ACUTE POST-TRAUMATIC ENDOPHTHALMITIS SECONDARY TO BACILLUS PUMILUS / SAFENSIS

PURPOSE

To report a case of post-traumatic endophthalmitis secondary to Bacillus pumilus/safensis .

METHODS

Observational case report of a single patient.

RESULTS

A 62-year-old man presented with a traumatic corneal laceration because of baling wire while working on a sheep farm. Appropriate corneal laceration repair with injection of intravitreal antibiotics (ceftazidime, clindamycin, and vancomycin) was performed. A single organism, identified as B. pumilus or Bacillus safensis, was isolated from the vitreous aspirate. A subsequent pars plana vitrectomy, pars plana lensectomy, anterior capsulotomy, and fluid-air exchange was required because of severe inflammatory reaction from retained lens material, retinal edema, and vitreous opacities. Vision improved from hand motion to 20/60 at the three-month follow-up visit.

CONCLUSION

We describe a case of acute post-traumatic endophthalmitis secondary to B. pumilus/safensis.

Management of scleral tears with concurrent intraocular foreign bodies and factors affecting outcomes

AIM

To report the clinical settings and factors predicting outcomes in scleral tears with concurrent retained intraocular foreign bodies METHODS: All cases with scleral and corneoscleral wounds with retained intraocular foreign bodies (RIOFB) from January 2014 to January 2021 were retrospectively analysed. Favourable anatomic outcome was defined as presence of globe integrity, attached retina, absence of hypotony and active inflammation at last visit. Favourable functional outcome was defined as final visual acuity (VA) > 20/200.

RESULTS

Total 139 eyes were included. Mean age was 30.66 ± 13.32 years (median 29 years, IQR 17). Penetrating trauma accounted for 87.1%, rupture for 5.8%, perforation for 7.2%. In 5.8% of the eyes the injury involved zone I extending till Zone II while in 66.9% it involved Zone II and in 27.3% in Zone III. Snellen visual acuity at presentation was logMAR 2.97 ± 1.01 and at last visit was logMAR 2.38 ± 1.45 (p < 0.0001). Time between presentation and repair was 13.93 ± 19.56 h (median 7.6 h, IQR 17.17). Favourable functional outcome was seen in 34.5% eyes and 2/3rd achieved favourable anatomic outcome. Absence of endophthalmitis (OR = 6.25, p = 0.003) and ability to remove the foreign body (OR = 7.05, p = 0.003) were associated with a favourable anatomic outcome. Better presenting Snellen visual acuity (OR = 2.77, p = 0.003), manifest scleral tear (OR = 3.36, p = 0.04), and absence of endophthalmitis (OR = 50, p = 0.0009) were associated with a favourable functional outcome.

CONCLUSION

A third of the cases achieved favourable visual outcome while 2/3rd achieved favourable anatomic outcome. Absence of endophthalmitis is an important factor predicting both.

Review of Management and Outcomes of Delayed Repair Open Globe Injuries

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.

Fall-related ocular trauma in patients over 90 years in tertiary ophthalmic center in Germany: 90-TOSG Report 1

PURPOSE

To investigate the clinical characteristics of fall-related ocular trauma in patients over 90 years of age.

METHODS

Retrospective, medical record reviews. Patients over the age of 90 years treated in a tertiary center with fall-related ocular trauma were included in the study.

RESULTS

Fifty consecutive patients (fifty eyes) were analyzed. The mean age was 93.6 ± 1.8 years and 41 patients (82%) were female. The most common site of the injuries was orbital fracture (18 patients, 36%), accompanied with open globe rupture (OGR) in three patients, and globe contusion in two patients. Seventeen patients (34%) presented with OGR. Ocular trauma score in those patients was category 1 in 10 patients (58.8%) and category 2 in the others. Conjunctival hemorrhage and/or periocular contusion was seen in 14 patients (28%) and globe contusion in six patients (12%). At the presentation, the mean best corrected visual acuity (BCVA) was 2.82 ± 0.24 logMAR in patients with OGR and 1.98 ± 0.81 logMAR in six patients with globe contusion. Three of the patients with OGR had a final vision of 20/200 or better whereas the remaining patients had hand movements or less. The most common risk factors were female gender (82%) and use of antihypertensive drugs (46%).

CONCLUSION

Patients with OGR had a poor visual outcome despite the early treatment. It is important to raise public awareness about of the poor prognosis of ocular injuries due to falls in the elderly population in order to establish preventive measures.

TEMPORARY KERATOPROSTHESIS COMBINED WITH VITRECTOMY FOR SEVERE GLOBE INJURY

PURPOSE

To describe a case of a 44-year-old man with ocular trauma after a mine explosion. From the moment of the injury, the patient reported significant visual impairment (no perception of light in the right eye and a perception of light without localization in the left eye). The patient was diagnosed with a double-sided penetrating corneal scleral wound and traumatic cataract, retinal detachment, and intraocular foreign bodies after a battlefield mine explosion.

METHODS

The three-stage procedure, consisting of using soft contact lens as temporary keratoprosthesis, vitrectomy, and penetrating keratoplasty, was performed in the damaged eye.

RESULTS

A soft contact lens allowed for excellent visualization of the posterior segment during vitrectomy. At the 1-month follow-up, the eye that was operated on could sense light. The corneal transplant remained translucent, and the retina was attached.

CONCLUSION

The described method, when performed by an experienced surgeon, may aid in simultaneously treating coexisting corneal opacification and vitreoretinal disorders.

REPAIR OF THE EXIT WOUND OF A PERFORATING GLOBE INJURY WITH THE AMNIOTIC MEMBRANE: A SURGICAL ADJUVANT FOR EARLY VITRECTOMY

PURPOSE

To describe the use of the amniotic membrane for the repair of the exit wound of a perforating injury involving the retina and the choroid.

METHODS

Case report.

RESULTS

A 46-year-old man presented one day after a perforating ocular injury with an exit wound close to the inferior temporal retinal vascular arcade. The next day, the patient underwent a combined vitrectomy and phacoemulsification with intraocular lens implantation. During vitrectomy, a retinochoroidectomy was performed at the exit wound and the internal limiting membrane was peeled over the macula and up to the exit wound. Laser retinopexy was followed by plugging of a piece of the amniotic membrane to the exit wound. A second piece of the amniotic membrane was used to cover the bare retinochoroidectomy area. The surgery was concluded with a silicone exchange. Postoperatively, no sign of proliferative vitreoretinopathy was observed, and at 3 months, the silicone oil was removed. The follow-up was uneventful, and the eye achieved a final visual acuity of 20/30.

