[Ocular accidents from the breaking of windshields]

A survey of 502 cases of ocular plagues, hospitalized in a 5-years period shows 5 cases produced by windscreen cracking. To avoid such accident compulsory the use of life-bear, even in short city departures. It is advisable that the windscreen to be made of lamellar glass (triplex), which produces less ocular lesions than "security" glass.

Trauma-induced retinal detachment associated with giant retinal tears

Giant retinal tears may arise spontaneously, but approximately 25% occur in association with ocular trauma. The clinical findings and results of surgical management in 38 cases of traumatic giant retinal tear seen at Moorfields Eye Hospital in London during a 10-year period are presented. Patients were young (mean age = 29 years) and mostly men (n = 36; 95%). Trauma was penetrating in 14 eyes (37%) and nonpenetrating in 24 (63%). Initial surgical management consisted of pars plana vitrectomy and fluid-silicone oil exchange in the majority of cases. Lensectomy was performed for opacity or dislocation in 23 (61%) eyes. Reattachment was achieved in 34 (89%) eyes 12 months after surgery. Most of the surgical failures occurred in eyes with penetrating trauma. Raised intraocular pressure was an associated problem that required treatment in 12 (32%) eyes. Visual acuity at final follow-up examination ranged from 6/6 to no perception of light (NPL; mean = 6/36). These results compare favorably with published figures for the treatment of spontaneous giant retinal tears.

The treatment of persistent wound leak after radial keratotomy

BACKGROUND

Macroperforation of the cornea during refractive keratotomy can result in persistent wound leak and may need treatment by suturing.

METHODS

We describe two eyes that developed a macroperforation during radial keratotomy with persistent leakage of aqueous. The wounds were sutured with 10-0 and 11-0 nylon sutures.

RESULTS

The sutures induced irregular astigmatism as shown by corneal topography. Removal of sutures improved the topography and led to an acceptable outcome.

CONCLUSION

Macroperforations with persistent aqueous leaks should be sutured. Suture removal within a few weeks after surgery can avoid persistent irregular astigmatism and lead to a good refractive result.

Our experience in intraocular foreign-body removal

Foreign bodies embedded in the retina and choroid that cannot be extracted by a magnet and require vitreous surgery for their removal comprise a separate group. A retrospective review of 40 consecutive cases (between 1977-1990) showed that this type of trauma frequently accompanied extensive ocular damage, including corneal and or scleral perforation, disruption of the lens, significant vitreous hemorrhage, retinal and choroid hemorrhage, and retinal detachment. Intraoperative and late complications occurred frequently, making the visual and structural outcomes of such eyes uncertain; therefore, another alternative must be sought that might improve the prognosis of these eyes. In this review, we emphasize (1) the time elapsed between the accident and the removal of the foreign body and (2) the final visual acuity and the time before the surgery.

Orbital impalement by a gearshift knob: case report

Penetrating trauma to the orbit may cause complex injuries involving the bone, globe, and brain. Successful treatment requires a strategic scheme for preoperative assessment and management and a multidisciplinary surgical approach. These principles are demonstrated by report of a motor vehicle accident in which the driver sustained orbital impalement by a gearshift knob.

A comparison of visual outcome in open-globe repair: succinylcholine with D-tubocurarine vs nondepolarizing agents

We compared the visual outcome in patients with ocular perforations who received succinylcholine with d-tubocurarine during anesthesia induction, with the visual outcome of those who did not. No statistically significant differences in visual outcome were detected. No extrusion of intraocular contents occurred during induction in either group.

[Change in the etiology and sequelae of severe eye injuries. A comparison of 197 personal patient admissions with other reports from the literature]

The spectrum of severe eye-injuries has clearly changed. We have analysed the documents of 197 patients treated in our clinic from 1988-1990. Of 119 (60.4%) contusions and 78 (39.6%) perforating injuries only 25.3% were occupational accidents. A more detailed analysis showed above all an increase of sport- and leisure-injuries and a considerable decrease of traffic-injuries (4.6%). Shocking is in contrast the percentage (10.7%) of severe injuries by brutality. More details concerning the consequences of injuries are presented and compared with older statistics. From this conclusions are drawn for better prophylaxis.

