gas-permeable (12 of 28), soft (9 of 28), hybrid (3 of 28), scleral gas-permeable (2 of 28), and piggyback (2 of 28) lenses were prescribed. CONCLUSION In this study, patients with a history of trauma and open globe repair with good neurosensory visual potential had improvements in visual acuity with contact lens greater than manifest refraction. Soft and gas-permeable lenses were used to improve visual acuity in patients with a history of open globe repair and corneal scarring, aphakia, iris abnormalities, or other ocular sequelae. Although corneal rigid gas-permeable lenses were prescribed most often, additional consideration should be given to other contact lens modalities, including soft, piggyback, hybrid, and scleral gas-permeable lenses.
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Affiliation(s)
- Angelica C Scanzera
- Department of Ophthalmology and Visual Sciences (A.C.S., G.D., V.S., M.S.C., Y.L., E.S.), Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, IL; Division of Epidemiology and Biostatistics (A.C.S.), School of Public Health, University of Illinois at Chicago, Chicago, IL; Currently Department of Ophthalmology and Visual Sciences (G.D.), University of Michigan, Ann Arbor, MI; and Dr. Gary Gold & Associates (V.S.), Sunnyvale, CA
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29
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Jung HC, Lee SY, Yoon CK, Park UC, Heo JW, Lee EK. Intraocular Foreign Body: Diagnostic Protocols and Treatment Strategies in Ocular Trauma Patients. J Clin Med 2021; 10:1861. [PMID: 33923011 DOI: 10.3390/jcm10091861] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 04/19/2021] [Accepted: 04/23/2021] [Indexed: 11/29/2022] Open
Abstract
Intraocular foreign bodies (IOFBs) are critical ophthalmic emergencies that require urgent diagnosis and treatment to prevent blindness or globe loss. This study aimed to examine the various clinical presentations of IOFBs, determine the prognostic factors for final visual outcomes, establish diagnostic protocols, and update treatment strategies for patients with IOFBs. We retrospectively reviewed patients with IOFBs between 2005 and 2019. The mean age of the patients was 46.7 years, and the most common mechanism of injury was hammering (32.7%). The most common location of IOFBs was the retina and choroid (57.7%), and the IOFBs were mainly metal (76.9%). Multivariate regression analysis showed that poor final visual outcomes (<20/200) were associated with posterior segment IOFBs (odds ratio (OR) = 11.556, p = 0.033) and retinal detachment (OR = 4.781, p = 0.034). Diagnosing a retained IOFB is essential for establishing the management of patients with ocular trauma. To identify IOFBs, ocular imaging modalities, including computed tomography or ultrasonography, should be considered. Different strategies should be employed during the surgical removal of IOFBs depending on the material, location, and size of the IOFB.
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30
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Liu X, Wang L, Yang F, Xie J, Zhao J, Liu Z, Su G, Yang L. Surgical management and outcomes of pediatric open globe injuries requiring vitrectomy. Eur J Ophthalmol 2021; 32:546-552. [PMID: 33706579 DOI: 10.1177/11206721211000648] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To describe surgical management and establish visual outcomes of open globe injury (OGI) in pediatric patients requiring vitrectomy. METHODS Forty-eight eyes of 48 pediatric patients underwent vitrectomy for OGI with secondary vitreoretinal complications in the eye center of Jilin University were included. Characteristics of patients, details of ocular examination and operation, presenting and final visual acuity were recorded. RESULTS Presenting visual acuity less than 20/400 was found in 44 eyes (91.7%), which included no light perception (NLP) in four eyes. At last visit, there was no eyes with visual acuity of NLP, and 19 eyes (39.6%) had a vision recovery to 20/400 or better. Mechanisms of injury, intraocular contents prolapse, presence of hyphema, intraocular foreign body, vitreous hemorrhage, retinal detachment, and total time from injury to PPV > 2 weeks were significant predictors of visual prognosis. Logistic regression analysis showed that hyphema was a significant predictive factor for poor visual outcome. CONCLUSION Visual acuity was improved in most of the patients with OGI in this study. Hyphema is an important presenting ocular sign in estimating the post-vitrectomy visual outcome for OGI in children. Proper timing of vitrectomy is suggested, and in this study patients may benefit more with early vitrectomy as less proliferative vitreoretinopathy (PVR) was found together with a better visual acuity.
