1
|
Wan C, Mao Y, Xi W, Zhang Z, Wang J, Yang W. DBPF-net: dual-branch structural feature extraction reinforcement network for ocular surface disease image classification. Front Med (Lausanne) 2024; 10:1309097. [PMID: 38239621 PMCID: PMC10794599 DOI: 10.3389/fmed.2023.1309097] [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] [Received: 10/07/2023] [Accepted: 12/11/2023] [Indexed: 01/22/2024] Open
Abstract
Pterygium and subconjunctival hemorrhage are two common types of ocular surface diseases that can cause distress and anxiety in patients. In this study, 2855 ocular surface images were collected in four categories: normal ocular surface, subconjunctival hemorrhage, pterygium to be observed, and pterygium requiring surgery. We propose a diagnostic classification model for ocular surface diseases, dual-branch network reinforced by PFM block (DBPF-Net), which adopts the conformer model with two-branch architectural properties as the backbone of a four-way classification model for ocular surface diseases. In addition, we propose a block composed of a patch merging layer and a FReLU layer (PFM block) for extracting spatial structure features to further strengthen the feature extraction capability of the model. In practice, only the ocular surface images need to be input into the model to discriminate automatically between the disease categories. We also trained the VGG16, ResNet50, EfficientNetB7, and Conformer models, and evaluated and analyzed the results of all models on the test set. The main evaluation indicators were sensitivity, specificity, F1-score, area under the receiver operating characteristics curve (AUC), kappa coefficient, and accuracy. The accuracy and kappa coefficient of the proposed diagnostic model in several experiments were averaged at 0.9789 and 0.9681, respectively. The sensitivity, specificity, F1-score, and AUC were, respectively, 0.9723, 0.9836, 0.9688, and 0.9869 for diagnosing pterygium to be observed, and, respectively, 0.9210, 0.9905, 0.9292, and 0.9776 for diagnosing pterygium requiring surgery. The proposed method has high clinical reference value for recognizing these four types of ocular surface images.
Collapse
Affiliation(s)
- Cheng Wan
- College of Electronic Information Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, China
| | - Yulong Mao
- College of Electronic Information Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, China
| | - Wenqun Xi
- Shenzhen Eye Institute, Shenzhen Eye Hospital, Jinan University, Shenzhen, China
| | - Zhe Zhang
- Shenzhen Eye Institute, Shenzhen Eye Hospital, Jinan University, Shenzhen, China
| | - Jiantao Wang
- Shenzhen Eye Institute, Shenzhen Eye Hospital, Jinan University, Shenzhen, China
| | - Weihua Yang
- Shenzhen Eye Institute, Shenzhen Eye Hospital, Jinan University, Shenzhen, China
| |
Collapse
|
2
|
Redzuwan NS, Ahmad Tarmizi NA, Mohd Khialdin S. From Simple to Sinister: Kaposi Sarcoma Masquerading as a Subconjunctival Hemorrhage. Cureus 2023; 15:e45296. [PMID: 37846262 PMCID: PMC10576943 DOI: 10.7759/cureus.45296] [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: 09/14/2023] [Indexed: 10/18/2023] Open
Abstract
A young male in his early 30s presented with spontaneous left eye redness for three months associated with blood-stained eye discharge. There was no history of trauma, blood dyscrasias, or anticoagulant intake. On examination, visual acuity was normal in both eyes. An anterior segment examination of the left eye showed subconjunctival hemorrhage with a fleshy bright red conjunctival mass hidden in the inferotemporal fornix. Other parts of the ocular examination including the contralateral eye were unremarkable. Upon further inquiry, the patient revealed a history of a retroviral disease diagnosed eight years ago but had not pursued treatment. Systemic examination revealed a raised non-pigmented lesion of the tongue and a painless purplish plaque at the back. Investigations showed a high viral ribonucleic acid (RNA) load and confirmed the Kaposi sarcoma of the conjunctiva, tongue, and skin; cryptococcal meningitis; smear-negative pulmonary tuberculosis; and late latent syphilis. He was comanaged by multidisciplinary teams. Highly active antiretroviral therapy (HAART) was commenced. Treatment was a challenge considering the simultaneous presence of malignancy and a serious fungal infection of the brain in an immunosuppressed patient. Fortunately, three months post treatment, he showed remarkable improvement as there was almost a complete resolution of conjunctival Kaposi sarcoma. This case revealed an unusual presentation of Kaposi sarcoma affecting the conjunctiva, which could have been mistaken for simple subconjunctival hemorrhage in a young patient without informed comorbidity.
