Orbital trauma

Assessment of the orbit for orbital trauma is best achieved expeditiously with CT in the determination of extent of injury and the presence of foreign body. MR imaging has a limited role but is valuable in examining the optic nerve and globe for injury and has proven to be an adjunct modality in the assessment of orbital injury.

[Prevalence of symptoms associated with blood pressure in normal and hypertensive population]

BACKGROUND

High blood pressure should be symptomless. However, popular knowledge attributes some symptoms such as headache, epistaxis or dizziness to high blood pressure.

AIM

To compare the prevalence of headache, epistaxis, subconjunctival hemorrhages and dizziness in people with normal or high blood pressure.

SUBJECTS AND METHODS

A representative sample of an urban population in Chile was studied. Each subject with high blood pressure was paired with a non-related individual of the same sex and age. These subjects were interrogated about the presence of symptoms.

RESULTS

One thousand forty eight subjects with high blood pressure (481 male) and 1052 individuals with normal pressure (483 male), were studied. In subjects with high or normal blood pressure, the prevalence of headache was 22 and 21.8% respectively, epistaxis was 11.6 and 11% respectively, dizziness was 7.4 and 7.6% respectively, tinnitus was 9.1 and 9.4% respectively and subconjunctival hemorrhage was 2.9 and 3.1% respectively (p = NS).

CONCLUSIONS

No differences in the prevalence of symptoms, popularly attributed to hypertension, were observed between subjects with normal or high blood pressure.

[Vitreous hemorrhage after vitrectomy in diabetic retinopathy and tissue plasminogen activator]

PURPOSE

To determine if intraocular recombinant tissue plasminogen activator (r-TPA) can be used to treat fibrin blood clots (hyphemas/vitreous) after vitrectomy surgery for diabetic retinopathy.

MATERIAL AND METHOD

After a retrospective review of medical records, we found 52 patients who underwent vitrectomy for diabetic retinopathy and non-resolving vitreous hemorrhage and/or hyphema during the early postoperative (6 weeks). They were administered r-TPA in dose of 25 microgr/0.1 ml. Hyphemas and vitreous hemorrhages were classified in four grades.

RESULTS

Tissue Plasminogen Activator was used after vitrectomy surgery in 52 fibrin clotted eyes (52 patients), within the first 3 days post surgery. Vitreous hemorrhages were categorized as grade 2 (21%), grade 3 (67.3%) and grade 4 (11.5%). Hyphemas observed in 18 eyes presented grade 3 (38.9%) and grade 4 (61%). We saw no evidence of intraocular reactions against the r-TPA solution at the dose used in this study.

CONCLUSIONS

Fibrin blood clots can successfully and effectively be treated with intraocular r-TPA in doses of 25 microgr/0.1 ml (Arch Soc Esp Oftalmol 2002; 77: 7-12).

[Transmission electron microscopy of the pupillary membranes in neovascular glaucoma and chronic hemophthalmos]

The authors examined using transmission electron microscopy the pupillary membrane in neovascular glaucoma. The membrane was formed by connective tissue where fibroblasts, pigment cells and collagen fibres predominated. The high cell content suggested a high metabolic and growth activity.

Bilateral eye hemorrhage after laparoscopic cholecystectomy

A case of bilateral eye hemorrhage after laparoscopic cholecystectomy, probably caused by an increase in venous blood pressure due to carbon dioxide insufflation, is reported.

[Hemophthalmos in patients with diabetes mellitus]

A total of 110 patients with diabetes mellitus with intraocular hemorrhages were examined using computer densitometry of ultrasonic beta-scanograms of the eyes. Indications for various treatments were determined and the outcomes of hemophthalmia predicted, depending on its topography, intensity, and volume of blood released into the vitreous. Hemorrhages were located mainly in the posterior segments of the vitreous body in diabetics with hemophthalmia. High efficiency and good prospects of using objective methods of computer analysis of beta-scanograms for evaluating the status of the vitreous and extending the diagnostic potentialities of modern ophthalmology are shown.