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Affiliation(s)
- Xin Liu
- Eye Center, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Lufei Wang
- Eye Center, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Fengjuan Yang
- Eye Center, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Jia'nan Xie
- Eye Center, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Jinsong Zhao
- Eye Center, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Zaoxia Liu
- Eye Center, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Guanfang Su
- Eye Center, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Longfei Yang
- Jilin Provincial Key Laboratory on Molecular and Chemical Genetics, The Second Hospital of Jilin University, Changchun, Jilin, China
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Agrawal D, Parchand S, Agrawal D, Chatterjee S, Gangwe A, Mishra M, Sahu A. Impact of COVID-19 pandemic and national lockdown on ocular trauma at a tertiary eye care institute. Indian J Ophthalmol 2021; 69:709-713. [PMID: 33595506 PMCID: PMC7942066 DOI: 10.4103/ijo.ijo_3200_20] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [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: 12/13/2022] Open
Abstract
Purpose: To evaluate the impact of the COVID-19 pandemic and the national lockdown on the demographic and clinical profile of patients presenting with ocular trauma. Methods: In this retrospective, hospital-based, comparative analysis, patients presenting to the emergency department with ocular trauma in the following COVID-19 period (March 25, 2020 to July 31, 2020) were compared with patients in the pre-COVID-19 period (March 25, 2019 to July 31, 2019). Results: Overall, 242 patients (COVID-19 period: 71 and pre-COVID-19 period: 171) presented with ocular trauma. The mean age of the patients in COVID-19 and pre-COVID-19 periods were 26.7 ± 17.3 and 34.1 ± 20.3 years, respectively (P = 0.008). A majority of patients (68.6%) in both groups were from the rural background. Home-related injuries were common in the COVID-19 period (78.8%) as compared to pre-COVID-19 period (36.4%) (P < 0.0001). Iron particles (29.5%) were the common inflicting agents in the COVID-19 period while it was plant leaves (25.5%) in the pre-COVID-19 period. The most common ocular diagnosis was open globe injury (40.8%) in the COVID-19 period and microbial keratitis (47.9%) in the pre-COVID-19 period. Surgical intervention was required in 46.4% of patients in the COVID-19 period and 32.1% of patients in the pre-COVID-19 period (P = 0.034). Conclusion: During the COVID-19 period, there was a significant decline in the number of patients presenting with ocular trauma. In this period, a majority of patients sustained ocular trauma in home-settings. About half the patients required surgical intervention which was most commonly rendered in the form of primary wound repair.
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Affiliation(s)
- Deepanshu Agrawal
- Vitreoretina and Uvea Services, MGM Eye Institute, Raipur, Chhattisgarh, India
| | - Swapnil Parchand
- Vitreoretina and Uvea Services, MGM Eye Institute, Raipur, Chhattisgarh, India
| | | | | | - Anil Gangwe
- Vitreoretina and Uvea Services, MGM Eye Institute, Raipur, Chhattisgarh, India
| | - Mihir Mishra
- Orbit, Oculoplasty and Ocular Oncology Services, Raipur, Chhattisgarh, India
| | - Anupam Sahu
- Pediatric, Squint and Community Ophthalmology Services, MGM Eye Institute, Raipur, Chhattisgarh, India
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Mayer CS, Baur I, Storr J, Markard A, Khoramnia R. Surgical Management for Silicone Oil Barrier of Traumatic Aniridia with Aphakia: Suturing of Temporary Iris-Diaphragm Prior to Final Iris-Lens-Diaphragm Implantation. Clin Ophthalmol 2020; 14:4439-4450. [PMID: 33376298 PMCID: PMC7762446 DOI: 10.2147/opth.s284159] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 10/01/2020] [Accepted: 11/24/2020] [Indexed: 12/30/2022] Open
Abstract
Purpose Patients with traumatic aniridia, aphakia and retinal complications can require silicone oil endotamponade. In the absence of compartmentalization, there is a risk of silicone oil migrating to the anterior chamber which can cause long-term complications. We report a two-step procedure in trauma cases, using sutures for silicone oil retention in primary care and subsequently prior to secondary artificial iris (AI) and intraocular lens (IOL) implantation, to achieve a reconstruction of the anterior and posterior chamber. Material and Methods Seven patients with loss of the iris-lens-diaphragm after an ocular trauma and the need for silicone oil endotamponade underwent a primary intervention including wound closure, placement of silicone oil retention sutures and silicone oil filling. Four of those underwent secondary reconstruction with silicone oil removal and AI and IOL implantation and could be included in this retrospective observational study. All main outcome measures were evaluated after the first and after the second surgery. The main outcome measures were morphological findings, subjective impairment from glare, subjective cosmetic disfigurement, patient satisfaction and intraocular pressure (IOP) as well as best-corrected distance visual acuity and objective refraction. Results The retention sutures could effectively prevent silicone oil migration into the anterior chamber in the first surgery. Silicone oil emulsifications in the anterior chamber were observed in one patient. In two patients, pigment deposition at the sutures was seen. Subjective impairment from glare and subjective cosmetic disfigurement could be reduced after the second surgery compared to the evaluation after the first surgery. IOP and best-corrected distance visual acuity remained stable. No eye needed silicone oil refilling after the secondary reconstruction surgery. Conclusion Our two-step approach is viable and provides good functional and aesthetic results. We observed a high patient satisfaction.