Collapse
|
3
|
Singh A, Rana J, Sharma A, Nagarajan S. Observing the factors affecting fibrovascular regrowth after pterygium excision and comparing the efficacy and complications of conjunctival autograft with sutures versus fibrin glue. Rom J Ophthalmol 2023; 67:289-297. [PMID: 37876514 PMCID: PMC10591428 DOI: 10.22336/rjo.2023.47] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2023] [Indexed: 10/26/2023] Open
Abstract
Aim: To observe the factors affecting fibrovascular regrowth after pterygium excision and to compare the efficacy and complications of conjunctival autograft with sutures versus fibrin glue. Materials and methods: 65 consenting patients with primary pterygium attending the outpatient department having appropriate indications for surgery were enrolled. Data was collected using personal interviews. Routine pre-operative ophthalmic examination was done, including visual acuity assessment, slit lamp examination, and fundus evaluation. Pterygium excision surgery was done on all patients using either Fibrin Glue or 10-0 nylon sutures. Patients were followed up at weeks 1, 4, 12, and 24 and any complications were duly noted. Results: The fibrin glue group showed milder postoperative discomfort, symptoms, and signs compared to the suture group. Pyogenic granuloma (3.12%), corkscrew vessels (6.25%), and subconjunctival hemorrhage (24.99%) were more common in the fibrin glue group. FVG not crossing the limbus was observed in 6.25% of glue cases and 9.09% of suture cases, more in fleshy and large pterygia, while age and gender did not alter the incidence of FVG. No recurrences were observed in any group. Conclusion: The incidence of fibrovascular regrowth (FVG) was not affected by age, gender, smoking, and surgical technique, but was positively correlated with length and grade of pterygium. The complication rate between the two groups was not found to be statistically significant. Despite causing severe postoperative discomfort and requiring prolonged surgical time, suture-assisted pterygium surgery is a cost-effective method still being used with long-term outcomes similar to fibrin glue.
Collapse
Affiliation(s)
- Arti Singh
- Department of Ophthalmology, Moti Lal Nehru Medical College, Prayagraj, India
| | - Jagriti Rana
- Department of Ophthalmology, Moti Lal Nehru Medical College, Prayagraj, India
| | - Anirrud Sharma
- Department of Ophthalmology, Moti Lal Nehru Medical College, Prayagraj, India
| | - Srishti Nagarajan
- Department of Ophthalmology, Moti Lal Nehru Medical College, Prayagraj, India
| |
Collapse
|
4
|
Kumar S, Beketova T, Rosenbaum PS, Amin A. A Rare Case of Vomiting-Induced Retrobulbar Hemorrhage. Cureus 2023; 15:e34839. [PMID: 36919065 PMCID: PMC10008326 DOI: 10.7759/cureus.34839] [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] [Accepted: 02/06/2023] [Indexed: 02/12/2023] Open
Abstract
Retrobulbar hemorrhage may result in sudden accumulation of blood in the retrobulbar space which can lead to an orbital compartment syndrome. This potentially blinding condition is characterized by a rapid increase in intra-orbital pressure. While most commonly associated with orbital trauma, it may rarely occur with Valsalva events in patients on anticoagulants. In this report, we present a case of a retrobulbar hemorrhage secondary to self-induced vomiting, occurring in a patient on no anticoagulation medication.
Collapse
Affiliation(s)
| | - Tatyana Beketova
- Department of Ophthalmology, Westchester Medical Center/New York Medical College, Valhalla, USA
| | - Pearl S Rosenbaum
- Department of Ophthalmology/Ophthalmic Pathology and Oncology, Westchester Medical Center/New York Medical College, Valhalla, USA
| | - Abha Amin
- Department of Ophthalmology/Cornea, Refractive Surgery and Glaucoma, Westchester Medical Center/New York Medical College, Valhalla, USA
| |
Collapse
|
5
|
Karademir Z, Semerci SY, Ozdemir FE, Bayramoglu SE. Subconjunctival hemorrhage in the newborn: Experience of a tertiary care hospital. North Clin Istanb 2023; 10:74-8. [PMID: 36910442 DOI: 10.14744/nci.2021.19971] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 07/08/2021] [Accepted: 08/02/2021] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE The aim of this study is to determine the incidence and characteristics of newborns with subconjunctival hemorrhage (SCH). METHODS In our study, patient files of term infants referred to the study hospital's ophthalmology clinic in 2018-19 were analyzed. Demographic data of infants including gestational week, birth weight, gender, and head circumference were all recorded. The frequency of SCH detection was evaluated depending on delivery type. Demographic data of infants with and without retinal hemorrhage (RH) were compared. RESULTS A total of 172 eyes of 86 infants were included in study. Forty-two (48.8%) of 86 neonates were male, and 44 (51.2%) were female. Mean gestational week was 38.62±1.1. SCH was detected in 31.4% (27) in the right eye, 36% (31) in the left eye, and 32.6% (28) in both eyes. The diagnosis was made at the mean of 3.74 days (range 1-20). Mean birth weight was found as 3621.1±453.3 g, head circumference as 35.4±1.3 cm, height as 50.7±2 cm, and chest circumference as 33.6±1.4 cm. Mean Apgar score in 1st min was 7.1±0.4; 5th min was 9. About 11.6% (10) of the mothers were nulliparous, and 88.4% (76) were multiparous. It was found that 79 of the deliveries were vaginal and seven with cesarean section. RH was not detected in any of the infants born with cesarean section. CONCLUSION SCH and RH were more common in infants born vaginally. If SCH is detected, a fundus examination should be performed to not miss possible RH.
