A system for classifying mechanical injuries of the eye (globe). The Ocular Trauma Classification Group

Bomb Explosion: Ocular Effects of Primary, Secondary and Tertiary Mechanisms

Purpose

To report the type and severity of ocular injuries sustained by the survivors of a bomb-loaded explosion that occurred in Mogadishu, Somalia on December 28, 2019.

Patients and Methods

The recorded data included age, gender, wounded eye, initial examination of ocular injuries and associated systemic injuries, initial visual acuity, anterior and posterior segment examinations. The type of injury (open vs closed globe), the injured zone of the globe, and the presence of a relative afferent pupil defect were evaluated in all cases where possible.

Results

After the explosion, ocular injuries were detected in 28 of 114 patients in our hospital. Thirty-two eyes of 28 patients were included in the study. The mean age was 32.4±6.7 years. The number of open-globe injuries was more than that of closed-globe injuries (26 vs 6; 81.25% vs 18.75%, respectively). Zone 1 was the most affected zone in open-globe injuries (18/26 eyes, 61.6%), followed by Zone 3 in six (23%) patients and Zone 2 in four (15.4%) patients. Sixteen open-globe injuries were laceration type (61.5%) and 10 (38.5%) were rupture type. An intraocular foreign body was detected in eight (30.8%) eyes with open-globe injuries. A total of 28 patients had 11 (39.3%) isolated eye injuries, whereas 17 (60.7%) had concomitant systemic injuries.

Conclusion

The frequency of blast-related ocular injuries is increasing. Today, the increase in the use of vehicle-borne improvised explosives in terrorist-related explosions leads to more frequent and serious ocular injuries.

Clinical Characteristics and Visual Outcomes of Patients Hospitalized for Ocular Trauma in Shandong Province, China

Purpose

To analyze the clinical characteristics and visual prognoses of patients with ocular trauma treated in Shandong Eye Hospital.

Methods

The inpatient data of patients with eye injuries hospitalized in our institution from January 2014 to December 2018 were retrospectively reviewed, including demographic information, types of trauma, causes of injury, treatment, and initial and final visual acuities.

Results

A total of 1,425 patients (1,622 eyes), aged 39.5 ± 18.5 years, were included. The ratio of male to female was 5.3 : 1. Of the mechanical eye injuries, there were 490 (34.4%) open-globe injuries and 454 (31.9%) closed-globe injuries. Nonmechanical eye injuries had 426 patients (29.9%), while 55 patients (3.9%) had adnexal injuries. Over a half of the traumas were work-related (51.1%, 728 patients). Most patients were treated with surgical intervention (1,404 eyes, 87.9%). There were significant differences in the final visual acuities between open-globe injuries and closed-globe injuries (P < 0.001), as well as between mechanical injuries and nonmechanical injuries (P < 0.001). The final visual acuity was closely correlated with the initial visual acuity (Spearman's correlation coefficient = 0.618, P < 0.001) and the OTS score (Spearman's correlation coefficient = 0.691, P < 0.001).

Conclusion

Ocular trauma usually occurs in young and middle-aged men and in the workplace in Shandong Province. The proportion of nonmechanical injuries is high, and the prognosis is poor. A comprehensive understanding of the characteristics of ocular trauma is useful for blindness prevention and treatment.

Ocular Trauma in Pediatric Age Group at a Tertiary Eye Care Center in Central Maharashtra, India

PURPOSE

To study the demographic profile and visual outcome in pediatric ocular trauma.

STUDY DESIGN

Prospective and interventional study.

SETTING

Tertiary eye care center in central Maharashtra.

MATERIALS AND METHODS

The study included all children of age group 15 years and younger sustaining eye injuries and presented to the outpatient department or emergency services. The duration of the study was 1 year. A detailed medical history was obtained. Demographic profile was noted. A detailed ocular examination included visual acuity, slit-lamp biomicroscopy, and fundus examination. All patients were followed up to 6 months.

RESULTS

Out of 350 children examined, 66 (18.9%) had ocular trauma. The mean age at presentation was 8.33 ± 4.03 years. Children aged 6-10 years (39.3%) were most commonly affected followed by children from 11 to 15 years (36.1%). There were no significant differences between rural (54.1%) and urban (45.9%) children. Most (63.9%) had open and 24.6% had closed globe injuries. Perforating injuries to the cornea (n=29, 47.5%) was the most common injury. Sports-related injuries were common (n= 18) followed by wooden stick- (n = 14) and firecracker-related (n = 11) injuries. In the open and closed globe injuries, 36 (92.3%) and 5 (33.3%) patients, respectively, required immediate surgical intervention.