Penetrating injury from hammering with subtle ocular damage

Penetrating ocular injuries are usually associated with major disruption of the globe and vision loss. On occasion, the signs and symptoms accompanying an intraocular foreign body can be subtle. Such a case is presented in this paper and hammer injuries as a cause of penetrating ocular injury are reviewed.

Favourable outcome in a patient with penetrating intraocular BB pellet injury

Intraocular BB pellet injuries are a devastating form of ocular trauma with a poor prognosis. The penetration of the eye by the pellet causes a marked disruption of the intraocular contents that in most cases leads to enucleation. We describe a 15-year-old boy who suffered a penetrating intraocular BB pellet injury to his right eye and underwent primary repair of the injury followed by secondary vitrectomy and prophylactic panretinal photocoagulation. The postoperative management was complicated by a retinal detachment; however, this responded to a scleral buckling procedure. Eighteen months after the injury the acuity in the affected eye was 20/30 with a contact lens. To our knowledge this is the first case in which useful vision has been recovered in this type of injury.

Vitrectomy for perforating eye injuries from shotgun pellets

Pars plana vitrectomy and scleral buckling were performed on 22 eyes of 19 patients for treatment of perforating eye injuries from shotgun pellets. We reviewed the intraoperative findings at the time of vitrectomy to determine what factors might influence final visual acuity. The presence of a total retinal detachment at vitrectomy portended a poor prognosis when compared with eyes without total retinal detachment, as only one of ten eyes with total retinal detachment obtained useful vision (P = .002). Preoperative separation of the posterior vitreous was associated with a favorable outcome when compared with the absence of posterior vitreous detachment (P = .035), as ten of 16 eyes with posterior vitreous detachment at the time of vitrectomy ultimately achieved functional vision. The locations of the exit wounds did not affect visual success in the overall series of patients. However, in the patients who achieved visual success, exit wounds outside the vascular arcades were more likely to be associated with final visual acuities of, or better than, 20/70 than were those within the arcades (P = .022). Other prognostic factors, such as the number of perforations and the use of cryotherapy, were also examined for their effects on final visual outcome. However, these factors did not appear to affect visual outcome statistically.

Repair of telecanthus by anterior fixation of cantilevered miniplates

BACKGROUND

The accepted surgical method for telecanthus repair is transnasal wiring. This procedure requires a stable posterior lacrimal crest on the affected side and surgical manipulation of the wires as they exit the contralateral side. A method for repairing telecanthus that obviates these prerequisites is presented. Indications for use of this technique and comparison to transnasal wiring is discussed.

METHODS

A Y-shaped titanium rigid orbital plating system ("miniplate") was used to surgically correct traumatic telecanthus in five patients, two in the acute setting and three in late reconstruction. The miniplate was cantilevered from the lateral aspect of the nose and directed posteriorly into the orbit. This provided a stable fixation point for the medial canthal tendon.

RESULTS

Marked resolution of the telecanthus was noted in four patients. No post-operative complications have been encountered to date.

CONCLUSIONS

Miniplate fixation was used successfully to repair unilateral traumatic telecanthus. Miniplate fixation of the medial canthal tendon should be considered in unilateral cases of traumatic telecanthus and in cases where poor bony support for transnasal wires is evident.

[A case of blast injury of the brain]

Cases of craniocerebral injuries associated with foreign body penetration into the cranial cavity are not frequent in peacetime. The reported case was that of shot wound of the head caused by a steel pin used in construction works. The foreign body penetrated into the cranial cavity through the right eyeball and across the brain to the occipital lobe. The foreign body was not removed, and after 34 days in hospital the patient was discharged home with only a slight neurological deficit, i.e. low-grade paresis of his left foot. No remote complications were observed during 4 years of follow-up.