Collapse
|
6
|
Sen S, Nayak B, Parija S. Bilateral optic disc edema with subconjunctival hemorrhage: Attributed to scrub typhus? Oman J Ophthalmol 2022; 15:99-101. [PMID: 35388247 PMCID: PMC8979387 DOI: 10.4103/ojo.ojo_262_2019] [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: 01/09/2020] [Revised: 05/17/2021] [Accepted: 05/21/2021] [Indexed: 11/25/2022] Open
Abstract
A 15-year-old female patient presented with complaints of headache, blurring of vision, and redness of both eyes for 15 days and fever for 20 days. Her best-corrected visual acuity (BCVA) was 20/40 in both eyes. Anterior segment examination was normal except for subconjunctival haemorrhage in both eyes. Examination of the posterior segment showed disc oedema in both eyes. Her blood investigations revealed platelet count to be 1.5 lakhs per cubic mm, and leucocyte count to be10,700 per cubic mm. CSF culture showed seven cells per microlitre,76% lymphocytes and CSF samples negative for gram stain, acid-fast bacilli, and culture. Further investigation for IgM titre for scrub typhus was positive. She was treated with oral doxycycline. On follow up after three weeks, both the subconjunctival haemorrhage and bilateral disc oedema resolved with BCVA of 20/20 in both eyes. She was kept on follow up and has not presented with any fresh complaints until six months after the initial presentation."
Collapse
Affiliation(s)
- Saswati Sen
- Department of Ophthalmology, AIIMS, Bhubaneswar, Odisha, India,Address for correspondence: Dr. Saswati Sen, Department of Ophthalmology, AIIMS, Sijua, Patrapada, Bhubaneswar, Odisha, India
| | - Bhagabat Nayak
- Department of Ophthalmology, AIIMS, Bhubaneswar, Odisha, India
| | - Sucheta Parija
- Department of Ophthalmology, AIIMS, Bhubaneswar, Odisha, India
| |
Collapse
|
7
|
Çalış Karanfil F, Karanfil M, Toklu Y. Association of nocturnal subconjunctival hemorrhage and non-dipper blood pressure pattern: A benign clue for serious diseases. Eur J Ophthalmol 2021; 32:3043-3049. [PMID: 34964388 DOI: 10.1177/11206721211070939] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To evaluate the association between non-dipper blood pressure pattern and subconjunctival hemorrhage (SCH). METHODS Twenty-seven consecutive patients with nocturnal SCH and 27 age, sex-matched controls were enrolled. Demographic, blood parameters, office blood pressure measurements, 24-h ambulatory blood pressure monitoring (ABPM) were evaluated. RESULTS Mean diastolic blood pressure (DBP) for nighttime (65.03 ± 7.1 vs. 70.78 ± 10.5, p: 0.22), mean heart rate for nighttime (64.54 ± 8.26 vs. 69.93 ± 9.85, p: 0.034), Minimum Systolic Blood pressure(SBP) and DBP values for nighttime (92.44 ± 9.72 vs. 99.44 ± 10.66, p:0.015 and 51.15 ± 8.31 vs. 57.7 ± 11.2, p: 0.018) were higher, nocturnal fall ratio of SBP and DBP were significantly lower in the SCH ( + ) group compared to SCH (-) group (5.38 ± 8.39 vs. 10.34 ± 6.08, p: 0.016 and 4.26 ± 8.92 vs. 13.78 ± 6.97, p < 0001 respectively). Ten patients (37%) in the SCH (-) group and 18 patients (66.7%) in the SCH ( + ) group were non-dippers (p: 0.029). Mean daytime SBP and DBP were higher compared to office measurements of 4 patients (14.8%) in the SCH (-) group and 11 patients (40.7%) in the SCH ( + ) group (p: 0.033). CONCLUSION SCH had a strong association with non-dipper blood pressure pattern, higher nocturnal heart rate and masked hypertension which are precursors of myocardial infarction, stroke and renal failure. So, SCH should be considered as a clue for serious diseases such as coronary artery disease, myocardial infarction, stroke and patients should be evaluated for ABPM.