CONCLUSION

Sports-related activities were a common cause of ocular trauma in the pediatric age group in the central region of Maharashtra. We propose setting of rapid action ocular trauma team to prevent blindness occurring due to trauma.

Traumatic endophthalmitis and the outcome after vitrectomy in young children

AIM

To explore the traumatic endophthalmitis in young children and the outcome of pars plana vitrectomy (PPV).

METHODS

Twenty-two eyes of 22 cases of young children consecutive pediatric traumatic endophthalmitis treated and followed up between September 2014 and May 2018 were included. Aqueous humor or vitreous samples were taken for bacterial culture and sensitivity tests. Intravitreal antibiotics (norvancomycin and ceftazidime) injection, combined with 23-gauge PPV, were administered in 22 eyes. Silicone oil (SO; 5000 centistoke) tamponade or perfluoropropane gas (C₃F₈) was used in all patients. Main outcome measures were best-corrected visual acuity (BCVA) and retinal attachment, the ratio of penetrating injury, and the existence of intraocular foreign body.

RESULTS

The mean age of patients was 6.9±2.2 (range, 3-10)y. All injured eyes suffered from penetrating ocular injury with retained intraocular foreign body in one eye. Bacterial culture was positive in only 2 eyes. The mean follow-up time was 21.1±4.7 (range, 12-30)mo. In the primary PPV, intravitreal antibiotics was administrated in all eyes, SO in 18 eyes, and C₃F₈ in 4 eyes. The secondary operation of SO removal and C₃F₈ endotamponade was performed in 16 eyes and a second SO endotamponade due to emulsification of the oil and retinal detachment (RD) was operated in 7 eyes underwent 3 to 11.5mo after primary PPV. A third operation was done in 7 eyes. The final intraocular pressure (IOP) was 8.9±1.8 (range, 6.9-11.4) mm Hg. The final BCVAs were 20/200 or better in 5, counting fingers in 2, and light perception to hand movement in 8 eyes. Whose (66.7%) had retinal injury exhibited worse BCVA (P=0.019, Fisher's exact test). Eyes underwent SO tamponade exhibited worse final BCVA than that with C₃F₈ in the primary PPV (P=0.026, Fisher's exact test).

CONCLUSION

Traumatic endophthalmitis in children is generally more severe and associated with more complicated surgical procedures. Most patients have retinal injury need multiple operations and the final BCVA is poor. Prevention of ocular trauma, especially in children, is still critical.

[Functional results and prognostic factors in open-globe ocular trauma with presenting visual acuity of no-light perception]

PURPOSE

To analyse the clinical ocular characteristics and determine prognostic factors for functional recovery in eyes presenting with no light perception (NLP) after open globe ocular trauma.

MATERIALS AND METHODS

In this retrospective study were included all the patients with no light perception after open globe trauma who presented to Amiens University Hospital between October 2014 and June 2018.

RESULTS

Fifteen eyes of 15 patients were included in this study. The main mechanism of the trauma was globe rupture (80 %, n=12). The most common location was zone III (66 %, n=10). The wound size was greater than 10mm in 9 patients (60 %). The ocular lesions included expulsion of the crystalline lens or posterior chamber intraocular lens, hyphema, retinal detachment, vitreous hemorrhage and ciliochoroidal lesions. Damage to the ciliary body was a negative prognostic factor for functional recovery (P=0.04). Nine patients remained with no light perception, whereas 6 patients experienced an improvement in visual acuity (2.3 logMAR in 3 patients, 0.7 logMAR in 1 patient, 0.4 logMAR in 1 patient and 0.2 logMAR in 1 patient). These 6 patients had undergone posterior vitrectomy due to vitreoretinal involvement (P<0.001).

CONCLUSION

In the case of open globe trauma with no light perception on presentation, a functional recovery is possible if there is no irreversible anatomical damage.

Pathophysiology and management of glaucoma and ocular hypertension related to trauma

Ocular trauma is a significant cause of blindness worldwide, particularly if associated with glaucoma. Direct damage from blunt or penetrating trauma, bleeding, inflammation, lens-related problems, orbital and brain vascular pathologies related to trauma, and chemical injuries may increase intraocular pressure and lead to traumatic glaucoma. Treatment may be as simple as eliminating the underlying cause in some conditions or management can be challenging, depending on the mechanism of damage. If proper management is not undertaken, visual outcomes can be poor. We discuss a broad spectrum of trauma-related mechanisms of intraocular pressure elevation, as well as their management.

Epidemiology and Outcomes Following Open Globe Injury in Agricultural Region, an 11-Year Experience

PURPOSE

To determine the characteristics and epidemiology of open globe injury (OGI) in a third referral centre over 11 years.