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Affiliation(s)
- Christian S Mayer
- Department of Ophthalmology, University Hospital Heidelberg, University of Heidelberg, Heidelberg, Germany
| | - Isabella Baur
- Department of Ophthalmology, University Hospital Heidelberg, University of Heidelberg, Heidelberg, Germany
| | - Julia Storr
- Department of Ophthalmology, Technical University Munich, Munich, Germany
| | - Alexander Markard
- Department of Ophthalmology, University Hospital Heidelberg, University of Heidelberg, Heidelberg, Germany
| | - Ramin Khoramnia
- Department of Ophthalmology, University Hospital Heidelberg, University of Heidelberg, Heidelberg, Germany
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Silpa-Archa S, Dejkong A, Kumsiang K, Chotcomwongse P, Preble JM, Foster CS. Poor prognostic factors in post-traumatic endophthalmitis following open globe injury. Int J Ophthalmol 2020; 13:1968-1975. [PMID: 33344198 DOI: 10.18240/ijo.2020.12.19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 03/10/2020] [Accepted: 06/29/2020] [Indexed: 11/23/2022] Open
Abstract
AIM To demonstrate prognostic factors for poor visual outcome in patients with post-traumatic endophthalmitis (PTE) following open globe injury. METHODS A retrospective study was conducted on 66 patients (66 eyes) with PTE following open globe injury from 2005 to 2015. Potential factors accounting for good and poor visual outcome were statistically analyzed by Chi-square test and Logistic regression model. RESULTS In 66 cases, 39 cases (59%) had a poor visual outcome. Univariate and multivariate Logistic regression analysis identified retained intraocular foreign body (IOFB) as the only factor significantly associated with poor visual outcome [adjusted odds ratio, 4.62; 95% confidence interval (1.04-20.53); P=0.04]. The most common causative agents were gram-positive organisms (83%), of which Bacillus cereus (33%), was the most common pathogen. All cases received intravitreal antibiotic injections. Oral ciprofloxacin was the most used systemic antibiotic (33%). Pars plana vitrectomy was performed in 83% (55/66) of cases. At 6mo follow-up, mean BCVA was 1.74±0.72 logMAR units. CONCLUSION In patients with PTE following open globe injury, the only predictor of poor visual outcome is the presence of IOFB. Bacillus cereus is the most isolated microorganism.
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Affiliation(s)
- Sukhum Silpa-Archa
- Department of Ophthalmology, Faculty of Medicine, Rajavithi Hospital, Rangsit University, Bangkok 10400, Thailand
| | - Akkaranisorn Dejkong
- Department of Ophthalmology, Faculty of Medicine, Rajavithi Hospital, Rangsit University, Bangkok 10400, Thailand
| | - Kwanchanoke Kumsiang
- Department of Ophthalmology, Faculty of Medicine, Rajavithi Hospital, Rangsit University, Bangkok 10400, Thailand
| | - Peranut Chotcomwongse
- Department of Ophthalmology, Faculty of Medicine, Rajavithi Hospital, Rangsit University, Bangkok 10400, Thailand
| | - Janine M Preble
- Department of Ophthalmology Kresge Eye Institute, Wayne State University School of Medicine, Detroit, Michigan 48201, USA
| | - C Stephen Foster
- Massachusetts Eye Research and Surgery Institution, Waltham, Massachusetts 02451, USA.,Ocular Immunology & Uveitis Foundation, Waltham, Massachusetts 02451, USA.,Harvard Medical School, Boston, Massachusetts 02115, USA
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Abstract
Purpose To investigate characteristics of Open Globe Injuries (OGI) that presented with Intra-Ocular Foreign Body (IOFB), along with their long-term visual outcomes, complications and need for subsequent surgeries. Methods Retrospective interventional consecutive case series of OGIs with IOFBs that presented to the Eye Trauma service at the Massachusetts Eye and Ear from 2010 to 2015. Data collected included time from injury to OGI repair, location of injury and IOFB, retinal detachment (RD) rate, presenting and final visual acuity (VA) and subsequent surgeries. Results Fifty-seven consecutive cases of OGIs with IOFBs were included. The majority of patients were male (93%), mean age was 37 years and mean follow-up was 28 +/- 22 months. The median time from injury to OGI repair was 0 days (range: 0-16 days). Overall, 38/57 (66.7%) eyes achieved final vision of 20/40 or better and 43/57 (75.4%) vision of 20/150 or better. Zone I injuries were the most common (86%), followed by Zone II (16%), and Zone III (10%). 33 cases had IOFBs in the anterior segment only and 24 cases had posterior segment involvement. In total, 30% of cases (17/57) were complicated by an RD, 58.3% (14/24) in the posterior versus 9.1% (3/33) in the anterior IOFB group.( p<0.01). There were no cases of endophthalmitis. Posterior IOFB and higher zone of injury were found to be risk factors for RD both at presentation (all p<0.05) and post-primary repair.(all p<0.05) Posterior IOFB was associated with higher vitrectomy rates both at presentation (p<0.0001) and post-primary repair (p=0.002) and worse long-term visual outcome (p = 0.014). Conclusion OGIs with IOFB involving the posterior segment are associated with higher complication and re-operation rates and worse visual prognosis compared to those involving the anterior segment only.