CONCLUSION

The amniotic membrane may offer a simple and safe solution for the repair of the exit wounds of perforating injuries involving the retina and the choroid. The use of the amniotic membrane for this purpose may afford the opportunity for early vitrectomy in the management of perforating ocular injuries.

Removal of Intraocular Foreign Bodies Using a Modified Flute Needle

PURPOSE

To describe the construction of a novel intraocular snare and evaluate its effectiveness in intraocular foreign body (IOFB) removal.

METHOD

This is a retrospective consecutive case series. Five patients underwent pars plana vitrectomy and IOFB removal using the intraocular snare constructed from modified flute needle.

RESULTS

All IOFBs were successfully engaged and removed with the snare on the first attempt. Three of the 5 cases (60%) enjoyed good visual outcome (0.4-1.0) postoperatively. No complication related to the use of the snare was encountered in this case series.

CONCLUSION

Intraocular foreign body snare is simple, safe, and effective in IOFB removal.

Mapping prognostic factors for globe survival in panophthalmitis using logistic regression and Cox proportional hazard models: A retrospective study

Purpose

The aim of this study was to report the outcomes of panophthalmitis and to identify factors significantly affecting globe survival in the disease.

Methods

This was a retrospective study on patients with panophthalmitis in a tertiary hospital between January 1, 2017, and December 31, 2019. The demographics, treatment details, culture results, and final outcomes were recorded. Logistic regression and Cox proportional hazards (CPH) were calculated to identify variables associated with globe loss. A P < 0.05 was considered significant.

Results

Eighty-five eyes of 85 patients (31 culture positive) were eligible for review. The mean age of the participants was 55.21 ± 20.17 years with a male-to-female ratio of 2.04:1. Corneal ulcer (38.82%; n = 33) and open globe injuries (OGIs) (38.82%; n = 33) were the most common etiologies. Pseudomonas aeruginosa (n = 10; 11.76%) was the most common isolate. The mean duration of hospital stay was 7.58 ± 2.32 days. Overall, 44 (51.76%) globes could be salvaged. The need for evisceration (P = 0.901) and hospital stays (P = 0.095) were similar for culture-positive and -negative cohorts. The unadjusted logistic regression and CPH models showed that culture sterility did not affect globe survival [OR = 1.210 (0.501-2.950), P = 0.668; HR = 1.176 (0.617-2.243), P = 0.623]. The adjusted logistic regression and the CPH models showed that corneal ulcers [OR = 10.900 (2.460-48.200), P = 0.002; HR = 5.393 (1.603-18.140), P = 0.006] and OGI [OR = 7.360 (1.650-32.700), P = 0.009; HR = 4.548 (1.321-15.660), P = 0.016] were significantly associated with globe loss.

Conclusion

Corneal ulcer or OGI as the primary etiology is detrimental to globe survival in panophthalmitis.

Presenting clinical characteristics of open globe injuries in ocular trauma: baseline analysis of cases in the ASCOT national clinical trial

BACKGROUND/OBJECTIVES

The Adjunctive Steroid Combination in Ocular Trauma (ASCOT) trial is a unique pragmatic, multi-centre, patient and assessor masked, randomised controlled trial. We evaluate the clinical characteristics and pathology of this large trial cohort of patients with open globe injuries undergoing vitreoretinal surgery, including the associations between patient characteristics and their baseline vision.

SUBJECTS/METHODS

We (i) summarise demographics, injury history and ocular history of the 280 participants recruited into the ASCOT trial using descriptive statistics; (ii) analyse the national and seasonal variation across England and Scotland in these participant characteristics; and (iii) explore the associations between participant demographic, trauma history, ocular history and presenting baseline visual acuity (measured using the Early Treatment Diabetic Retinopathy Study, ETDRS) using multivariable regression analyses.

RESULTS

The majority of participants with open globe penetrating injuries were of white ethnicity (233, 84%), male (246, 88%), with a median age of 43 years (IQR 30-55 years). There was considerable variability in presenting visual acuity with 75% unable to read any letters on the ETDRS chart, whilst the median ETDRS letter score was 58 (IQR 24-80) for those who could read ≥1 letter. The most common causes of injury were workplace related (31%) or interpersonal violence (24%). Previous eye surgery, visual axis corneal scar, lens status, hyphaemia and vitreous haemorrhaging were found to be associated with presenting vision as measured by the ETDRS chart.

CONCLUSION

The ASCOT trial provides valuable insights into the spectrum of pathology of patients with open globe eye injuries undergoing vitreoretinal surgery. The identified causes of injury and clinical presentation of the cases will help in training and resource planning to deal with these often challenging surgical cases.

TRIAL REGISTRATION

EudraCT No. 014-002193-37. HTA Project 12/35/64.

Total Filling of the Vitreous Cavity With a Cohesive Ophthalmic Viscosurgical Device to Support the Removal of the Intraocular Foreign Body

PURPOSE

To evaluate the effectiveness of loading the vitreous cavity with a cohesive ophthalmic viscosurgical device in aiding the removal of the posterior segment intraocular foreign body (IOFB).

METHODS

Seven consecutive patients underwent a small-gauge vitrectomy due to eye trauma with the IOFB between January 2019 and December 2019. The IOFB removal was initiated after total filling the vitreous cavity with the ophthalmic viscosurgical device (Eyefill C or Bio-Hyalur Plus) to facilitate maneuvering and slow the descent in cases of the unintendedly released IOFBs. The eye examination was performed at presentation and at 1 day, 7 days, 1 month, and 3 months after surgery. The best-corrected visual acuity and intraocular pressure were evaluated.

RESULTS

In all eyes, IOFBs were elevated into the center of the vitreous cavity and could be securely gripped while suspended in the ophthalmic viscosurgical device to allow the surgeon for successful and harmless removal. In the 3-month follow-up, the best-corrected visual acuity was 20/20 in 5 patients and 20/25 in 2 patients. In the early postoperative period, the elevation of intraocular pressure did not occur. No patient developed endophthalmitis.

CONCLUSION

The authors demonstrated that this uncomplicated technique is an effective surgical option for more reliable removal of posterior segment IOFBs.

Outcomes of Zone 3 Open Globe Injuries by Wound Extent: Subcategorization of Zone 3 Injuries Segregates Visual and Anatomic Outcomes

PURPOSE

Open globe injuries (OGIs) are categorized by zone, with zone 3 (Z3) comprising wounds > 5 mm beyond the limbus. Outcomes of Z3 OGIs are highly heterogeneous. Open globe injuries with far posterior Z3 (pZ3) wounds were hypothesized to have worse visual and anatomic outcomes.