Collapse
Affiliation(s)
| | - Mustafa Karanfil
- Department of Cardiology, 536164Ankara City Hospital, Ankara, Turkey
| | - Yasin Toklu
- Department of Ophthalmology, 442146Ankara Yıldırım Beyazit University, Ankara, Turkey
| |
Collapse
|
8
|
Jeon HS, Byun SJ, Hyon JY, Park KH, Park SJ. Risk of Stroke or Acute Myocardial Infarction in Subconjunctival Hemorrhage: A Nationwide Cohort Study. Ophthalmic Epidemiol 2021; 29:662-671. [PMID: 34793286 DOI: 10.1080/09286586.2021.2003820] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE To investigate whether subconjunctival hemorrhage (SCH) raises the risk of subsequent stroke or acute myocardial infarction (AMI) in the general population. METHODS Using the National Health Insurance Service-National Sample Cohort database records from 2002 to 2013. Of 1,025,340 individuals in the database, we included 703,090 aged ≥ 20 years old without any history of SCH, cerebrovascular diseases, and ischemic heart diseases in the analyses. Of these, we identified 46,251 cases of incident SCH and regarded it as a time-varying covariate. We performed sensitivity analyses using 1:4 propensity score (PS)-based matched controls. To adjust for potential confounders, we investigated Cox regression models using defined demographic information, comorbidities, co-medications, and the Charlson Comorbidity Index score. RESULTS The SCH group showed higher incidence probability of stroke or AMI than the general population (3.17% versus 2.71%, respectively; p < .001); however, when compared to the PS-based matched controls, there was no difference (3.17% versus 3.03%, respectively; p = .76). Time-varying covariate Cox regression analyses without adjusting for confounders showed that SCH was associated with increased risk of subsequent stroke or AMI; however, after adjusting for confounders, SCH did not increase the risk of stroke or AMI. CONCLUSION This population-based cohort study showed that SCH itself is not a risk factor for stroke or AMI. Clinicians could reassure patients with SCH that it would not increase the risk for stroke or AMI. We recommend attentive evaluation of underlying diseases for patients with SCH for identifying risk factors of stroke or AMI.
Collapse
Affiliation(s)
- Hyun Sun Jeon
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, South Korea.,Department of Ophthalmology, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Seong Jun Byun
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seongnam, South Korea.,School of Pharmacy, Sungkyunkwan University, Suwon, South Korea
| | - Joon Young Hyon
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, South Korea.,Department of Ophthalmology, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Kyu Hyung Park
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, South Korea.,Department of Ophthalmology, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Sang Jun Park
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, South Korea.,Department of Ophthalmology, Seoul National University Bundang Hospital, Seongnam, South Korea
| |
Collapse
|
9
|
Chiang PH, Lai JN, Chiang YC, Hu KC, Hsu MY, Wei JCC. Association Between Subconjunctival Hemorrhage and Acute Coronary Syndrome: A 14-Year Nationwide Population-Based Cohort Study. Front Cardiovasc Med 2021; 8:728570. [PMID: 34660729 PMCID: PMC8518183 DOI: 10.3389/fcvm.2021.728570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 08/24/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose: Subconjunctival hemorrhage (SCH) is usually a benign ocular disorder that causes painless, redness under the conjunctiva. However, since SCH and acute coronary syndrome (ACS) share many vascular risk factors, studies have suggested that these two disorders may be significantly associated with each other, and evaluate the concomitance of ACS in patients with SCH. Methods: This population-based cohort study, enrolled 35,260 Taiwanese patients, and used the Taiwan National Health Insurance Research Database to identify patients with ACS and SCH. Outcomes were compared between the with and without SCH groups. The study population was followed until the date of ACS onset, the date of withdrawal, death, or December 31st 2013, whichever came first. Results: Of the 85,925 patients identified with SCH between 1996 and 2013, 68,295 were excluded based on the study's exclusion criteria, and a total of 17,630 patients with SCH who were diagnosed by ophthalmologists between 2000 and 2012 were eligible for analysis. After 1:1 propensity score matching for 5-year age groups, gender, and the index year, the results showed that SCH was more common in the 40–59 age group (53.82%) and females (58.66%). As for the ACS-related risk factors, patients with diabetes mellitus (aHR = 1.58, 95% CI = [1.38, 1.81]), hypertension (aHR = 1.71, 95% CI = [1.49, 1.96]) and patients taking aspirin (aHR = 1.67, 95% CI = [1.47, 1.90]) had a notably higher risk of ACS. However, it was found that there were no significant differences in the occurrence of ACS between the non-SCH and SCH patients. Conclusion: This results of this study regarding the risk factors and epidemiology of SCH and ACS were in keeping with previously reported findings. However, the results revealed no significant association between SCH and ACS.