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Affiliation(s)
| | - Yvonne Wang
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Seanna Grob
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts.,Orbit and Oculofacial Plastic Surgery, Department of Ophthalmology, University of California, San Francisco, San Francisco, CA
| | | | - Dean Eliott
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts.,Retina Service, Massachusetts Eye and Ear, Boston, MA
| | - Leo A Kim
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts.,Retina Service, Massachusetts Eye and Ear, Boston, MA
| | - Demetrios G Vavvas
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts.,Retina Service, Massachusetts Eye and Ear, Boston, MA
| | - John B Miller
- Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Boston MA.,Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts.,Retina Service, Massachusetts Eye and Ear, Boston, MA
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Xue C, Yang LC, Kong YC. Application of pediatric ocular trauma score in pediatric open globe injuries. Int J Ophthalmol 2020; 13:1097-1101. [PMID: 32685398 DOI: 10.18240/ijo.2020.07.13] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 09/17/2019] [Accepted: 11/08/2019] [Indexed: 11/23/2022] Open
Abstract
AIM To evaluate the predictive value of pediatric penetrating ocular trauma score (POTS) on the visual outcome in children with open globe injury. METHODS A retrospective study in 90 children (60 males and 30 females) aged 1-15y (average, 7.48±2.86y) with penetrating ocular trauma was performed. Each patient's POTS was calculated. The effects of POTS on final visual acuity (FVA) were examined. Correlation between factors affecting POTS and the FVA was established. RESULTS All patients presented with single-eye trauma. The follow-up time was 3-21mo (average, 10.23±3.54mo). Among the 90 cases of penetrating wounds, 71 eyes (78.89%) were injured in Zone I (wound involvement limited to the cornea, including the corneoscleral limbus), 17 eyes (18.89%) were injured in Zone II (wound involving the sclera and no more posterior than 5 mm from the corneoscleral limbus), and 2 eyes (2.22%) were injured in Zone III (wound involvement posterior to the anterior 5 mm of the sclera). Analysis of POTS and FVA showed important correlation between them (r=0.414, P=0.000). Initial visual acuity (P=0.00), age (P=0.02), injury location (P=0.002), traumatic cataract (P=0.00), vitreous hemorrhage (P=0.027), retinal detachment (P=0.003), and endophthalmitis (P=0.03) were found to be statistically significant factors for the FVA outcome. CONCLUSION Ocular trauma presents serious consequences and poor prognosis in children. The POTS may be a reliable prognostic tool in children with open globe injury.
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Affiliation(s)
- Chao Xue
- Tianjin Eye Hospital, Tianjin Key Laboratory of Ophthalmology and Visual Science, Tianjin Eye Institute; Clinical College of Ophthalmology, Tianjin Medical University, Tianjin 300020, China
| | - Li-Chun Yang
- Tianjin Eye Hospital, Tianjin Key Laboratory of Ophthalmology and Visual Science, Tianjin Eye Institute; Clinical College of Ophthalmology, Tianjin Medical University, Tianjin 300020, China
| | - Yi-Chun Kong
- Tianjin Eye Hospital, Tianjin Key Laboratory of Ophthalmology and Visual Science, Tianjin Eye Institute; Clinical College of Ophthalmology, Tianjin Medical University, Tianjin 300020, China.,Tianjin NanKai Hospital, Tianjin Medical University NanKai Hospital, Nankai University Affiliated Nankai Hospital, Tianjin 300100, China
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Abstract
PURPOSE Orbital trauma, particularly with open globe injury, can have a wide range of visual outcomes, which can be difficult to predict at presentation. Clinical features on presentation may provide insight into visual prognosis. We hypothesized that patients with open globe injuries and concomitant orbital fractures have poorer visual outcomes than patients without orbital fractures. METHODS We reviewed the charts of 77 patients with isolated open globe injuries (OG) and 76 patients with open globe injuries and concomitant orbital fractures (OGOF). Multivariate regression analysis was performed to assess the relative influence of individual presenting historical and clinical features on visual outcome. RESULTS OGOF patients were more likely to have sustained blunt trauma than a sharp, penetrating injury compared to OG patients. Ocular wound locations were more posterior and likely to involve multiple zones in OGOF compared to OG patients. Among OGOF patients, orbital floor fractures were the most common and roof fractures were the least common, but the latter was associated with presenting NLP vision and multiple zone involvement. The presence of an orbital fracture independently increased the odds of subsequent evisceration/enucleation (OR: 4.6, 95% CI 1.3-20.1, p = .0246) and NLP vision (OR: 6.81, 95% CI 2.42-21.85, p = .0005) when controlling for zone, mechanism of injury, uveal prolapse and demographic variables. CONCLUSIONS The presence of an orbital fracture independently confers a worse visual and ocular prognosis in patients with open globe injuries. Patients with open globe injuries in this category should be appropriately counseled.