DESIGN

Single-center retrospective cohort study.

PARTICIPANTS

A total of 258 eyes with Z3 OGIs.

METHODS

A retrospective review of Z3 OGIs treated at a tertiary center over 12 years. Wounds ≥ 10 mm posterior to the limbus were defined as pZ3. Outcomes were compared between pZ3 and anterior Z3 (aZ3) eyes.

MAIN OUTCOME MEASURES

Visual acuity on a logarithm of the minimum angle of resolution (logMAR) scale. Secondary outcomes included anatomic outcomes, development of retinal detachment and proliferative vitreoretinopathy, and the number of secondary surgeries.

RESULTS

A total of 258 Z3 OGI eyes with > 30 days follow-up were assessed; 161 (62%) were pZ3. At 3-month follow-up, pZ3 OGIs were more likely to exhibit no light perception (pZ3: 38%; aZ3: 17%; P < 0.003), lack count fingers vision (pZ3: 72%; aZ3: 43%; P < 0.002), and fail to read a letter on the eye chart (pZ3: 83%; aZ3: 64%; P < 0.001). The visual acuity distribution at 3 months was significantly worse for pZ3 compared with aZ3 injuries (P < 0.004). Similar results were found at final follow-up. Multiple linear regression showed that pZ3 location was independently associated with worse visual acuity (β = 0.29, 95% confidence interval [CI], 0.09-0.50, P < 0.006) in addition to presenting acuity, age, vitreous hemorrhage, uveal prolapse, and afferent pupillary defect. Far posterior wounds injuries were more likely to develop retinal detachments (pZ3: 87%; aZ3: 71%; P < 0.01) and proliferative vitreoretinopathy (pZ3 66%; aZ3 47%; P < 0.03). Patients with pZ3 OGIs were significantly more likely to reach poor anatomic outcome (phthisis, enucleation, need for keratoprosthesis) compared with patients with aZ3 OGI (pZ3: 56%; aZ3: 40%; P < 0.03).

CONCLUSIONS

Posterior OGI extension independently portends worse visual and anatomic outcomes. The effect on visual outcome was durable and clinically relevant compared with established predictors of OGI outcomes. Application of these findings improves the prognostic precision and will guide future research efforts to optimize surgical decision-making in severe OGI cases.

FINANCIAL DISCLOSURE(S)

Proprietary or commercial disclosure may be found after the references.

Pediatric Open Globe Injuries Caused by Firecrackers in a Tertiary Eye Care Hospital in Iran

OBJECTIVE

The aim of the study is to determine characteristic features of open globe injuries caused by firecrackers among pediatric population.

METHODS

In this retrospective cross-sectional chart review, medical records of children with ocular trauma who were hospitalized in Isfahan, Iran, during 2013-2017 were reviewed. We analyzed the collected data before and after propensity score (PS) matching.

RESULTS

Of 396 pediatric patients with open globe injury, 22 injuries (5.9%) were caused by firecrackers. Hyphema, iris prolapse, and lens rupture were noted in 15 (68.18%), 10 (45.45%), and 2 (9.09) eyes, respectively. None of patients had endophthalmitis. The mean age of patients in firecracker group was higher and significant (11.86 ± 4.05 in firecracker vs 7.80 ± 4.68 in nonfirecracker, P < 0.001). Furthermore, most boys were in firecracker group (95.5%, P = 0.005). Patients in firecracker group resided more in urban areas (86.4%, P = 0.054) and had more intraocular foreign body (IOFB) in the eyes (40.9%, P < 0.001). After PS matching, patients in firecracker group had higher IOFB ( P = 0.008). In logistic regression models, patients with corneal lacerations had lower odds for long-time admission (≥4 days) than patients with both corneal and scleral lacerations in crude model (odds ratio, 0.35; 95% confidence interval, 0.17-0.69) and adjusted model (odds ratio, 0.37; 95% CI, 0.18 to 0.74). After PS matching, there was no significant association between risk factors and outcomes.

CONCLUSIONS

The present study showed several differences between the pediatric open globe injuries caused by firecrackers and other mechanisms of injuries, including the age, sex, living place, presence of IOFB, and length of hospital stay.

International Globe and Adnexal Trauma Epidemiology Study (IGATES): Visual outcomes in open globe injuries in rural West India

BACKGROUND/OBJECTIVES

To evaluate the factors influencing final visual outcome after surgical repair of open globe injuries (OGIs) in a rural population using the International Globe and Adnexal Trauma Epidemiology Study (IGATES) online registry.

SUBJECTS/METHODS

Retrospective cohort study of patients with OGI. OGIs were identified from the IGATES database at a tertiary referral eye care centre in rural West India over a period of 12 years. Patient demographics, clinical and pre-operative factors affecting final visual outcome was evaluated.

RESULTS

A total of 791 eyes with OGIs were included in data analysis. 11 eyes that were lost to follow-up and 12 eyes with incomplete data were excluded. Most of the patients were male (559, 70.6%) and mean age of all patients was 23.9 years ± 19.4 years. Occupational hazards (including domestic housework) (307, 38.8%) and leisure play (324, 41.0%) were the leading causes of OGI. The most common mechanism of injury was being struck by a wooden stick (250, 31.6%). Univariate analysis of pre-operative variables showed initial visual acuity (VA), zone of injury, size of wound, structures involved in the injury and presence of infection were significant prognostic factors for worse final visual outcome (p < 0.001). Multivariate analysis showed VA ≤ 3/60 or worse at presentation had statistically significantly higher odds ratio of ending up with worse visual outcomes (p < 0.012).

CONCLUSIONS

Males in working age groups suffer from OGIs more frequently, usually from agricultural and pastoral activities. Initial VA, zone 3 injuries, corneoscleral wound, large wound size and presence of post-traumatic infections are significant prognostic factors.

Clinical Profile, Etiology, and Management Outcomes of Pediatric Ocular Trauma in Saudi Arabia

OBJECTIVE

To evaluate cases of pediatric ocular trauma at a tertiary eye hospital in central Saudi Arabia and determine the demographics, causes, ocular injuries, and visual status before and after management.

METHODS

A retrospective review was performed of health records of children younger than 16 years with ocular trauma managed from January 1998 to December 2019. Data were collected on patient demographics, eye involved, cause of trauma, the presenting and final vision, and the duration of follow-up. Best-corrected visual acuity at the last follow-up was compared between open and closed eye injury groups. The Birmingham Eye Trauma Terminology was used to classify the ocular injuries.