Collapse
Affiliation(s)
- Ping-Hao Chiang
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Department of Allergy, Immunology & Rheumatology, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Jung-Nien Lai
- School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan.,Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Yun-Chi Chiang
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Department of Allergy, Immunology & Rheumatology, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Kai-Chieh Hu
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.,College of Medicine, China Medical University, Taichung, Taiwan
| | - Min-Yen Hsu
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Department of Ophthalmology, Chung Shan Medical University Hospital, Taichung, Taiwan.,Biotechnology Center, National Chung Hsing University, Taichung, Taiwan
| | - James Cheng-Chung Wei
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Department of Allergy, Immunology & Rheumatology, Chung Shan Medical University Hospital, Taichung, Taiwan.,Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan
| |
Collapse
|
10
|
Desco MC, Martín JCM, Mataix-Boronat J, Pascual-Camps I, Palacios-Pozo E, Barón-García M, Piñero DP, Navea-Tejerina A. Prophylactic effect of brimonidine to minimize the incidence of subconjunctival hemorrhage in the early postoperative period after 23G pars plana vitrectomy. Ther Adv Ophthalmol 2021; 13:25158414211045753. [PMID: 34632270 PMCID: PMC8495506 DOI: 10.1177/25158414211045753] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 08/24/2021] [Indexed: 11/15/2022] Open
Abstract
Background Several studies have investigated and demonstrated the prophylactic effect of brimonidine drops in preventing subconjunctival hemorrhage in some microincisional ophthalmic surgeries, such as intravitreal injections or cataract surgery. However, there are no previous studies investigating this prophylactic effect after 23G microincisional vitreoretinal surgery. Aim The aim of the current study was to determine whether subconjunctival hemorrhage after 23G pars plana vitrectomy (PPV) could be prevented with the use of prophylactic topical brimonidine. Methods This was a phase III, prospective, interventional, randomized, controlled single-center clinical trial with a follow-up of 2 weeks. A total of 77 eyes (mean age: 68.4 ± 10.7 years) undergoing 23G PPV were included and randomized into two groups: group 1 including 41 patients receiving prophylactic preoperative treatment with brimonidine, and group 2 (control group) including 36 patients not receiving this prophylactic treatment. Differences in terms of number of conjunctival quadrants affected with subconjunctival hemorrhage were evaluated in each of the follow-up visits. Results The presence of subconjunctival hemorrhage was similar in both groups the first days after surgery (p > 0.05). At the last visit (10-14 days after surgery), this condition was significantly more frequent in control group where there was a significant difference, being more frequent in the control group (7.3% vs 28.6%, p = 0.022). The number of conjunctival quadrants affected was also similar in both groups, except for the last visit in which most of the patients treated with brimonidine (92.7%) showed no bleeding compared to 71.4% in control group. No effect on the efficacy of brimonidine treatment of the presence of blood hypertension, diabetes, and antiplatelet or anticoagulant treatment was observed. Conclusion Brimonidine seems to be a useful option to decrease subconjunctival hemorrhage after microincisional vitreoretinal surgery or improve its resolution during the first postoperative week. This finding should be mainly due to the vasoconstrictor effect of brimonidine. Trial registration EudraCT, 2012-002895-15 (registered 19 December 2012); https://www.clinicaltrialsregister.eu/ctr-search/search?query=2012-002895-15.
Collapse
Affiliation(s)
- Mari Carmen Desco
- FISABIO Oftalmología Médica, Av. Pío Baroja 12, 46035 Valencia, Spain
| | | | | | | | | | | | - David P Piñero
- Department of Optics, Pharmacology and Anatomy, University of Alicante, Crta San Vicente del Raspeig s/n, San Vicente del Raspeig, Alicante 03690, Spain
| | | |
Collapse
|
11
|
Joshi RS, Bandgar RR. Incidence of Non-Traumatic Subconjunctival Hemorrhage in an Indian Rural Population. Clin Ophthalmol 2021; 15:183-188. [PMID: 33488067 PMCID: PMC7815081 DOI: 10.2147/opth.s277428] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 12/07/2020] [Indexed: 11/29/2022] Open
Abstract
Purpose To determine the incidence of non-traumatic subconjunctival hemorrhage (NTSH) in Indian rural population and analyze the associated risk factors. Methods The study included patients diagnosed having subconjunctival hemorrhage (SCH) who attended the out-patient department (OPD) of ophthalmology. Demographic characteristics of subjects included age, gender, medical and ocular history, and location of hemorrhage. Results The incidence rate of NTSH in this study was 3.07 per 1000 patients per year attending OPD. The men to women ratio for NTSH was 1.26 (95% CI). The commonest site of presentation was nasal side (n=36, 51.4%). Right eye (n= 37, 54.3%) was affected more than the left eye (n=28, 40%). The analysis showed 24 patients (34.3%) did not have any etiological factor attributable to SCH. Conjunctivochalasis (CCH) was associated in 15 patients (21.4%). An antiplatelet agent was associated with SCH in 7 patients (10%). Other factors associated with SCH were hypertension, leukemia, and anemia (n=6, 8.6%). Conclusion This study indicates that NTSH occurs in 3 out of 1000 individuals per year in the rural population presenting to the OPD. Nasal conjunctiva was commonly involved. CCH was associated with 15 patients. Use of antiplatelet agents, hypertension and blood disorders are associated with the risk of NTSH. Patients presenting for the first time with NTSH should be screened for systemic etiological factors.