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Affiliation(s)
- Eric D Gaier
- Department of Ophthalmology, Boston Children's Hospital , Boston, MA, USA.,Picower Institute for Learning and Memory, Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology , Cambridge, MA, USA.,Department of Surgery, Medical University of South Carolina , Charleston, SC, USA.,Foundation Medicine , Cambridge, MA, USA
| | - Sami Tarabishy
- Department of Surgery, Medical University of South Carolina , Charleston, SC, USA
| | | | - Natalie Wolkow
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary , Boston, MA, USA.,Harvard Medical School , Boston, MA, USA
| | - Matthew Gardiner
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary , Boston, MA, USA.,Harvard Medical School , Boston, MA, USA
| | - Daniel R Lefebvre
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary , Boston, MA, USA.,Harvard Medical School , Boston, MA, USA
| | - Seanna Grob
- Department of Ophthalmology, University of California , San Francisco, CA, USA
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McKay BR, Martin JA. Combined branch retinal artery and branch retinal vein occlusion from a globe penetrating nail gun injury. GMS Ophthalmol Cases 2019; 9:Doc24. [PMID: 31355122 PMCID: PMC6637433 DOI: 10.3205/oc000113] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background: Nail gun injuries represent a significant proportion of work-related ocular trauma. Here we report a rare case of a combined branch retinal arterial occlusion (BRAO) and branch retinal venous occlusion (BRVO) from a nail gun injury in a patient who was wearing eye protection. Case description: A 23-year-old male presented with a left globe penetrating injury from a pneumatic nail gun. The nail ricochet bypassed the patient’s protective eyewear, penetrating the left globe causing multiple retinal tears and a combined BRAO and BRVO in the inferior temporal vascular arcade. The patient underwent prompt surgical repair obtaining an excellent anatomic outcome. However, the visual outcome was 20/200 OS at one and two years post injury primarily due to extensive ischemic damage of the retina. Conclusion: This case is the first to describe a combined BRAO and BRVO from a globe penetrating injury. What makes this case even rarer is that the patient was wearing eye protection at the time of the injury. Despite appropriate emergency management, rapid referral for ophthalmologist assessment, and timely surgical management of this patient, the visual outcome was poor. The vascular injury ultimately compromised a significant segment of the retina, including the macula.
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Affiliation(s)
- Bryon R McKay
- Department of Ophthalmology and Vision Sciences, The University of Toronto, Toronto, Ontario, Canada
| | - James A Martin
- Department of Eye Medicine & Surgery, McMaster University & St. Joseph's Healthcare, Hamilton, Ontario, Canada
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Abstract
Purpose: To report the incidence, modes of injury, treatment, and short-term outcomes in eyes with post-traumatic elevated intraocular pressure (IOP). Methods: This was a 5-year hospital-based retrospective study of children ≤16 years who presented with open (OGI) or closed globe injury (CGI) and developed elevated IOP >21 mmHg. Those with a minimum follow up of 3 months were included. Analysis of various parameters such as influence of demographics, mode of injury, IOP, best-corrected visual acuity (BCVA), and effect of medical and surgical treatment on IOP and BCVA was done. Results: Out of 205 pediatric eyes with ocular trauma, 121 (59%) had CGI and the remaining 84 (41%) had OGI. Thirty-two eyes (15.6%) developed elevated IOP. The incidence of elevated IOP following CGI [25 eyes (20.6%)] was significantly higher than that following OGI [7 eyes (8.3%, P = 0.02)]. Hyphema (37.5%) and lens-related mechanisms (18.75%) were the most common causes of elevated IOP. The mean IOP at the time of diagnosis was 29.8 + 6.3 mmHg and reduced to 16.2 ± 2.2 mmHg at last follow up (P < 0.001). Surgical management was required in 12 eyes (37%) and significantly more eyes with CGI required trabeculectomy (24% in CGI vs. 0% in OGI, P = 0.03). Poor baseline vision and vitreoretinal involvement [0.67 line decrement, 95% confidence interval (CI) =0.1–1.25 lines, P = 0.025] increased risk of poor visual outcome. Conclusion: Post-traumatic IOP elevation occurred in 15% pediatric eyes, was more common with CGI compared to OGI and nearly one-fourth of eyes with CGI required glaucoma filtering surgery for IOP control. Overall, medical management was needed in 63% eyes and 37% required surgical management. Visual acuity was poor in eyes with OGI due to posterior segment involvement.
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Affiliation(s)
- Charudutt Kalamkar
- Glaucoma Unit, Shri Ganesh Vinayak Eye Hospital, Raipur, Chhattisgarh, India
| | - Amrita Mukherjee
- Glaucoma Unit, Shri Ganesh Vinayak Eye Hospital, Raipur, Chhattisgarh, India
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Sahraravand A, Haavisto AK, Holopainen JM, Leivo T. Ocular traumas in working age adults in Finland - Helsinki Ocular Trauma Study. Acta Ophthalmol 2017; 95:288-294. [PMID: 27935236 DOI: 10.1111/aos.13313] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [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: 05/12/2016] [Accepted: 10/02/2016] [Indexed: 12/01/2022]
Abstract
PURPOSE To describe epidemiology, causes, treatments and outcomes of ocular injuries in adults aged 17 to 60 in southern Finland. METHODS All new ocular trauma patients admitted to the Helsinki University Eye Hospital (HUEH), during 1 year in 2011-2012. The data were from hospital records and prospectively from patient questionnaires. The follow-up time was 3 months. RESULTS The incidence for ocular injury was 88/100 000/year. From 831 trauma patients, 80% were men, 34% were work-related injuries, and 11% were assaults. Most of the injuries were minor traumas (54%). Contusions (22.5%) and chemical injuries and burns (13%) were common. Fractures (5%), lid wounds (3%), open globe injuries (OGI, 2%) and optic nerve injuries (0.5%) were rare. The main causes of ocular injury were superficial foreign bodies (33%), chemicals (13%), body parts (13%) and sports equipment (10%). The most dangerous objects were needles, stones, pellet guns, tools and guns. No patient with OGI used protective eyewear. All OGI and most of contusions needed a lifelong follow-up. Permanent impairment (73 patients, 9%) was caused most often by body parts, sports equipment and work tools. CONCLUSION A typical ocular trauma patient was a man aged 31-45 with a minor trauma caused by a foreign body at work and a final visual acuity of 20/20. Most common serious injuries were contusion, OGI or fracture at home or at work and were caused by a body part, sport equipment or work tool. Factors causing common and serious eye injuries provide the targets for protective measures.