METHODS

The study was a retrospective observational study. The medical records of 978 OGI cases (a total of 998 eyes), admitted to Chiang Mai University Hospital, Thailand from January 2006 to December 2016, were reviewed.

RESULTS

The mean age (SD) of patients was 39.1 (17.5) years. Patients were predominantly male (867, 88.7%). The age with the highest incidence of injury ranged from 41 to 60 years, in both genders. Most injuries happened at the workplace (64.8%), with flying objects from electric grass trimmers (23.9%) being the major injury-related mechanism. Penetration injuries were found in 479 eyes (48.0%). In elderly group (aged >60 years), a higher proportion of a globe rupture injuries were observed (13.3%). In general, intraocular foreign body group presented with better initial visual acuity (VA) compared to other injury types (p< 0.001). In all types of injury, final VA was significantly improved after treatment. However, rupture and perforation globe injuries had significantly worse final VA outcomes, compared to penetration and intraocular foreign body injuries (p< 0.001). With multivariable regression analysis, poor initial VA (p< 0.001), type of injury (p= 0.028), positive relative afferent pupillary defect (RAPD) (p< 0.001), and endophthalmitis (p< 0.001) were associated with poor visual outcomes.

CONCLUSIONS

Work-related eye injury is a major cause of OGI. Poor initial VA, endophthalmitis, presence of RAPD, and rupture were the predictors for poor final visual outcomes.

Clinical characteristics and visual outcomes of work-related open globe injuries in Japanese patients

Purpose: To investigate the clinical characteristics and visual outcomes of patients with work-related open globe injuries (OGIs) and compare them with patients with non-work-related OGIs. Design: Retrospective, observational, multicentre, case-control study. Methods: A total of 374 patients with work-related OGIs and 170 patients with non-work-related OGIs who presented to hospitals that belong to the Japan-Clinical Research of Study group from 2005 to 2015 were included in this study. Clinical data including age, sex, initial and final visual acuity, type of open globe injury, lens status, zone of injury, wound length, and presence of proliferative vitreoretinopathy, retinal detachment, expulsive haemorrhage, and endophthalmitis were recorded. Main Outcome Measures: Visual acuity. Results Work-related OGIs were associated with younger age, male sex, better initial and final visual acuity, more laceration, smaller wounds, presence of retinal detachment, and expulsive haemorrhage, compared with non-work-related OGIs. Multiple regression analysis revealed that final visual acuity is significantly associated with initial visual acuity, wound length, and the presence of proliferative vitreoretinopathy in work-related OGIs. Conclusions: Work-related OGIs showed better visual outcomes than other OGIs. Initial visual acuity, wound length, and the presence of proliferative vitreoretinopathy are predictors of visual outcomes in patients with work-related OGIs.

An unusual case of nine cilia embedded in the retina after a perforating ocular injury

Purpose

To report an extremely rare case involving a 41-year-old man with nine intraocular cilia embedded in the retina after a perforating ocular injury caused by a metal wire. This case is particularly rare because of the number and location of the cilia.

Observations

The patient underwent an uneventful corneal suturing and extracapsular extraction of the damaged lens of his right eye. Intraocular foreign bodies were discovered following surgery and were removed at a later date. Following lens extraction and ocular repair, the patient's best-corrected visual acuity (BCVA) was counting fingers. Fundus examination during follow-up revealed several eyelashes embedded in the retina. Thirty-two days after the injury, the patient showed signs of ocular inflammation. Therefore, the patient underwent vitrectomy and intraocular foreign body removal. Nine cilia were embedded in the retina at the posterior perforation site. At the final follow-up visit, his BCVA was 20/25.

Conclusion and importance

This report describes an unusual case where intraocular cilia were embedded in the retina after a perforating ocular injury. The eyelashes caused an intraocular inflammatory reaction that subsided after their removal.

Lateral Canthotomy and Cantholysis in Operations Iraqi Freedom and Enduring Freedom: 2001-2011

PURPOSE

To describe outcomes and associated ocular injuries of lateral canthotomy and cantholysis (LCC) as performed in combat ocular trauma.

METHODS

Data from the Walter Reed Ocular Trauma Database of patients requiring LCC during Operations Iraqi Freedom and Enduring Freedom was reviewed as a retrospective cohort. Primary outcome measures included final visual acuity (VA) and Ocular Trauma Score. Secondary outcome measures were associated injuries and timing of surgery.