RESULTS

Among 1003 patients, 728 (72.6%) had open globe and 275 (27.4%) had closed globe injuries. The main causes of trauma were unsafe playing-related activities (n = 394; 39.3%), unsafe home environment (n = 158;15.8%) and injury by metallic objects (n = 166; 16.6%). Gunshot-related ocular trauma was noted in 62 (6.2%) children. Presenting vision less than 20/400 was noted in 292 (40.1%) eyes with open globe injuries and 110 (40%) eyes with closed globe injuries (P = 0.4). After a median follow-up of 13.3 months, best-corrected visual acuity was 20/20 to 20/200 in 393 (53%) eyes with open globe injuries and 137 (49.8%) eyes with closed globe injuries (P = 0.03).

CONCLUSIONS

Despite proper management, children in this study sustained significant permanent visual loss secondary to ocular trauma. Public health efforts in Saudi Arabia are needed to reduce preventable injury-related childhood blindness.

Characteristics and visual prognosis of pediatric open globe injury in Shanghai, China

Introduction To describe the characteristics of open globe injury and the relationship between the complications and visual outcomes in children with this type of injury. Methods This was a retrospective chart review of 1664 children, under the age of 16 years, who were hospitalized for open globe injury between January 1, 2007, and December 31, 2015. Each patient's age, sex, cause and agent of injury, complications, visual acuity, and classification of ocular trauma were collected for review and analysis. Results The mean age was 5.6 ± 3.4 years. Right eyes were particularly vulnerable to injury (right eye:left eye ratio = 1.2:1). Traumatic cataract was the most common complication. The average initial and final best-corrected visual acuity (BCVA) were logMAR 2.04 ± 0.78 and logMAR 1.74 ± 0.88, respectively. Logistic regression analysis showed that hyphema (OR = 1.850), iris prolapse (OR = 1.702), vitreous hemorrhage (OR = 9.703), retinal detachment (OR = 11.938), endophthalmia (OR = 5.377), intraocular foreign body (OR = 3.346), and initial visual acuity < 0.05 (OR = 9.017) were risk factors for visual acuity < 0.05 at hospital discharge. Conclusion Open globe injury was most frequent in preschool children and boys. Right eyes were more vulnerable than left eyes. Poor visual outcomes were associated with hyphema, iris prolapse, vitreous hemorrhage, retinal detachment, endophthalmia, intraocular foreign body, and an initial visual acuity < 0.05.

A rare asymptomatic metallic intraocular foreign body retained in the anterior chamber for 15 years: A case report

RATIONALE

Intraocular foreign bodies (IOFBs) are common in ocular injuries, but asymptomatic metallic IOFBs retained in the anterior chamber for years are rare.

PATIENT CONCERNS

A 31-year-old female presented with blurred vision in her right eye after lumbar magnetic resonance imaging. Her best-corrected vision acuity was 0.6 in the right eye and 1.0 in the left eye. Slit-lamp examination revealed a brown granular foreign body in the anterior chamber and pigmentation of the limbus. Lens and retina examination indicated ocular siderosis. Corneal endothelioscopy revealed decreased endothelial cell density. A detailed history showed ocular globe injury 15 years earlier.

DIAGNOSES

Anterior chamber IOFB with ocular siderosis.

INTERVENTIONS

Anterior chamber foreign body removal was performed with appropriate incision and forceps.

OUTCOMES

The anterior chamber IOFB was successfully removed and examined as a magnetic metal foreign body. The best-corrected vision acuity was 1.0 at 1 day postoperatively. An abnormal electroretinogram with a 12% decrease in the "b" wave and a 91% decrease in the "a" wave was observed 3 months postoperatively. There were no intraoperative or postoperative complications during a 3-month follow-up.

LESSONS

Eye trauma should be examined carefully to exclude IOFBs. Asymptomatic anterior chamber foreign bodies can also cause corneal endothelial injury and ocular siderosis. Careful examination and timely management are needed in such cases.

Clinical outcomes of posterior segment intraocular foreign bodies: The volume effect

PURPOSE

To assess the effect of foreign body volume on visual and anatomic outcomes in patients with a posterior segment intraocular foreign body (IOFB).

METHODS

Patients were divided into three groups according to the volume of the IOFB; group 1 (n=18 eyes) with IOFBs<2mm³, group 2 (n=15 eyes) with 2mm³≤IOFBs<6mm³, group 3 (n=18 eyes) with IOFBs≥6mm³. All eyes underwent pars plana vitrectomy (PPV) for removal of the IOFB. Demographic characteristics, features of the injury and IOFB, findings of the initial and final ophthalmological examinations, and timing of IOFB removal were studied.

RESULTS

The mean age was 38.8±12.0years, and the median follow-up period was 12.0 (range: 6-98) months. Initial visual acuity (VA) was significantly lower in group 3 (P=0.005), while final VA was similar between the three subgroups. Frequencies of primary globe repair, initial vitreous hemorrhage (VH), corneoscleral entry, and IOFB removal through the cornea were significantly higher in eyes with large volume IOFBs (P<0.05). Siderosis was only seen in 4 patients in group 1 (22.2%). No patients developed postoperative endophthalmitis.

CONCLUSION

Large volume posterior segment IOFBs are associated with poor initial VA, initial VH and corneoscleral injury. Nevertheless, PPV and IOFB extraction under favorable conditions may provide significant visual improvement in eyes with large volume IOFBs.

Proliferative Vitreoretinopathy After Combat Ocular Trauma in Operation Iraqi Freedom and Operation Enduring Freedom: 2001-2011

BACKGROUND AND OBJECTIVE

To determine the risk factors associated with developing proliferative vitreoretinopathy (PVR) from combat ocular injuries in U.S. service members.

PATIENTS AND METHODS

Retrospective review of associated risk factors and outcomes of PVR within the Walter Reed Ocular Trauma Database. Ocular injuries in U.S. service members wounded during Operation Enduring Freedom and Operation Iraqi Freedom from 2001 to 2011 were assessed, and of these all cases of PVR were studied. Principal outcome measures were the risk factors associated with PVR development and rate of final visual acuity (VA) less than 20/200.