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Affiliation(s)
- Ahmad Sahraravand
- Ophthalmology; University of Helsinki and Helsinki University Hospital; Helsinki Finland
| | - Anna-Kaisa Haavisto
- Ophthalmology; University of Helsinki and Helsinki University Hospital; Helsinki Finland
| | - Juha M. Holopainen
- Ophthalmology; University of Helsinki and Helsinki University Hospital; Helsinki Finland
| | - Tiina Leivo
- Ophthalmology; University of Helsinki and Helsinki University Hospital; Helsinki Finland
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Kıvanç SA, Akova Budak B, Skrijelj E, Tok Çevik M. Demographic Characteristics and Clinical Outcome of Work-related Open Globe Injuries in the Most Industrialised Region of Turkey. Turk J Ophthalmol 2017; 47:18-23. [PMID: 28182158 PMCID: PMC5282536 DOI: 10.4274/tjo.81598] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 05/02/2016] [Indexed: 12/01/2022] Open
Abstract
Objectives: To evaluate demographic characteristics and clinical outcomes of work-related open globe injuries in the most industrialized region of Turkey. Materials and Methods: The demographic and medical records of patients with work-related open globe injuries who presented to the ophthalmology or emergency departments with an official occupational accident report were retrospectively reviewed. Visual acuity categories were defined according to the World Health Organization. The injury types and zones of the open globes were classified according to Birmingham Eye Trauma Terminology System. Results: Among 479 patients with work-related eye injuries in 5 years, there were 102 eyes of 101 patients with open globe injuries (21%). The mean age of the patients was 34.5±8.9 years with a mean follow-up of 12.5±12.6 months. The injuries peaked in June in the hour between 12:00 and 13:00. Eighty-six percent presented to emergency services within 12 hours after the injury. Twenty-two percent of the patients had been wearing protective eyewear at the time of injury. The open globe injuries were penetrating in 51%, intraocular foreign body in 40%, rupture in 7% and perforation in 2% of the eyes. The most frequent finding was traumatic cataract. Final visual acuity of 33.3% of patients was below 3/60. Seventy-eight percent of patients that had visual acuity worse than 6/18 at presentation had visual acuity of 6/18 or better at final visit. Sixty-three percent of eyes which had injuries involving all 3 zones resulted in phthisis bulbi, enucleation or evisceration. Conclusion: Work-related open globe injuries may have severe consequences such as visual impairment and blindness among the young male working population in industrialized areas. Nearly half of the occupational open globe injuries resulted in visual impairment and blindness.
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Affiliation(s)
- Sertaç Argun Kıvanç
- Uludağ University Faculty of Medicine, Department of Ophthalmology, Bursa, Turkey
| | - Berna Akova Budak
- Uludağ University Faculty of Medicine, Department of Ophthalmology, Bursa, Turkey
| | - Emina Skrijelj
- Uludağ University Faculty of Medicine, Department of Ophthalmology, Bursa, Turkey
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Tan G, Huang X, Ye L, Wu AH, He LX, Zhong YL, Jiang N, Zhou FQ, Shao Y. Altered spontaneous brain activity patterns in patients with unilateral acute open globe injury using amplitude of low-frequency fluctuation: a functional magnetic resonance imaging study. Neuropsychiatr Dis Treat 2016; 12:2015-20. [PMID: 27570455 PMCID: PMC4986910 DOI: 10.2147/ndt.s110539] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE The aim of this study was to evaluate altered spontaneous brain activities in patients with unilateral acute open globe injury (OGI) using amplitude of low-frequency fluctuation (ALFF) method and its relationship with their clinical manifestations. PATIENTS AND METHODS A total of 18 patients with acute OGI (16 males and two females) and 18 healthy controls (HCs, 16 males and two females) closely matched in age, sex, and education were recruited in this study. The ALFF method was used to evaluate the altered spontaneous brain activities. The relationships between the mean ALFF signal values of different brain regions and the clinical features were evaluated by correlation analysis. Acute OGI patients were distinguished from HCs by receiver operating characteristic curve. RESULTS Compared with HCs, acute OGI patients had significantly higher ALFF values in the left cuneus, left middle cingulum cortex, and bilateral precuneus. Furthermore, the age of OGI patients showed a negative correlation with the ALFF signal value of the left middle cingulum cortex (r=-0.557, P=0.016) and a negative correlation with the mean ALFF signal value of the bilateral precuneus (r=-0.746, P<0.001). The ALFF signal value of the bilateral precuneus was negatively correlated with the duration of OGI (r=-0.493, P=0.038) and positively correlated with the vision acuity of the injured eye (r=0.583, P=0.011). CONCLUSION Acute OGI mainly induces dysfunction in the left cuneus, left middle cingulum cortex, and bilateral precuneus, which may reflect the underlying pathologic mechanisms of abnormal brain activities in OGI patients.