RESULTS

Thirty-six LCCs were recorded on a total of 890 eyes (4.04 %) in the Walter Reed Ocular Trauma Database. Eighteen out of 36 eyes (50.00%) had a final VA of the affected eye of 20/200 or worse vision. From the initial available VA measured either at the time of injury or at Walter Reed Army Medical Center, 13 eyes (40.63%) had no change in VA, 15 eyes (46.88%) had improvement, and 4 (12.5%) had a decrease in VA (n = 32, data unavailable for 4 eyes). Ocular Trauma score 0-65 was noted in 14 (38.9%) and 66-100 (61.1%). Retinal detachment (6, 16.67%), optic nerve injuries (7, 19.44%), orbital fractures (20, 55.56%), and retrobulbar hematoma (25, 69.44%) were commonly associated injuries. Of the 36 LCC, 18 (50.00%) were performed as the first surgery performed at the combat support hospital, 13 (36.11%) as the second, 4 (11.11%) as the third, and 1 (2.78%) as the fourth.

CONCLUSIONS

The largest subgroup of patients had an improvement in VA associated with performance of LCC; however, half of patients remained with a final VA of equal to or worse than 20/200 due to severe ocular trauma.

Hyphema in Open-Globe Versus Closed-Globe Injuries in Operation Iraqi Freedom and Enduring Freedom: 2001–2011

Introduction

The goal of this study is to update the incidence of hyphema in Operation Iraqi (OIF) and Enduring Freedom (OEF). We wanted to assess associated ocular injuries and final visual acuity (VA) in open-globe versus closed-globe injuries with a hyphema.

Materials and Methods

We performed a retrospective review of the Walter Reed Ocular Trauma Database (WRTOD) to identify U.S. Service members and DoD civilians with hyphema who were evacuated to Walter Reed Army Medical Center between 2001 and 2011. Primary outcome measures were the final VA and differences in concomitant ocular injuries in open-globe hyphema and closed-globe hyphema.

Results

168 of 890 eyes (18.9%) in the WROTD had a hyphema. Closed-globe injuries were noted in 64 (38.1%) eyes and open-globe injuries in 104 (61.9%) eyes. A final VA of less than 20/200 was noted in 88 eyes (51.8%). Eyes with hyphema were more likely to have traumatic cataract formation (odds ratio (OR) 6.2, 95% confidence interval (CI) 4.2–9.2, P &lt; 0.001), retinal detachment (OR 4.2, CI 2.8–6.4, P &lt; 0.001), angle recession (OR 8.1, CI 2.9–24.3, P &lt; 0.001), and final VA of less than 20/200 (OR 3.7, CI 2.6–5.4, P &lt; 0.001). Traumatic cataract formation (OR 7.4, CI 2.9–18.7, P &lt; 0.001), retinal detachment (OR 6.1, CI 2.1–17.5, P &lt; 0.001), and a final VA less than 20/200 (OR 6.1, CI 2.4–15.4 P &lt; 0.001) were statistically more likely to occur with an open-globe hyphema than with a closed-globe hyphema.

Conclusions

Close follow-up in patients with hyphema is important due to the associated development of traumatic cataract and retinal detachment and poor final visual outcome.

Optimal timing of vitrectomy for severe mechanical ocular trauma: A retrospective observational study

Mechanical ocular trauma could lead to disastrous visual outcomes. There has been a controversy regarding the timing of vitrectomy for such cases. This study aimed to find out the optimal timing of vitrectomy for severe mechanical ocular trauma. Patients with severe mechanical ocular trauma who had undergone vitrectomy were enrolled and followed up for at least 6 months. Clinical data were collected including ocular trauma score (OTS), the timing of vitrectomy upon injury, visual acuity, vitrectomy results, post-operation complications and etc. All cases were classified according to the timing of vitrectomy upon injury into 3 groups: group A 1–7 days, group B 8–14 days, group C more than 14 days. A total of 62 cases were enrolled, including 20 eyes in group A, 25 eyes in group B, and 17 eyes in group C. No significant differences were shown of the gender, age or OTS among the 3 groups. Both functional success rate and visual outcome were optimal in group B, then in group A, and worst in group C. These results suggested that the best timing of vitrectomy for severe mechanical ocular trauma is 8–14 days upon injury; second best is 1–7 days; worst is after 14 days.

Consensus Nomenclature for Reporting Neovascular Age-Related Macular Degeneration Data: Consensus on Neovascular Age-Related Macular Degeneration Nomenclature Study Group

PURPOSE

To establish a process to evaluate and standardize a state-of-the-art nomenclature for reporting neovascular age-related macular degeneration (AMD) data.

DESIGN

Consensus meeting.

PARTICIPANTS

An international panel of retina specialists, imaging and image reading center experts, and ocular pathologists.

METHODS

During several meetings organized under the auspices of the Macula Society, an international study group discussed and codified a set nomenclature framework for classifying the subtypes of neovascular AMD and associated lesion components.