RESULTS

Eight hundred ninety eyes of 651 U.S. service members were evaluated. A total of 76 eyes (8.5%) of 66 patients developed PVR. Five patients had bilateral PVR. Nineteen patients had bilateral eye injuries. Sixty-one eyes (80.2%) had a final VA less than 20/200. PVR was found to be a significant risk factor for a poor final VA (P < .001). Retinal detachment (RD) was found in 52 eyes (68.4%) of patients. In patients with a RD, intraocular foreign bodies (IOFBs) (P < .001), unsuccessful repair (P = .002), and macular hemorrhage (P = .04) were significant risk factors for the development of PVR. Time to initial retina surgery was not found to be a risk factor for PVR development (P = .5). Time to initial retina surgery was available in 41 patients and the time to surgery on average was 22.56 days (range: 3 to 87 days).

CONCLUSIONS

PVR occurs frequently in combat trauma and is a significant cause of poor final VA. In patients with PVR and RD, injuries caused by an IOFB, macular hemorrhage, or unsuccessful repair were significant risk factors for the development of PVR. [Ophthalmic Surg Lasers Imaging Retina. 2020;51:556-563.].

Trauma-induced filtering bleb formation and blebitis 40 years following a penetrating eye injury

A 49-year-old man presented to the emergency eye clinic with a 3-week history of redness, irritation and blurred vision in his right eye, with a noticeable lesion superotemporally on the conjunctiva. He had a previous ocular history of penetrating glass injury in the right eye at the age of 9 years (40 years ago), of which no surgical intervention was performed at that time, as his parents did not seek medical attention. Slit lamp examination revealed a thin, conjunctival cystic bleb at 10 o'clock position with surrounding conjunctival injection and chemosis at close proximity to the site of previous ocular trauma. Investigations confirmed a diagnosis of trauma-induced filtering bleb with blebitis (bleb inflammation). The patient was treated with a combination of steroid and antibiotic drops for duration of 2 weeks. Subsequent follow-up revealed marked improvement of symptoms with reduced inflammation. Patient is being monitored regularly to prevent recurrence of blebitis and bleb associated complications.

Repair of Rhegmatogenous Retinal Detachment Following Globe Perforation by Retrobulbar Anesthesia

Globe perforation following retrobulbar or peribulbar anesthetic injection is a rare but dreaded complication that often results in suboptimal visual outcomes. This video describes a 72-year-old woman who sustained a globe perforation during retrobulbar block in the setting of cataract extraction and later developed a retinal detachment. The retina was repaired with pars plana vitrectomy and silicone oil, resulting in a favorable visual outcome. The authors discuss various modes of local anesthesia for vitreoretinal surgery, risks for globe perforations, and how to approach retinal detachment secondary to needle perforations, which are complex cases at high risk for proliferative vitreoretinopathy.

Orbital myositis revealing a vegetal intraorbital foreign body: a case report

INTRODUCTION

Foreign intraorbital bodies are rare. Their clinical manifestation is usually late.

CLINICAL CASE

    We report a case of 32 years-old man presenting an old vegetal foreign intraorbital body. The orbitotomy allowed its extraction with favorable result.

DISCUSSION

Vegetal foreign intraorbital bodies have clinical aspects. The latency between the trauma and the onset of symptoms is variable. Radiological examination can identify exactly the size and location. Surgical removal is often necessary but can expose to major risks.

CONCLUSION

The diagnosis of ignored intraorbital foreign body remains difficult. The management should be early in order to avoid severe functional consequences.

Challenging Surgical Approach to a Lost Inferior Rectus Muscle Following Penetrating Orbital Trauma

A 37-year-old man suffered a penetrating left orbital injury with rupture of the inferior rectus muscle and avulsion of the optic nerve. The orbit was explored and the inferior rectus muscle stump was identified 25 mm from the limbus. Despite this, the muscle was successfully reattached and the patient achieved satisfactory postoperative alignment. [J Pediatr Ophthalmol Strabismus. 2019;56:e49-e52.].

Sympathetic Ophthalmitis: A Rare Case Report

Sympathetic ophthalmitis (SO) is defined as bilateral granulomatous panuveitis occurring after penetrating ocular trauma or intraocular surgery. It is now rare due to micro-surgical repair of ocular injury and use of steroid. An 18 years old boy admitted into Ophthalmology department of Mymensingh Medical College Hospital, Mymensingh, Bangladesh on 2nd March 2018. He got penetrating corneal injury in R/E with sharp pointed object 01 month back. It was conservatively managed but his right eye became phthisical. After 04 weeks his left eye was affected in which VA became 3/60, features of panuveitis developed. It was managed with high dose steroid and immunomodulatory drug (Azathioprine). Ultimately his vision of left eye is fully preserved (6/6). So, after a trauma or surgery to one eye, another eye should be meticulously examined and followed up. Early diagnosis and prompt treatment of Sympathetic Ophthalmitis may prevent from blindness.

Post-traumatic intraocular ophthalmomyasis due to Phormia sp

CLINICAL CASE

An 18 year-old male patient presented with an injury to the left eye caused by a firearm. He remained unconscious for 2 days in an agricultural area, had a visual acuity of non-perception of light, wounds with loss of substance in upper and lower eyelid, atalamia, hypotonia, corneal oedema, wound with uveal exposure and exit of larvae in zone II. He was subjected to evisceration of the left eye.

DISCUSSION

An untreated open ocular traumatism is a risk factor for intraocular ophthalmomyiasis.

Corps étranger intraoculaire et endopthalmie: facteurs de risque et prise en charge

Le but est d'identifier les facteurs de risque de survenue d'endophtalmie post traumatique (EPT) avec corps étrangers intra oculaire (CEIO) dans les traumatismes pénétrants du globe et d'évaluer les résultats de la prise en charge thérapeutique. Il s'agit d'une étude descriptive rétrospective portant sur 60 patients hospitalisés pour plaie pénétrante avec corps étranger intraoculaire à l'institut Hédi Raies d'ophtalmologie de Tunis, sur une période de 10 ans. Nous avons inclus dans notre travail les patients présentant un traumatisme oculaire pénétrant avec CEIO présentant une EPT. Nous avons également identifié les facteurs de risque cliniques de survenue d'endophtalmie chez ces patients. Nous avons colligé 60 patients présentant un traumatisme pénétrant avec corps étranger intraoculaire. Dix de ces patients soit 16,66% ont présenté des manifestations cliniques d'endophtalmie. Tous les CEIO étaient localisés dans le segment postérieur. L'acuité visuelle (AV) moyenne initiale était de 2,26 en Log MAR. L'AV moyenne finale était de 2,18 en Log MAR. Nous avons trouvé un lien statiquement significatif entre la survenue d'une endophtalmie et les facteurs suivants: l'origine rurale p=0,021, le délai d'extraction du CEIO p=0,01, la localisation postérieure du CEIO p=0.012, la rupture capsulaire p=0,022, le décollement de rétine associé p<0,0001. L'identification des facteurs de risque de survenue d'EPT vont permettre de mieux adapter la prise en charge thérapeutique et préventive de cette complication à fin d'améliorer le pronostic et la qualité de vie des patients.