Simultaneous corneal laceration repair, cataract removal, and posterior chamber intraocular lens implantation

Frequently, patients with lens laceration or traumatic cataract coincident with corneal laceration, or both, must undergo two separate procedures-primary repair of the corneal laceration and secondary lens removal with or without intraocular lens implantation. We performed simultaneous corneal laceration repair, extracapsular cataract extraction, and posterior chamber lens implantation in seven patients with lacerating ocular injuries who met inclusion criteria for this procedure. With average follow-up of 10 1/2 months, all seven patients achieved visual acuity of 20/40 or better with spectacle correction. YAG posterior capsulotomy was the only additional procedure. One patient had macular pigmentation consistent with either traumatic or photic maculopathy. There were no other complications attributable to the surgical procedures. We believe that certain lacerating injuries of the anterior segment are particularly amenable to cataract extraction and lens implantation at the time of primary laceration repair. This approach obviates additional operative and anesthetic risks, while affording more timely visual rehabilitation.

[Experience in rendering ophthalmological care to the wounded]

Medical losses from ophthalmological injuries inflicted by small arms were from 2.2 to 4.5%, and taking into account concomitant injuries--up to 5.6%. Frequently there were binocular lesions, perforating wounds and destructions of eyeballs. Complicated ophthalmological operations were performed on patients who simultaneously had severe injuries of extremities, chest, abdomen, etc. Vitrectomy was a basic stage in the treatment of eye-penetrating wounds. Application of active measures for management of ophthalmological wounds at the stages of medical care made it possible to improve the outcome of treatment, diminish the frequency of purulent complications, for example endophthalmitis by 2 times.

Penetrating ocular fish-hook injuries. Surgical management and long-term visual outcome

BACKGROUND

Ocular penetrating fish-hook injuries represent a rare yet potentially devastating ocular trauma. To date, only five cases have been reported in the medical literature. The authors present five new cases with long-term follow-up.

METHODS

All individuals who presented to the Wilmer Ophthalmological Institute emergency room with ocular fish-hook injuries between 1974 and 1990 were identified, and ophthalmic follow-up evaluations were performed.

RESULTS

Individuals were male, between the ages of 10 and 27, with follow-up evaluation of 2.0 to 15.5 years (mean, 6.7 years). The left eye was involved in 80% and in no instance had a single hook penetrated the lid and globe simultaneously. Initial visual acuity was uniformly poor (20/200 or worse). Using specialized surgical techniques, ultimate visual outcome was excellent in 80% of cases (4 of 5 with visual acuity of 20/30 or better). One eye was enucleated because of panendophthalmitis after delayed wound closure. Similar overall results are achieved when previous reports are included in the analysis (90% with visual acuity of 20/40 or better).

CONCLUSIONS

These results suggest that penetrating ocular fish-hook injuries may have an excellent long-term prognosis if prompt, appropriate surgical intervention is accomplished.

[A surgical method for the treatment of traumatic low-solubility hyphema]

Presents experimental and clinical data on the operation of 'angular drainage' of the anterior chamber in traumatic poorly soluble hyphemas. The operation consists in conduction of a supramide thread through performed orifices in the cornea and formation of an angular drainage for blood evacuation from the anterior chamber. High efficacy and safety of the suggested method for treatment of recurrent complicated hyphemas is proved.

Vitrectomy for intra ocular foreign body removal

Ten consecutive cases of perforating ocular injuries with retained intraocular foreign bodies over a period of 2 years were reviewed retrospectively in this study. All cases were operated upon by a 3 port pars plana vitrectomy and if necessary endolaser done. All ten cases (100%) were successful in terms of intraocular foreign body removal through the pars plana sclerotomy but ultimately we lost three [3] [30%] cases of which two had retinal detachments with P.V.R. D-3 preoperatively and the other had endophthalmitis. Of the seven (70%) successful cases four eyes (40%) had a post-operative vision of 6/12 or better while 2 [20%] had 6/24 and the last had 6/60 [10%]. Nine cases [90%] had a magnetic Intraocular foreign body. Various complications of Intraocular foreign bodies like vitreous haemorrhage, retinal incarceration, cataract and retinal detachment were noted preoperatively. Silicone oil was used in three (30%) cases. Sulfur Hexafluoride was used in 5 cases (50%). Endolaser photocoagulation was done in 7 cases (70%).