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Affiliation(s)
- Gang Tan
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi; Department of Ophthalmology, The First Affiliated Hospital of University of South China, Hengyang, Hunan
| | - Xin Huang
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi; Department of Ophthalmology, The First People's Hospital of Jiujiang City, Jiujiang
| | - Lei Ye
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi
| | - An-Hua Wu
- Department of Ophthalmology, The First Affiliated Hospital of University of South China, Hengyang, Hunan
| | - Li-Xian He
- Department of Ophthalmology, The First Affiliated Hospital of University of South China, Hengyang, Hunan
| | - Yu-Lin Zhong
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi
| | - Nan Jiang
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi
| | - Fu-Qing Zhou
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Jiangxi Province Medical Imaging Research Institute, Nanchang, Jiangxi, People's Republic of China
| | - Yi Shao
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi
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Abstract
Background The purpose of this study was to analyze eyes presenting with no light perception (NLP) after open globe injury (OGI) to determine visual outcomes and prognostic indicators for visual recovery. Methods The records of consecutive patients with at least 6 months of follow-up presenting with OGI and NLP to a single institution between January 1, 2003 and December 31, 2013 were reviewed for demographics, ophthalmic history, context and characteristics of injury, ocular examination findings, surgical interventions, and follow-up visual acuity. Unpaired t-tests and Fisher’s Exact tests were used for statistical analysis. Results Twenty-five patients met our inclusion criteria. The mean age was 50.4±25.5 (range 8–91) years. Four patients (16%) regained vision (hand motion in three patients and light perception in one patient) while 21 patients (84%) remained with NLP or had a prosthesis at final follow-up. Fourteen eyes (56%) were enucleated; nine (36%) were secondary enucleations. Although the sample sizes were small, neither ocular trauma score nor wound size was found to predict visual recovery. Conclusion Four patients regained some vision after presenting with NLP due to OGI. These findings suggest that, in select cases, physicians should discuss the possibility of regaining some vision.
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Affiliation(s)
- Yong S Han
- Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, CT, USA
| | - Shaheen C Kavoussi
- Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, CT, USA
| | - Ron A Adelman
- Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, CT, USA
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Abstract
We report an unusual case of choroidal neovascularization secondary to intraocular foreign body (IOFB) penetrating trauma. A 44-year-old man was referred to our department for IOFB trauma in the right eye. Vitrectomy and IOFB extraction was performed with good visual results. However, 2 months after surgery, he returned complaining of a drop in visual acuity. Choroidal neovascularization originating from a direct choroidal rupture at the IOFB impact site was observed. The patient was treated with 6-monthly intravitreal injections of antivascular endothelial growth factor, and showed regression of neovascularization and a final visual acuity of 20/80. IOFB trauma is a serious condition, indeed in spite of initially good results after a favorable surgical outcome. Choroidal neovascularization after direct traumatic choroidal rupture is usually aggressive and requires more active antivascular endothelial growth factor therapy.
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Affiliation(s)
| | | | | | | | - Amparo Navea
- Department of Vitreoretinal Diseases, FISABIO Oftalmología Médica, Valencia, Spain
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Skopiński P, Woronkowicz M, Langwińska-Wośko E, Korwin M, Kołodziejczyk W, Ambroziak AM. Multi-procedure management in an eyeglasses-related open globe injury. Wideochir Inne Tech Maloinwazyjne 2014; 9:101-6. [PMID: 24729818 DOI: 10.5114/wiitm.2013.40104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2013] [Revised: 05/29/2013] [Accepted: 06/15/2013] [Indexed: 11/23/2022] Open
Abstract
We present a case of successful multi-procedure management of a patient with an open globe injury. A 47-year-old man sustained an injury to his left eye caused by glass fragments of his own spectacles shattered while he was protecting an unknown woman from physical assault at a bus stop. Over a span of 65 months the patient underwent multiple procedures including primary wound repair, penetrating keratoplasty combined with extracapsular cataract extraction, neodymium: YAG laser capsulotomy, and laser-assisted subepithelial keratectomy (LASEK), and had a successfully treated episode of corneal graft rejection. This sequence of treatment substantially improved his left eye vision from hand movements at the time of admission to 0.9–0.5 × 90 at the last follow-up nearly 10 years after the trauma. Proper initial surgical management of an open globe injury can create the possibility for virtually complete vision restoration.
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Abstract
BACKGROUND Ocular trauma is a major cause of visual impairment and morbidity worldwide. AIMS To identify the various type of ocular injury in a rural area, determine the presence of any associated visual damage and assess the final visual outcome after treatment. METHOD Hospital-based, prospective study conducted over a period of two years. A total of 60 patients of ocular trauma were included. RESULTS Ocular injuries were more commonly seen in adult (55 per cent) patients who were associated with agricultural work (43.33 per cent). They were more common in male patients (71.67 per cent). Closed globe injury (68.33 per cent) was more common than open globe injury (31.67 per cent). Both in open and closed globe injuries, the commonest object causing injury was a wooden stick. Just 26.7 per cent of the patients had a visual acuity better than 6/60 at presentation; while after completed treatment at two months follow-up, 68.3 per cent had best corrected visual acuity better than 6/60. CONCLUSION Agricultural trauma is an important cause of monocular blindness in rural India. The visual outcome depends upon the site and size of the injury and the extent of the ocular damage.