Removal of an intraorbital metallic foreign body following double-penetrating ocular injury: A case report

RATIONALE

Open eye injury is one of the commonest ophthalmic emergencies, and when accompanied by intraorbital foreign bodies, the condition carries a poor prognosis.

PATIENT CONCERNS

A 28-year-old man presented to the emergency department of our hospital complaining of sudden painful loss of vision in the left eye after he hammered an iron plate.

DIAGNOSIS

The ocular examination revealed a 4-mm full thickness scleral laceration with prolapsed uveal tissue, a traumatic cataract. Computed tomography (CT) demonstrated an orbital foreign body in the retrobulbar area.

INTERVENTIONS

The patient underwent emergency scleral suturing, severance of medial rectus muscle, and removal of the orbital foreign body. Twelve days after the emergency operation, pars plana lensectomy and pars plana vitrectomy were performed.

OUTCOMES

After 3 months of follow-up, there was no immune response. Visual acuity in the left eye was the perception of hand motion. The retina remained mostly attached with normal intraocular pressure, and good cosmetic appearance. The globe anatomy was maintained, but the vision could not be restored due to the grave nature of the trauma.

LESSONS

Transconjunctival approach extraocular muscle severance may thus be a suitable approach to the removal of intraorbital metallic foreign body.

Surgical Management of an Externally Protruding, Perforating Intraocular Foreign Body

Ru-ik Chee Felix Y. Chau In this case of a perforating eye injury by a 2-inch-long nail that went through the cornea, lens, and posterior eye wall, the authors describe a combined external, anterior, and posterior segment surgical approach that resulted in safe and successful removal of the foreign body. Initial external trimming of the protruding nail facilitated the use of a noncontact viewing system. Combined limbal and pars plana placement of the vitrectomy cannulas optimized access to both anterior and posterior intraocular structures. Most importantly, careful removal of potential sources of foreign body adhesion to intraocular structures prior to extraction likely increased the likelihood for a successful clinical outcome. Care was taken to remove as much of the vitreous as possible and to keep the eye formed. The patient recovered 20/25+2 vision with aphakic correction.

Nocardia Keratitis following penetrating corneal injury treated with topical ampicillin

BACKGROUND

Nocardia keratitis following surgical management of penetrating corneal injury is very rare.

CASE

A 38-year-old male presented with a deep stromal corneal infiltration with hypopyon of 10 days duration in his left eye. He had undergone a corneal tear repair on that eye 15 days prior to the onset of keratitis. The infiltrations were along the sutured corneal tear tracts. Before presenting to us, he was treated empirically with hourly topical antifungal and antibiotic for 10 days with poor clinical response. Microbiological investigations revealed the presence of Nocardia in both smear and culture. The infiltrations responded well to fortified 5% ampicillin eye drops.

CONCLUSION

Although Nocardia keratitis is very rare following penetrating corneal injuries and clinically can mimic mycotic keratitis, it should also be suspected in cases not responding to standard treatment. Management of Nocardia keratitis requires a good clinical judgement with appropriate microbiological support.

Improvement of Siderotic ERG

For fear of endophthalmitis and siderosis, ferrous intraocular foreign bodies are usually removed as soon as they are discovered; markedly reduced, siderotic ERG changes are considered permanent. We report a patient who presented with a chronically retained intravitreal foreign body and significant clinical as well as electrophysiologic signs of siderosis. Only 3 months after surgery, the ERG showed almost complete recovery. If siderosis is not present, adequate and regular follow-up examinations may in certain cases substitute for immediate removal of chronically retained intraocular foreign bodies.

Endolaser Photocoagulation in Penetrating and Perforating Intraocular Foreign Bodies

Ten consecutive eyes that had undergone a pars plana vitrectomy and argon endolaser photocoagulation for penetrating or perforating posterior segment foreign bodies were reviewed. All eyes had undergone a pars plana vitrectomy plus or minus lensectomy, removal of the intraocular foreign body in those eyes with a retained foreign body, endolaser photocoagulation of posterior chorioretinal tears, and peripheral buckle for peripheral retinal pathology. Postoperatively (minimum follow-up, 6 months), all eyes had an attached retina. Eighty percent of the eyes had a visual acuity of 20/40 or better. Advantages of endolaser photocoagulation of posterior breaks include: microscopically controlled sealing of posterior tears, less destructive than posterior cryotherapy, effective when severe choroidal swelling is present, and absence of dispersion of viable retinal pigment epithelial cells which has been documented with external cryotherapy.

Posttraumatic Endophthalmitis

In a group of 615 cases of perforating trauma, 25 cases (4%) of proven endophthalmitis were seen. The percentage of Bacillus infections was unusually high compared to other types of endophthalmitis (3.8% for the whole group, 31% for the group with intraocular foreign bodies). Bacillus cases have a very poor outcome and in fact the overall functional results in the posttraumatic endophthalmitis group were poorer than in other categories.

Combined Cataract Extraction With Pars Plana Vitrectomy and Metallic Intraocular Foreign Body Removal Through Sclerocorneal Tunnel Using a Novel "Magnet Handshake" Technique

PURPOSE

To study the outcomes of combined cataract extraction with pars plana vitrectomy (PPV) and metallic intraocular foreign body (IOFB) removal through a sclerocorneal tunnel using the "magnetic handshake" technique.

DESIGN

A retrospective review.

METHODS

Retrospective review of case records of 14 patients from 2010 to 2016 with metallic IOFB and traumatic cataract was performed. Cataract extraction was combined with PPV. Two intraocular magnets (IOMs) introduced through 20-gauge vitrectomy port and sclerocorneal tunnel helped achieve safe delivery of IOFB outside the globe by the "magnetic handshake" technique.

RESULTS

All patients were males with a mean age of 33.04 years. A final best corrected visual acuity (BCVA) of 20/60 or better was noted in 10 (71.42%) of 14 patients. Final reattachment with more than 1 surgery was achieved in 13 (92.85%) patients. Postoperative complications included retinal detachment (RD) and phthisis bulbi in 1 (14.28%) patient each.

CONCLUSIONS

Combined cataract extraction with PPV and metallic IOFB removal through sclerocorneal tunnel using the "magnet handshake" technique gives good visual and surgical outcomes.