[Episcleral single injection anesthesia in the caruncle for cataract surgery: report of 350 cases]

Episcleral single injection anesthesia in the caruncle ovoïds the rare but potentially dangerous complications and incidents of classic local anesthesia. Excellent motor and sensory block is obtained with a single injection in the anatomic marks are well defined. We have practiced this technique since February 1999 for cataract surgery in 350 cases. The different surgical techniques used were manual extracapsular extraction in 52% of cases, phacosection through tunnel incision in 38%, and phacoemulsification in 10%. Our preliminary results show good acceptance of the episcleral anesthesia for both patients and surgeons. Because it is effective and safe, this anaesthtic technique may be an alternative to classic anesthetic techniques in all cases where topical anesthesia is not indicated.

[Treatment of the massive suprachoroidal hemorrhages]

PURPOSE

To analyze the anatomical and functional results obtained in post- surgical suprachoroidal hemorrhages treated from 1998 to 2000 and to review the information on the series of this complication that have been published during the last five years and which included at least 10 patients.

METHODS

A retrospective analysis of the medical records of patients with suprachoroidal hemorrhages at the Instituto Universitario de Oftalmobiología Aplicada (IOBA) - University Hospital of Valladolid. Bibliographic search by Med-Line/Pub Med from 1995 to 2000 was performed.

RESULTS

8 patients who fulfill these criteria have been treated and 8 papers, also complying with the criteria, have been found.

CONCLUSIONS

The functional and anatomic results of post-surgical suprachoroidal hemorrhages are still poor, even though the prognosis seems to have improved in the last 20 years. The standardized classification of massive suprachoroidal hemorrhages based on severity and the standardization of the follow-up would improve these results.

[A clinical study on black diaphragm posterior chamber intraocular lens implantation]

OBJECTIVE

To discuss the effect of black-diaphragm intraocular lens implantation in the management of cataract or aphakia with aniridia.

METHODS

Thirty-three cases (34 eyes) of black-diaphragm posterior chamber intraocular lens implantation were retrospectively analyzed, among which 18 eyes had undergone primary intraocular lens implantation and 16 secondary intraocular lens implantation.

RESULTS

After 1-52 months of follow-up, postoperative corrected visual acuities were greater-than-or-equal 1.0 in 17 eyes, 0.5-0.9 in 11 eyes and 0.1 -0.4 in 6 eyes. The complications included intraoperative ciliary body bleeding in 2 eyes and retinal detachment in one eye.

CONCLUSION

Black-diaphragm intraocular lens implantation is effective in the management of cataract or aphakia with aniridia.

Warfarin therapy and cataract surgery

PURPOSE

Cataract extraction in the warfarinized patient poses special considerations. Warfarin will increase the haemorrhagic risk but, more importantly, cessation or reduction in anticoagulation may well lead to serious thromboembolic phenomena. The purpose of this study was to assess the impact that warfarinization has on cataract extraction.

METHODS

One thousand consecutive cataract extractions performed at Christchurch Hospital between 1996 and 1998 were reviewed. Twenty-eight patients (29 eyes) were on warfarin. Reasons for anticoagulation, modification to treatment regimen and postoperative outcome measures were available for 23 eyes or 79% of the study population.

RESULTS

The preoperative international normalized ratio (INR) ranged from 1.00 to 2.40+/-0.37 with a mean of 1.52. No thromboembolic phenomena occurred and four minor perioperative haemorrhages were noted, none of which affected the final visual outcome.

CONCLUSIONS

If warfarin is required to counteract serious thromboembolic tendencies, then it should not be ceased perioperatively. The small numbers of perioperative haemorrhages that did occur were not visually significant.