MAIN OUTCOME MEASURES

A consensus classification of neovascular AMD.

RESULTS

The study group created a standardized working definition of AMD. The components of neovascular AMD were defined and subclassified. Disease consequences of macular neovascularization were delineated.

CONCLUSIONS

The framework of a consensus nomenclature system, a definition of AMD, and a delineation of the subtypes of neovascular AMD were developed. Establishing a uniform set of definitions will facilitate comparison of diverse patient groups and different studies. The framework presented is modified and updated readily, processes that are anticipated to occur on a periodic basis. The study group suggests that the consensus standards outlined in this article be used in future reported studies of neovascular AMD and clinical practice.

Clinical Results in Patients with Combined Penetrating Keratoplasty and Vitreoretinal Surgery Using Landers Wide-field Temporary Keratoprosthesis

Objectives

To evaluate the clinical results of combined pars plana vitrectomy (PPV) with Landers wide-field temporary keratoprosthesis and penetrating keratoplasty (PK).

Materials and Methods

From January 2016, traumatic eyes with coexisting corneal and vitreoretinal diseases that underwent combined keratoprosthesis/PPV/PK surgery were retrospectively evaluated. Demographic characteristics, visual acuity (VA), intraocular pressure (IOP) and clinical findings of the cornea, lens, and retina were recorded during the follow-up. Cases with clear corneal graft, attached retina, normotonic IOP, and improved or stable VA were considered successful.

Results

Eight eyes were enrolled in the study. The mean follow-up time was 21.1±8.20 months. Surgery was performed a mean of 23 (10-40) days after trauma. Preoperative VA ranged from no light perception to counting fingers from 50 cm. Postoperatively, corneal graft was clear in 5 patients (62.5%) and retina was attached in 6 eyes (75%). Chronic hypotonia developed in 3 patients (37.5%). VA was unchanged in 3 patients and improved in 5 patients. A total of 5 cases (50%) were considered successful. Shorter interval between trauma and surgery was associated with higher likelihood of success (p=0.043). No significant difference was observed between the groups in terms of type or location of trauma (p=1; p=0.143).

Conclusion

Although the functional results are not very satisfactory, the combined procedure provides a final opportunity for preserving remaining vision and anatomic reconstruction in eyes that will otherwise result in phthisis due to severe anterior and posterior segment pathologies.

Visual and Anatomic Outcomes in Perforating Ocular Injuries

Purpose

This article reports the presentation, management, and outcomes in patients suffering perforating ocular injuries.

Methods

A retrospective review was conducted at a single ophthalmology Level 1 trauma center. Patients with evidence of traumatic ocular perforation, with surgical intervention attended by a single vitreoretinal surgeon (W.F.M.), were reviewed between 2009 and 2017.

Results

Six eyes from 6 patients with perforating ocular injuries were studied. All patients were male, between ages 11 and 56 years. Perforation was the result of gunshots (3), other accidental injury (2), or surgical complication (1). Varying degrees of retinal detachments were seen in all 6 patients. Pars plana vitrectomy, with endolaser around posterior entry or exit wounds, was performed on average 21.7 ± 8.9 days from the time of injury (range, 0-58 days). In all cases with intraorbital foreign bodies, the foreign bodies were left in place. The most recent postoperative visual acuity ranged from 20/25 to counting fingers. Missile injuries tended to have poorer vision. All cases achieved full anatomic attachment at most recent follow-up. There have been no orbital complications related to retained intraorbital foreign bodies, including endophthalmitis, orbital infections, or mechanical strabismus.

Conclusion

This study demonstrates successful anatomic outcomes of 6 cases of perforating ocular injuries. Visual outcomes were variable, though missile injuries demonstrated worse prognosis, whereas several nonmissile macula-involving cases achieved quite favorable results. Although traumatic perforating injuries generally have guarded visual prognoses, favorable results may be achieved in select scenarios.

Prognostic factors associated with visual outcome of salvageable eyes with posttraumatic endophthalmitis

The purpose of this study is to evaluate the prognostic factors associated with visual outcomes in the salvageable eyes with posttraumatic endophthalmitis. We retrospectively reviewed the medical records of all patients diagnosed with posttraumatic endophthalmitis in our hospital between 2008 and 2015. The following information was collected: age, sex, etiology, past medical history, clinical manifestations, wound location, microbiology, blood leukocyte counts, types of interventions, initial visual acuities and final visual acuities. Univariate and multivariate analyses were used to explore the factors associated with final best-corrected visual acuity. In total, 98 eyes of 98 patients were included in our study. Fifty-seven eyes underwent vitrectomy, 27 of them had silicone oil tamponade, 38 eyes received intravitreal ceftazidime only and 3 eyes received intracameral ceftazidime. In univariate analysis, poor initial visual acuity, presence of intraocular foreign body, number of intravitreal injections, retinal detachment and Zone 3 injury were associated with poor visual outcome. In multivariable analysis, poor initial visual acuity, presence of intraocular foreign body and number of intravitreal injections were independently associated with poor visual outcome. The silicone oil group had fewer repeated intravitreal injections than the group without oil tamponade. We concluded that the visual outcome of salvageable eyes with posttraumatic endophthalmitis is associated with initial visual acuity, presence of intraocular foreign body and number of intravitreal antibiotic injections.