Visual and Refractive Outcomes of Children After Early Secondary Cataract Extraction Following Wound Repair for Penetrating Ocular Trauma

PURPOSE

To evaluate the visual and refractive outcomes in children 8 years of age or younger with corneal laceration and cataract following penetrating ocular injuries who underwent primary corneal tear repair followed within 1 to 8 weeks by early secondary cataract extraction.

METHODS

This retrospective, non-comparative case series reviewed the admission and operative charts of children 8 years of age or younger (range: 3 to 8 years) who underwent corneal wound repair as the primary surgical procedure followed within 1 to 8 weeks by cataract extraction with intraocular lens implantation, with a minimum follow-up period of 6 months. The main outcome measures were best corrected visual acuity (BCVA) and refractive error as the spherical equivalent at the final follow-up visit.

RESULTS

A total of 47 children (33 boys, 14 girls) were included. The mean age at the time of injury was 5.9 ± 2.2 years (range: 3 to 8 years). Follow-up periods ranged from 6 months to 3 years (median: 18 months). The mean time gap between the wound repair and cataract extraction was 5 weeks (range: 1 to 8 weeks). Approximately 36 (77%) eyes obtained BCVA better than 6/18. All but one eye achieved BCVA better than 6/60. The deviation from emmetropia was less than 1.00 diopter (D) in 23 (54%) eyes, 1.00 to 3.00 D in 15 (35%) eyes, and more than 3.00 D in 5 (12%) eyes.

CONCLUSIONS

Early removal of cataract with intraocular lens implantation 1 to 8 weeks after the primary wound repair in young children with penetrating corneal injuries can result in excellent visual and refractive outcomes with early intervention and aggressive amblyopia treatment. [J Pediatr Ophthalmol Strabismus. 2018;55(2):122-127.].

Secondary Management and Outcome of Massive Suprachoroidal Hemorrhage

PURPOSE

To present the results of secondary surgical treatment of five patients with massive suprachoroidal hemorrhage (MSCH), which occurred intraoperatively, postoperatively, or following ocular trauma.

METHODS

Five patients presenting with MSCH were included in this study during or after phacoemulsification surgery (1 patient), glaucoma surgery (1 patient), combined glaucoma and phacoemulsification surgery (2 patients), and after traumatic sclera rupture (1 patient). Diagnosis was confirmed by ophthalmoscopy and B-scan ultrasonography. Pre-existing risk factors and distance visual acuity were documented. All cases received medical therapy and underwent secondary surgical intervention with radial sclerotomies combined with vitrectomy, use of perfluorocarbon, and silicone oil. Postoperative assessment included visual acuity measurement, ocular examination, and ultrasonography.

RESULTS

In all cases, anatomic restoration of ocular structures was achieved. Distance visual acuity improved in all cases (preoperative Snellen visual acuity ranged from light perception to hand motions; postoperative Snellen visual acuity ranged from 0.05 to 0.3). The mean follow-up period was 17 months.

CONCLUSIONS

In general, despite the advanced surgical techniques, the prognosis of MSCH remains guarded and the visual outcome poor. However, secondary surgical treatment with combined radial sclerotomies and vitrectomy should be considered in order to minimize the damaging effect and maximize the anatomic and functional restoration.

Intravitreal Triamcinolone in Cystoid Macular Edema Due to Uveitis and Repeated Surgery after a Penetrating Trauma

PURPOSE

To test the effectiveness of intravitreal triamcinolone acetonide in treating macular edema due to multiple vitreoretinal surgical procedures and uveitis after a penetrating trauma with metallic foreign body retention in a 37-year-old man.

METHODS

The patient received two intravitreal injections of triamcinolone acetonide-2 mg/0.05 mL and 4 mg/0.1 ml(-1) month apart. The 6-month follow-up included best-corrected visual acuity (BCVA) measurement and optical coherence tomography evaluation.

RESULTS

After the first injection (2 mg) the foveal thickness (685 microm, as compared to a normal value of <165 microm) and the BCVA (20/200) remained unchanged with respect to the preinjection values; 1 week after the second injection (4 mg), the foveal thickness went down to 130 microm and the BCVA improved (20/80). Such results were unchanged at the 6-month control. No complications occurred.

CONCLUSIONS

A 2 mg dose of triamcinolone acetonide did not improve the anatomic and functional status of the macula. A 4 mg dose markedly improved BCVA and reduced the macular thickness in this case of macular edema.

Penetrating Ocular Trauma from a Bean Bag Gun: A Case Report and Review of Less-Lethal Force and Their Consequences

Although bean bag guns are considered a "less-lethal" form of law enforcement, these blunt projectiles have risk. The purpose of this study was to perform a literature review of morbidity and mortality associated with less-lethal munitions and present a case report of a bean bag injury leading to a traumatic globe evisceration and skull base fracture. Patients presenting with bean bag gun associated injuries warrant a high clinical suspicion for injury to deeper structures.

A new cause of lacrimal gland calcification: Retained metallic foreign bodies

A 49-year-old male presented with a 4 month history of dysaesthesia in the left periorbital region. A CT scan showed a lacrimal gland mass with areas of dense calcification. Biopsies of the left lacrimal gland revealed a silver material with associated chronic granulomatous inflammation and secondary calcification. The histological specimen was sent for X-ray microanalysis. This confirmed the silver material to be aluminium. The metal fragments were subsequently discovered to be from a car aerial, which caused an orbital impaling injury 20 years prior to presentation. This is the first reported case of lacrimal gland calcification secondary to chronic metal foreign body exposure. The case is presented alongside literature reviews of lacrimal gland calcification and associated radiological findings.

Epidemiology of Open-Globe Injuries in Hong Kong

PURPOSE

The aim of this study was to review the epidemiology and clinical outcomes of open-globe injuries (OGIs) in Hong Kong over a 10-year period.

DESIGN

Retrospective case-review.

METHODS

This study included patients with OGI who presented to Hong Kong Eye Hospital and Queen Elizabeth Hospital from 1999 to 2008. Patient demographics, causes and mechanisms of injury, visual acuity (VA) at presentation, clinical features, and final VA were collected. Univariate and multivariate analyses using logistic regression were performed to identify poor prognostic factors.

RESULTS

A total of 122 eyes of 121 patients were included. More than half (63%) were male, and the mean age was 54 years. Workplace injuries (36%) ranked first, followed by fall (32%) and assault (13%). The majority (66%) presented with VA less than 5/200. Common associations included hyphema, lens damage, uveal prolapse, and vitreous hemorrhage. Overall, about half (46%) sustained profound visual loss (final VA <5/200). Twelve eyes underwent evisceration or enucleation. Only 1 eye developed endophthalmitis. Univariate analysis suggested that profound visual loss was associated with poor initial VA, relative afferent pupillary defect, and posterior scleral involvement (P < 0.05). Multivariate analysis showed that poor initial VA and posterior involvement were independent poor prognostic factors.