Acute haemorrhagic keratoconjunctivitis following laser in situ keratomileusis

We report two cases of acute haemorrhagic keratoconjunctivitis which occurred following laser in situ keratomileusis (LASIK) during an ongoing epidemic. Both cases underwent preoperative investigation and surgery on the same day. The possible sources of contamination include the paramedical staff, the contact instruments used for performing preoperative investigation, surgeon, nurse, surgical instruments and eye drops. However, the flap was intact with no haze or regression and at 1 year follow up, the visual acuity was maintained at 6/6 in both the patients. We recommend greater caution while performing contact investigations and strict surgical asepsis during LASIK surgery, routinely as well as during epidemics of conjunctivitis.

Haemorrhage and risk factors associated with retrobulbar/peribulbar block: a prospective study in 1383 patients

Patients undergoing intraocular surgery are elderly and may have disease or be receiving medication which increases the risk of haemorrhage. We interviewed 1383 consecutive patients scheduled for eye surgery requiring retrobulbar/peribulbar block about their use of non-steroidal anti-inflammatory drugs, oral steroids and warfarin. A history of diabetes mellitus and globe axial length was noted. Medial peribulbar and inferolateral retrobulbar blocks were performed by three specialists and six doctors in training. The ensuing haemorrhages were graded as follows: 1 = spot ecchymosis; 2 = lid ecchymosis involving half of the lid surface area or less; 3 = lid ecchymosis all around the eye, no increase in intraocular pressure; 4 = retrobulbar haemorrhage with increased intraocular pressure. Acetylsalicylic acid was taken by 482 (35%) patients, non-steroidal anti-inflammatory drugs by 260 (19%) and warfarin by 76 (5.5%). Lid haemorrhages (grades 1-3) were observed in 55 patients (4.0%); in 33 of these patients the haemorrhages were spotlike (grade 1). No grade 4 haemorrhages occurred. The preoperative use of acetylsalicylic acid, non-steroidal anti-inflammatory drugs or warfarin, whether or not they had been discontinued, did not predispose to haemorrhage associated with retrobulbar/peribulbar block.

Pre-Descemet's hematoma in a patient of congenital glaucoma with Descemet's detachment: a unique form of hemorrhage

A unique form of anterior segment hemorrhage called Pre-Descemet's hematoma is a previously unreported type of hemorrhage in which blood collects in the narrow space between the corneal stroma and detached Descemet's membrane, which in our case was because of congenital glaucoma associated with Haab's straie.

Traumatic asphyxia complicated by unwitnessed cardiac arrest

We report a case of traumatic asphyxia complicated by unwitnessed cardiac arrest in which the patient has made a good, functional recovery. Traumatic asphyxia is an uncommon clinical syndrome usually occurring after chest compression. Associated physical findings include subconjunctival hemorrhage and purple-blue neck and face discoloration. These facial changes can mimic those seen with massive closed head injury; however, cerebral injury after traumatic asphyxia usually occurs due to cerebral hypoxia. When such features are observed, the diagnosis of traumatic asphyxia should be considered. Prompt treatment with attention to the reestablishment of oxygenation and perfusion may result in good outcomes.

Canine monocytic ehrlichiosis presenting as acute blindness 36 months after importation into the UK

A four-year-old Labrador retriever developed sudden-onset blindness, associated with bilateral uveitis, intraocular haemorrhage and retinal detachment. It had been imported into the UK from Sardinia 36 months before presentation. Haematological abnormalities included non-regenerative anaemia, thrombocytopenia and neutropenia. Serum and urine protein electrophoresis demonstrated a monoclonal gammopathy. An immunofluorescent antibody test for Ehrlichia canis was positive, with a titre of 1:320, confirming a diagnosis of chronic monocytic ehrlichiosis. This case highlights how the prolonged subclinical phase of monocytic ehrlichiosis could enable infected dogs to enter the UK without signs of disease. Chronic monocytic ehrlichiosis should be considered in dogs which have been imported from E canis-endemic countries and present with bleeding disorders and gammopathy, even if signs develop many years after importation.