Collapse
Affiliation(s)
- Rajesh Subhash Joshi
- Department of Ophthalmology, Government Medical College, Nagpur 440012, Maharashtra, India
| | - Rahul Ramchandra Bandgar
- Department of Ophthalmology, Shri Vasantrao Naik Government Medical College, Yavatmal 4510001, Maharashtra, India
| |
Collapse
|
12
|
Terrill SB, You H, Eiseman H, Rauser ME. Review of Ocular Injuries in Patients with Orbital Wall Fractures: A 5-Year Retrospective Analysis. Clin Ophthalmol 2020; 14:2837-2842. [PMID: 33061268 PMCID: PMC7522316 DOI: 10.2147/opth.s274567] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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] [Received: 08/04/2020] [Accepted: 09/10/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose The purpose of this study was to determine the incidence of minor and major ocular injuries in patients with orbital wall fractures at Loma Linda University Health, a level-one trauma center, to help determine the most appropriate setting for the initial dilated fundus examination by ophthalmologists. Methods A retrospective study was performed from January 2008 to January 2013 of patients diagnosed with orbital wall fracture secondary to trauma. Exclusion criteria included unknown mechanism of injury, the absence of ophthalmology consultation, or absence of imaging. Data collected included age, gender, mechanism of injury, visual acuity, and anterior/posterior segment findings. Ocular injuries were categorized as either minor or major. Results Of 567 charts reviewed, 460 met criteria and were included for analysis. In the analysis, 86.5% of patients were male, and 81.3% were Caucasian. The most common mechanism of orbital fracture was blunt injury. Visual acuity was better than 20/100 in 82.4% of patients. On chart review, 81.1% of patients were found to have either a minor injury, a major injury, or both. The most common injury was subconjunctival hemorrhage (53.5%). Globe rupture (2.9%) and vision-threatening posterior segment findings such as retinal tear and choroidal rupture (1.3%) were relatively rare. Only one retinal detachment (0.2%) was found, specifically in the setting of severe injury with concomitant globe rupture. Conclusion Knowledge of the common ocular injuries associated with orbital fractures will help emergency department (ED) physicians and ophthalmologists provide the dilated fundus exam in the most appropriate setting. The most frequent injuries identified were non-vision threatening, and visually significant posterior segment findings were relatively rare (1.3%). Thus, for the majority of patients presenting to the ED with orbital fracture, a dilated fundus exam can be performed at a later date in the outpatient clinic setting, unless urgent orbital fracture surgery is planned.
Collapse
Affiliation(s)
- Stephanie B Terrill
- Department of Ophthalmology, Loma Linda University Eye Institute, Loma Linda, CA, USA
| | - Hyelin You
- Department of Ophthalmology, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Heidi Eiseman
- Department of Ophthalmology, Loma Linda University Eye Institute, Loma Linda, CA, USA
| | - Michael E Rauser
- Department of Ophthalmology, Loma Linda University Eye Institute, Loma Linda, CA, USA
| |
Collapse
|
13
|
Lee CY, Chen HC, Huang JY, Sun CC, Yeh CB, Lin HY, Yang SF. Dermatologic Vasculature Diseases as a Risk Factor of Subconjunctival Hemorrhage. Int J Environ Res Public Health 2019; 16:ijerph16162865. [PMID: 31405118 PMCID: PMC6721046 DOI: 10.3390/ijerph16162865] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 08/05/2019] [Accepted: 08/08/2019] [Indexed: 01/18/2023]
Abstract
To evaluate the relationship between subconjunctival hemorrhage (SCH) and dermatologic vasculature diseases (DVDs) via the national health insurance research database (NHIRD) of Taiwan. This retrospective cohort study used data from the NHIRD for the 2009 to 2013 period. Patients diagnosed with DVDs were enrolled in the study group, and a propensity score-matching population was selected as the control group after exclusion. The main outcome was set as the development of SCH in both groups. Multivariable Cox regression analysis and survival analysis were performed to estimate the adjusted hazard ratio (aHR) and cumulative probability of SCH. A total number of 3426 patients were enrolled and split equally into the study and the control groups. There was no prominent difference between the age, gender, urbanization, income level, systemic co-morbidities, and ocular diseases between the two groups after matching. During the whole study period, 131 patients in the study group and 98 patients in the control group developed SCH with a significant higher aHR of 2.69 in the study group (p < 0.05). In the survival analysis, the study group also demonstrated a higher cumulative probability of developing SCH than the control group throughout the study period (p = 0.02). In conclusion, the presence of DVDs may be a risk factor for the development of SCH.
Collapse
Affiliation(s)
- Chia-Yi Lee
- Department of Ophthalmology, Show Chwan Memorial Hospital, Changhua 500, Taiwan
- Department of Optometry, College of Medicine and Life Science, Chung Hwa University of Medical Technology, Tainan 717, Taiwan
| | - Hung-Chi Chen
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou 333, Taiwan
- Department of Medicine, Chang Gung University College of Medicine, Taoyuan 333, Taiwan
- Center for Tissue Engineering, Chang Gung Memorial Hospital, Linkou 333, Taiwan
| | - Jing-Yang Huang
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung 402, Taiwan
| | - Chi-Chin Sun
- Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung 204, Taiwan
- Department of Chinese Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Chao-Bin Yeh
- Department of Emergency Medicine, Chung Shan Medical University Hospital, Taichung 402, Taiwan
| | - Hung-Yu Lin
- Department of Ophthalmology, Show Chwan Memorial Hospital, Changhua 500, Taiwan.