Motor Vehicle-Associated Traumatic Ocular Injuries Secondary to External Rear-Facing Sideview Mirrors: A Report of 3 Patients

Importance

Rear-facing sideview mirrors are a potentially reducible source of ocular morbidity following motor vehicle crashes.

Objective

To report cases highlighting shattered glass from sideview mirrors as a potential cause of ocular trauma in motor vehicle crashes.

Design, Setting, and Participants

Case series of 3 patients who presented to Grady Memorial Hospital, a level 1 trauma center and tertiary hospital, between May 5, 2017, and July 10, 2017, with ocular trauma as a result of shattered glass from sideview mirrors during motor vehicle crashes. A review of the literature was also conducted. Data were analyzed between July 2017 and August 2017.

Interventions or Exposures

Operation for exploration and repair of open globe in all 3 cases.

Main Outcomes and Measures

Visual prognosis and ocular morbidity postoperatively.

Results

All patients were white men in the age range of 26 to 43 years. This was a retrospective review of 3 of 208 patients who presented to Grady Memorial Hospital after motor vehicle crashes from May 5, 2017, to July 10, 2017. From the time of presentation of the 3 reported patients from Grady Memorial Hospital, all 3 had 2 surgeries inclusive of the initial open globe repair. Patients with this mechanism of injury experienced ocular morbidity, with all 3 cases resulting in uveal prolapse and 2 of 3 resulting in retinal detachments. Among the 3 patients, visual acuities after the second surgery within the first year were hand motion, 20/100, and 20/150.

Conclusions and Relevance

Sideview mirrors can be a cause of serious ocular injuries in motor vehicle crashes. These 3 reported cases, combined with cases previously reported, suggest that this mechanism of ocular injury does occur. Further studies seem warranted to investigate the frequency of these findings and whether any design modifications may help reduce the frequency.

The Vitrectomy Timing Individualization System for Ocular Trauma (VTISOT)

Ocular trauma is a major cause of monocular blindness worldwide. Vitrectomy at correct timing can significantly improve the efficacy and prognosis, but the timing of vitrectomy has remained highly controversial for decades. Trauma cases are different from each other, thus, a flexible timing system based on the details of each individual case is recommended. Unfortunately, no such a timing system is available for clinical application up to now. To establish the vitrectomy timing individualization system for ocular trauma (VTISOT), we first identified 6 independent tPVR risk factors (including Zone 3 Injury, Zone 3 retinal Laceration, Massive Vitreous Hemorrhage, Retinal Disorder, Timing of Vitrectomy and Type of Injury) by retrospective study. Then, the tPVR score was established by binary logistic regression analysis. Most importantly and critically, the vitrectomy timing individualization system for ocular trauma was established based on the identified tPVR risk factors and the tPVR score. The following evaluation of the VTISOT showed that the patients consistent with the VTISOT principles exhibited reduced tPVR incidence and better surgical results. In short, the VTISOT principles were established, which may provide a new approach to individualize the timing of vitrectomy and improve the prognosis after trauma.

Analysis of Ocular Injury Characteristics in Survivors of the 8.12 Tianjin Port Explosion, China

Introduction

On the evening of August 12, 2015, a large chemical explosion occurred at Tianjin Port. We analyzed ocular injury characteristics in the survivors of this accident.

Methods

Twenty injured eyes of 17 hospitalized patients were included. Initial best-corrected visual acuity (BCVA), injury type, injury cause, relative afferent pupillary defect (RAPD), zone of injury (ZOI), and ocular trauma score (OTS) were evaluated. Final BCVA and enucleation were the final outcome index. The relationship between risk factors and final outcomes was analyzed.