CONCLUSIONS

Profound visual loss was common after OGIs, especially in cases with poor vision at presentation and involvement of the posterior sclera. Identifying poor prognostic factors helps guide clinical management and facilitates counseling for patients. Early medical and surgical treatment may help to reduce the risk of endophthalmitis.

Effect of bone marrow and adipose tissue-derived mesenchymal stem cells on the natural course of corneal scarring after penetrating injury

In the present study, we investigate and compare the efficacy of bone marrow- and adipose tissue-derived mesenchymal stem cell (MSCs) in corneal wound healing. A penetrating injury was created in the right corneas of Wistar rats (n = 40). Ten microliters of phosphate-buffered solution (PBS) containing 2 × 10(5) green fluorescent protein (GFP) labeled bone-marrow-derived MSCs to group 1 (n = 15), 10 μl of PBS containing 2 × 10(5) GFP-labeled adipose-tissue-derived MSCs to group 2 (n = 15), 10 μl PBS was injected into anterior chamber in group 3 (n = 10, control). Corneal opacity scoring, in vivo confocal microscopy, and histopathological evaluation were done at the end of 8 weeks. Immunofluorescence sections were evaluated to detect transplanted cells. Immune staining was performed to measure the expression levels of keratocan, aldehyde dehydrogenase (ALDH) and CD34. The gene expression levels of tumor necrosis factor (TNF-α), the interleukin 6 receptor (IL-6R), interleukin 12b (IL-12b), and transforming growth factor beta (TGF-β1) was measured on corneas. The establishment of stem cells in the corneas of the transplanted groups was confirmed by immunofluorescence staining. The expression of keratocan, ALDH, and CD34 increased in the transplanted groups (p < 0.05). The density of keratocytes increased significantly in both transplanted groups according to the in vivo confocal microscopy data (p < 0.05). The expression of TNF-α, IL-6R, and IL-12b decreased significantly in the transplanted groups (p < 0.05). Based on our findings, we consider that allogeneic stem cells facilitate the regeneration of corneal stroma and can be a cell source for stromal repopulation in diseased cornea.

Abnormal increase of intraocular pressure in fellow eye after severe ocular trauma: A case report

BACKGROUND

An ocular injury can lead to secondary glaucoma in the traumatized eye in 3% to 20% of cases. Literature on the risk of developing elevated intraocular pressure in the nontraumatized fellow eye is scant. Clinicians treating ocular traumas should also bear in mind sympathetic ophthalmia, a rare bilateral granulomatous panuveitis following accidental or surgical trauma to 1 eye.

CASE REPORT

We report a case of high-pressure glaucoma of the fellow eye without any signs of uveitis. The left eye of a 24-year-old man was injured in an inadvertent movement during a free-time table-tennis match. The eye was severely crushed, leading to blindness. His right eye developed medically uncontrolled high-pressure glaucoma only 1 month after the injury.

CONCLUSION

To the best of our knowledge, there are no previous reports of post-traumatic glaucoma in the nontraumatized eye after open-globe injury.

Common causes of red eye presenting in northern Iran

AIM

This study aimed to determine the causes of red eye disease among patients of Mazandaran-Northern Iran.

METHODS

This cross sectional study included 840 patients who referred to eye clinics with ocular complaints. A detailed history of patients was recorded and their eyes were examined. Then, pre designed checklists were completed by the researcher.

RESULTS

The most common cause of red eye was conjunctivitis - 30% (252/ 840), foreign bodies 23.2%, trauma including penetrating or blunt 8.6%, respectively. There was a significant relationship between the red eye trauma, with acute onset and duration of less than a week (P=<0.0001). Diagnoses of red eye were conjunctivitis in 31.3% of the cases separately, viral causes (19.5%), allergic (7%) and bacterial (4%), foreign bodies 22.9%, pterygium 7%, and trauma 6.5%, respectively.

CONCLUSION

In the current study, the most common causes of red eyes were conjunctivitis, foreign bodies, and trauma respectively. Red eye was more common in males than in females. An appropriate and proper training of risky factors of red eyes in the future could reduce the risk of serious visual problems.

Impacted iron nail in the orbit and maxillary sinus through a corneo-scleral perforation: a case report

INTRODUCTION

Open globe injury is one of the commonest ophthalmic emergencies, and when accompanied by intraocular foreign bodies, the condition carries a poorer prognosis.

OBJECTIVE

To report a rare case of perforating injury of the globe with an iron nail which got lodged in the maxillary sinus.

CASE

A ten-year-old boy presented with the history of sudden painful loss of vision in his right eye. He reported that he was hit forcefully by the tail of a cow a day before the presentation. There was no perception of light in that eye. The ocular examination revealed a full thickness corneo-scleral perforation with prolapsed uveal tissue. The X-ray of the right orbit showed an impacted foreign body in the inferior orbit and computed tomography scan of the orbit confirmed the presence of a vertically impacted metal piece in the right orbit and right maxillary sinus. The repair of the perforation and removal of the impacted nail was done in two stages. The globe anatomy was maintained but the vision could not be restored due to the grave nature of the trauma.

CONCLUSION

Perforating globe injury is an important cause of monocular blindness.

Surgical treatment of open globe trauma complicated with the presence of an intraocular foreign body

BACKGROUND

Open globe injuries complicated with the presence of an intraocular foreign body constitute a vision threatening condition.

PURPOSE

To present the results of pars plana vitrectomy in patients with intraocular foreign body.

MATERIAL AND METHODS

Medical records of 22 patients were analyzed. Retrospective analysis of data included visual acuity, age, gender and type of injury.

RESULTS

All patients were men and the mean age was 37 years. All injuries occurred while working with a hammer. All patients were treated with pars plana vitrectomy combined with intraocular foreign body removal and internal limiting membrane peeling. The visual acuities improved in 9 cases (41%), in 13 cases (59%) the deterioration of visual acuity was observed, no eye was enucleated. In 14 eyes pars plana vitrectomy was combined with lens removal, in 14 eyes silicone oil was used as a tamponade.

CONCLUSIONS

Surgical intervention with pars plana vitrectomy combined with intraocular foreign body removal and cataract extraction may preserve severely traumatized eyes and maintain or even improve vision. ocular trauma, vitrectomy, intraocular foreign body.