- Institute of Medicine, Chung Shan Medical University, Taichung 402, Taiwan.
- Department of Optometry, Chung Shan Medical University, Taichung 402, Taiwan.
- Department of Exercise and Health Promotion, Chung Chou University of Science and Technology, Changhua 500, Taiwan.
| | - Shun-Fa Yang
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung 402, Taiwan.
- Institute of Medicine, Chung Shan Medical University, Taichung 402, Taiwan.
| |
Collapse
|
14
|
Khodabakhsh AJ, Hofbauer J. Contralateral eye comparison of the phacoemulsification metrics, patient experience and clinical outcomes in patients undergoing bilateral cataract surgery with two commonly used femtosecond laser systems. Clin Ophthalmol 2018; 12:1391-1398. [PMID: 30122892 PMCID: PMC6087026 DOI: 10.2147/opth.s164513] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose The purpose of the study was to compare phacometrics, patient experience factors and clinical outcomes in patients undergoing bilateral laser-assisted cataract surgery using two common femtosecond laser platforms. Setting This study was conducted in Beverly Hills Institute of Ophthalmology, Beverly Hills, California, USA. Study design This was a prospective, comparative, contralateral eye study. Methods Femtosecond laser-assisted cataract surgery was performed in the first eye of 50 patients with bilateral cataract (mean age 69.9 ± 8.61 years) using either the Catalys (Johnson & Johnson Vision) or the LenSx (Alcon Laboratories, Inc.) laser system. The fellow eye was treated with the laser not used in the first eye. The primary outcome measures included overall procedural times, and the secondary outcome measures included patient experience with the two laser systems. Results There were no statistical differences between the two groups in terms of patient interface preparation time and number of docking attempts as well as effective phaco time, average phaco power, total ultrasound time and nucleus removal time. However, the LenSx group demonstrated a significantly longer cortex removal time and higher perception of pressure and vision loss (p < 0.001) compared to the Catalys group. A significantly higher number of Catalys eyes achieved complete capsulotomy (p < 0.001). The ease of cortex removal was also better in the Catalys group. Postoperative visual acuity, keratometry, endothelial cell count and intraocular pressure were comparable in the two groups. Conclusion With similar phacometric and clinical outcomes, both laser platforms were efficient, safe and effective during cataract surgery; however, the Catalys group demonstrated superior outcomes in terms of the patient experience, completeness of capsulotomy and ease of cortex removal.
Collapse
Affiliation(s)
| | - John Hofbauer
- Beverly Hills Institute of Ophthalmology, Beverly Hills, CA, USA,
| |
Collapse
|
15
|
Abstract
We report a case of ocular injury after bungee jumping. A 29-year-old woman presented with bilateral subconjunctival hemorrhage and periorbital petechiae after bungee jumping. Her best-corrected visual acuity was 20/20 in both eyes. Ocular examinations revealed no other intraocular hemorrhages. She received conservative treatment. One week later, the subconjunctival hemorrhage and periorbital petechiae resolved spontaneously. Her vision remained stable, and no detectable ocular complications were found during the follow-up. In conclusion, bungee jumping can cause ocular injuries. Further studies are required to identify their causes and potential risk factors.
Collapse
Affiliation(s)
- Min-Tsang Hsieh
- Department of Ophthalmology, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi City, Taiwan
| | - I-Ting Sun
- Department of Ophthalmology, E-DA Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Chih-Hsin Chen
- Department of Ophthalmology, Chang Gung Memorial Hospital Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| |
Collapse
|
16
|
Abstract
We report an unusual presentation of an orbital cavernous hemangioma in a 26-year-old female, who noted sudden redness and swelling of the left eye (LE) on waking up. At presentation, upper eyelid edema with periorbital ecchymosis and subconjunctival hemorrhage were noted in the LE. Although there was transient symptomatic relief with topical medications, blurring of vision developed in the LE. When seen 10 days later, the patient’s LE showed axial proptosis. Magnetic resonance imaging revealed an intraconal soft tissue mass in the superomedial quadrant of the left orbit. Superior orbitotomy with mass excision was done; histopathological examination of the excised mass revealed a cavernous hemangioma. The patient had complete visual recovery following surgery. To our knowledge, an acute presentation of an orbital cavernous hemangioma with subconjunctival hemorrhage and periorbital ecchymosis has not previously been reported.