Results

The patients comprised 14 males and 3 females (mean age, 35.24 ± 12.68 years). Eighteen eyes had open-globe and 2 had closed-globe injuries. Fifteen ocular injury types were reported. Initial visual acuity (VA) was 20/50 to 20/200, 20/200 to finger counting (FC), hand motion to light perception (HM-LP), and no light perception (NLP) in 2, 7, 7, and 4 eyes, respectively. RAPD was found in 5 eyes. Most eyes sustained severe injuries with OTSs of 1 (25%) and 2 (40%). Of the injured eyes, 50% had Zone III injuries. In 95% of the injured eyes, glass was the cause of injury. Three of 4 eyes with an initial VA of NLP had a final VA of NLP and an outcome of enucleation. In 5 eyes with RAPD, 3 had a final VA of NLP and a final outcome of enucleation. Eyes with lower OTSs generally had poorer outcomes. All eyes with a final VA of NLP and an enucleation outcome had Zone III injuries. All 3 eyes with an enucleation outcome had retinal injuries, whereas eyes with no retinal injury had a better final BCVA.

Conclusions

Explosions can inflict severe ocular trauma, even indoors; 90% of injured eyes had open-globe injuries caused by glass fragments. Initial NLP, RAPD, low OTS, posterior extended wound, and retinal injury indicate a poor final outcome.

Predictors for choroidal neovascular membrane formation and visual outcome following blunt ocular trauma

Aim:

The aim of this study was to determine the predictors for choroidal neovascular membrane formation and visual outcome after blunt ocular trauma.

Methods:

Retrospective review of electronic medical records of patients with blunt ocular trauma from January 2013 to December 2016 at Narayana Nethralaya Super Speciality Eye Hospital (Bangalore, India) was done. Cases with positive macular findings were enrolled. Data such as age, sex, laterality, mode of injury, presenting and final vision, follow-up duration and retinal findings were noted.

Results:

A total of 853 cases were referred to the retina clinic with history of blunt ocular trauma. Of which, 37 cases with positive macular findings were identified. Trauma with ball (18/37, 49%) was the most common mode of injury. Choroidal rupture was seen in 33 (89%) eyes. Other retinal findings noted were as follows: retinal haemorrhages (11%), commotio retinae (22%), submacular haemorrhage (43%), macular hole (11%), epiretinal membrane (3%), macular scar (8%) and vitreous haemorrhage (4%). Choroidal neovascular membrane was noted in 6 (16%) out of 37 eyes. No retinal findings showed any positive association with choroidal neovascular membrane formation. Using Pearson’s correlation test, independent variables such as presenting visual acuity (r = 0.601, p = 0.000) and choroidal neovascular membrane formation (r = –0.356, p = 0.031) showed a strong correlation with final visual acuity.

Conclusion:

The occurrence rate of post-traumatic choroidal neovascular membranes is about 12% in eyes with choroidal rupture. Most choroidal neovascular membranes occur within 1 year of trauma. Eyes with poor presenting vision and choroidal rupture or subretinal haemorrhage warrant regular and shorter follow-up intervals for long periods to identify the choroidal neovascular membrane. Treatment with intravitreal anti-vascular endothelial growth factor therapy is useful.

Incidence, clinical profile, and short-term outcomes of post-traumatic glaucoma in pediatric eyes

Purpose:

To report the incidence, modes of injury, treatment, and short-term outcomes in eyes with post-traumatic elevated intraocular pressure (IOP).

Methods:

This was a 5-year hospital-based retrospective study of children ≤16 years who presented with open (OGI) or closed globe injury (CGI) and developed elevated IOP >21 mmHg. Those with a minimum follow up of 3 months were included. Analysis of various parameters such as influence of demographics, mode of injury, IOP, best-corrected visual acuity (BCVA), and effect of medical and surgical treatment on IOP and BCVA was done.

Results:

Out of 205 pediatric eyes with ocular trauma, 121 (59%) had CGI and the remaining 84 (41%) had OGI. Thirty-two eyes (15.6%) developed elevated IOP. The incidence of elevated IOP following CGI [25 eyes (20.6%)] was significantly higher than that following OGI [7 eyes (8.3%, P = 0.02)]. Hyphema (37.5%) and lens-related mechanisms (18.75%) were the most common causes of elevated IOP. The mean IOP at the time of diagnosis was 29.8 + 6.3 mmHg and reduced to 16.2 ± 2.2 mmHg at last follow up (P < 0.001). Surgical management was required in 12 eyes (37%) and significantly more eyes with CGI required trabeculectomy (24% in CGI vs. 0% in OGI, P = 0.03). Poor baseline vision and vitreoretinal involvement [0.67 line decrement, 95% confidence interval (CI) =0.1–1.25 lines, P = 0.025] increased risk of poor visual outcome.

Conclusion:

Post-traumatic IOP elevation occurred in 15% pediatric eyes, was more common with CGI compared to OGI and nearly one-fourth of eyes with CGI required glaucoma filtering surgery for IOP control. Overall, medical management was needed in 63% eyes and 37% required surgical management. Visual acuity was poor in eyes with OGI due to posterior segment involvement.