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Affiliation(s)
- Somen Misra
- Department of Ophthalmology, Pravara Institute of Medical Sciences, Loni, Ahmednagar, Maharashtra, India
| | - Rupali Nandwani
- Department of Ophthalmology, Pravara Institute of Medical Sciences, Loni, Ahmednagar, Maharashtra, India
| | - Pratik Gogri
- Department of Ophthalmology, Pravara Institute of Medical Sciences, Loni, Ahmednagar, Maharashtra, India
| | - Neeta Misra
- Department of Ophthalmology, Pravara Institute of Medical Sciences, Loni, Ahmednagar, Maharashtra, India
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Ilhan HD, Bilgin AB, Cetinkaya A, Unal M, Yucel I. Epidemiological and clinical features of paediatric open globe injuries in southwestern Turkey. Int J Ophthalmol 2013; 6:855-60. [PMID: 24392337 DOI: 10.3980/j.issn.2222-3959.2013.06.20] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Accepted: 08/28/2013] [Indexed: 01/31/2023] Open
Abstract
AIM To evaluate the epidemiologic, anatomic, and clinical features of open globe injuries in children. METHODS The medical files of patients under the age of 16 who had been operated for an open globe injury at Akdeniz University Hospital's Department of Ophthalmology were retrospectively evaluated. RESULTS A total of 90 patients were evaluated in this study. Among these patients, 26 (28.9%) were female and 64 (71.1%) were male. The mean age of the patients was 7.7±4.2 years. The male/female ratio was observed to increase with increasing age (P=0.006, r=7.48). Injuries were most likely to occur in spring and autumn (P=0.028). The time interval between the injury and the surgical repair was 9.36±27.4h. Forty (44.4%) of the injuries occurred in the home, 27 (30%) occurred in the yard, and 21 (23.3%) happened while playing in the street. The most common causes of injury were sharp metal objects (P<0.001). Injury to the cornea occurred in 47 (52.2%) of the patients (P<0.001). The most common complication to occur was cataract formation. Additional operations were necessary for 37 (41.1%) of the patients. The final visual acuity was correlated with both the initial visual acuity of the wounded eye prior to surgery and the length of the wound (P<0.001, r=0.502 and P<0.001, r=-0.442, respectively). CONCLUSION Open globe injuries that are suffered in childhood generally occur either at home, in the yard, or on the street, with sharp metal objects being the most common cause of injury. The initial visual acuity and the length of the wound are the most important determinants of the final visual acuity.
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Affiliation(s)
| | | | - Aslı Cetinkaya
- Department of Ophthalmology, Akdeniz University, Antalya 07059, Turkey
| | - Mustafa Unal
- Department of Ophthalmology, Akdeniz University, Antalya 07059, Turkey
| | - Iclal Yucel
- Department of Ophthalmology, Akdeniz University, Antalya 07059, Turkey
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Wang R, Wang XL, Wang Y, Chen SJ, Huang XY, Wu N, Ying X. Endotamponades in pars plana vitrectomy for metallic intraocular foreign body associated with endophthalmitis. Int J Ophthalmol 2011; 4:95-9. [PMID: 22553619 DOI: 10.3980/j.issn.2222-3959.2011.01.22] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2010] [Accepted: 01/18/2011] [Indexed: 11/02/2022] Open
Abstract
AIM To study the criterion-reference of endotamponades in pars plana vitrectomy for metallic intraocular foreign body (MIOFD) associated with endophthalmitis. METHODS Thirty-six patients of MIOFD with endophthalmitis accorded with exclusion and inclusion criteria were retrospectively analyzed. A detailed analysis of the patients' natural factors, preoperative examinations, intraoperative endotamponades choice, postoperative complications and therapeutic effects was performed. RESULTS BSS was used in 4 eyes without obvious retinal damage. There was no postoperative complication and the visual acuity (VA) was improved. Sixteen eyes that had mild retinal damage filled with C3F8 gas. The postoperative VA improved in 10 eyes (62.5%), 4 eyes (25.0%) remained unchanged and 2 eyes (12.5%) decreased. Only 2 cases occurred postoperative retinal detachment in gas group. Another 16 eyes with serious retinal damage were treated with silicone oil. Postoperative VA of 9 eyes (56.3%) improved, 3 eyes (18.8%) remained unchanged and 4 eyes (25.0%) decreased. The silicone oil group had higher incidence of postoperative complications, but the incidence of secondary treatment had no significant different between silicone oil and gas group. CONCLUSION An appropriate choice of endotamponades in vitrectomy surgery for MIOFB with endophthalmitis is important for prognosis.
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Affiliation(s)
- Rui Wang
- Department of Ophthalmology, the Affiliated Southwest Hospital of Third Military Medical University, Chongqing 400038, China
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