Collapse
Affiliation(s)
| | | | - Dominic Rodriguez
- Department of Medicine, Kauvery Medical Centre, Tiruchirapalli, India
| | | | | |
Collapse
|
17
|
Abstract
BACKGROUND The purpose of this prospective, noncomparative consecutive study was to examine active and retired amateur boxers in order to evaluate the nature and incidence of ocular pathologic conditions related to the boxing practice. RESULTS A total of 35 boxers were included in this study. The mean age of the boxers was 28.09±7.57 years (range 18-52 years). Sixteen (45.7%) boxers had >5 years of boxing experience. Fifteen (42.85%) of the boxers reported wearing protective equipment in the bouts and sparring rounds. The number of bouts ranged from 3 to 103, with a median of 20 (interquartile range [IQR] =7-44). The percentages of wins varied from 25% to 100%, with a median of 68.29% (IQR =50.00-79.54). Most of the eye injuries recorded were minor injuries (66.66%), with subconjunctival hemorrhage being the most common (24.24%). Lid scars were the second most common lesion, accounting for 18.18% of all lesions. Sight-threatening eye lesions accounted for 33.34% of injuries and included cataracts (12.12%), lens dislocation (3.03%), pseudoexfoliation syndrome (3.03%), unilateral glaucoma (3.03%), retinal detachment (3.03%), vitreous opacity (6.06%), and lattice degeneration (3.03%). CONCLUSION Boxing-related ocular traumas are common in Cameroon, and ocular surface lesions are the most common injury reported. Severe lesions are indications for premature retirement from boxing practice.
Collapse
Affiliation(s)
- Giles Kagmeni
- Eye Department, University Teaching Hospital Yaoundé (UTHY).,Eye Department, University of Yaoundé I
| | | | | | - Come Ebana Mvogo
- Eye Department, University of Yaoundé I.,Eye Department, Central Hospital Yaoundé, Cameroon
| |
Collapse
|
18
|
Abstract
Ebola hemorrhagic fever is a deadly disease caused by several species of ebolavirus. The current outbreak of 2014 is unique in that it has affected a greater number of people than ever before. It also has an unusual geographic distribution. Nonspecific findings such as fever and generalized weakness have traditionally been very common early in the acute phase. Ophthalmic manifestations have also been reported in significant numbers. Conjunctival injection has been identified in both the acute and late phases. Subconjunctival hemorrhage and excessive lacrimation have also been reported. Various forms of uveitis have been associated with the convalescent phase of the disease. When identified in conjunction with other signs such as fever, acute findings such as conjunctivitis may contribute to the diagnosis of Ebola hemorrhagic fever. Ideally, serologic testing should be performed prior to isolation and treatment of these individuals. Considering the prevalence of the current outbreak and the threat of transcontinental spread, ophthalmic health professionals need to be aware of the ocular manifestations of Ebola hemorrhagic fever as well as the associated signs and symptoms in order to prevent further spread.
Collapse
Affiliation(s)
- Majid Moshirfar
- Department of Ophthalmology, Francis I Proctor Foundation, University of California San Francisco, San Francisco, CA, USA
| | - Carlton R Fenzl
- John A Moran Eye Center, University of Utah, Salt Lake City, UT, USA
| | - Zhan Li
- University of Nevada School of Medicine, Reno, NV, USA
| |
Collapse
|
19
|
Abstract
Subconjunctival hemorrhage is a benign disorder that is a common cause of acute ocular redness. The major risk factors include trauma and contact lens usage in younger patients, whereas among the elderly, systemic vascular diseases such as hypertension, diabetes, and arteriosclerosis are more common. In patients in whom subconjunctival hemorrhage is recurrent or persistent, further evaluation, including workup for systemic hypertension, bleeding disorders, systemic and ocular malignancies, and drug side effects, is warranted.
Collapse
Affiliation(s)
- Bercin Tarlan
- Department of Ophthalmology, Kozluk State Hospital, Batman, Turkey
| | | |
Collapse
|
20
|
Thirumurugan K, Munzanoor RRB, Prasad GA, Sankar K. Maxillary tuberosity fracture and subconjunctival hemorrhage following extraction of maxillary third molar. J Nat Sci Biol Med 2013; 4:242-5. [PMID: 23633874 PMCID: PMC3633290 DOI: 10.4103/0976-9668.107317] [Citation(s) in RCA: 6] [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: 11/04/2022] Open
Abstract
Extraction of teeth is the most common minor surgical procedure performed. Complication of extraction ranges from periodontal injury to fracture of jaw in the mandible and fracture of tuberosity and oroantral communication in the maxilla. Subconjunctival hemorrhage after extraction of maxillary molar is a very rare complication, and so far, only one case is reported in the literature. We report a case of subconjunctival hemorrhage with maxillary tuberosity fracture after maxillary third molar extraction.
Collapse
Affiliation(s)
- Kanagasabapathy Thirumurugan
- Department of Oral and Maxillofacial Surgery, Mahatma Gandhi Post Graduate Institute of Dental Science, Pondicherry, India
| | | | | | | |
Collapse
|
21
|
Abstract
Most cranio-cerebral injuries seen in the emergency department are caused by acceleration-deceleration or a direct impact mechanism. Compression or crush injury to the head is less commonly seen. A crush injury occurs when a body part is subjected a degree of force or pressure, usually after being trapped between two heavy objects or hard surfaces. We describe here a case of accidental bitemporal and facial compression injury in a young lady.
Collapse
Affiliation(s)
- Fatimah Lateef
- Department of Emergency Medicine and Trauma, Singapore General Hospital, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| |
Collapse
|