Epidemiology of eye injuries in a high-income developing country: An observational study

Vision loss following eye trauma is a serious health problem worldwide. The aim of the study was to report the epidemiology of eye injury that requires hospitalization and surgery at a secondary referral center in a high-income developing country so as to give recommendations regarding its prevention.All patients who had an eye injury that required surgical intervention between 2012 and 2017 at Al-Ain Hospital were retrospectively studied. Demography, cause of injury, and visual acuity before and after treatment were studied.Results revealed that 141 patients were operated, 96 eyes with open globe and 48 with other injuries. The median (IQR) age was 25 (11.5-37) years, 89% were males. Majority of injuries occurred at work (50.4%) followed by home (31.2%). Sharp objects (24.1%) and blunt trauma (16.3%) were the most common mechanism of injury. Eye injury was less during the weekends (Friday and Saturday) and during the summer vacation. Cornea injuries (48.2%) were the most frequent cause for visual acuity deterioration followed by lens/cataract (23.4%). Among injured eyes, 30 eyes (21.3%) retained intraocular foreign bodies. There was significant improvement of the visual acuity after surgery (P < .0001, Wilcoxon signed rank test).Our study has shown that eye injury is a major risk for visual loss of young people which is mainly work-related. Use of personal protective equipment for the eyes and adopting legislative eye safety regulations will reduce the impact of eye injuries in our community.

Ocular hypotony: A comprehensive review

Ocular hypotony is an infrequent, yet potentially vision-threatening, entity. The list of differential causes is extensive, involving any condition that may compromise aqueous humor dynamics or the integrity of the globe and sometimes following medical treatments or procedures. Depending on the cause and the clinical impact, treatment options aim to correct the underlying pathology and to reestablish anatomical integrity, as well as visual function. We review the pathophysiology, clinical presentation, different causes, and associated therapeutic options of ocular hypotony.

Thomas A. Swift's Electric Rifle Injuries to the Eye and Ocular Adnexa: The Management of Complex Trauma

PURPOSE

To report the ocular and adnexal injuries sustained by patients with Thomas A. Swift's electric rifles (TASER; TASER International, Scottsdale, AZ), review the literature, and discuss the management of this complex trauma.

DESIGN

Multicenter, retrospective case series and literature review.

PARTICIPANTS

Seventeen eyes of 16 patients (5 eyes of 5 patients treated at 3 institutions, and 12 eyes of 11 previously reported cases).

METHODS

The clinical data of 17 eyes were pooled. Spearman's correlation coefficient was used to assess the association between the extent of TASER injury and patient outcomes.

MAIN OUTCOME MEASURES

Extent of TASER injury (zone of injury, penetrating vs. perforating) and association with patient outcomes (visual acuity [VA] and retinal detachment [RD]).

RESULTS

In our cohort, 4 patients were transported by law enforcement and 1 was transferred from a community hospital. Four patients were taken to the operating room for TASER removal and globe repair; 1 patient underwent removal in the emergency room. Of 17 pooled cases, 12 (71%) involved open-globe injury. Of these, there was a high rate of zone 3 injuries (100%; n = 12) and a high incidence of RD (73%; 8 of 11, eviscerated eye excluded). Among patients with closed-globe injury (n = 5), 1 patient demonstrated exudative RD and 1 patient demonstrated retinal dialysis with RD. Of 10 patients with RD, 1 (10%) achieved resolution with monitoring (exudative RD); 1 (10%) underwent cryopexy and pneumatic retinopexy; 3 (30%) underwent vitrectomy, and 5 (50%) with poor prognosis did not undergo vitreoretinal surgery. In the 3 patients who underwent vitrectomy, all 3 (100%) demonstrated redetachment resulting from proliferative vitreoretinopathy and required additional surgery. Visual acuity on presentation was significantly correlated with final VA (ρ = 0.783; P = 0.02). Men (94%) were more likely than women (6%) to sustain TASER trauma. Median age was 26 years. There was a 50% rate of loss to follow-up.

CONCLUSIONS

Thomas A. Swift's electric rifle injuries to the eyes or ocular adnexa represent complex trauma. Zone 3 injuries are common. The visual prognosis is guarded, and eyes may require multiple surgeries to preserve vision. Patients are at high risk for loss to follow-up by way of incarceration.

Intraocular application of Mitomycin C to prevent proliferative vitreoretinopathy in perforating and severe intraocular foreign body injuries

AIM

To assess the long-term anatomical and functional outcomes in addition to complications of a new surgical technique of localized intraocular application of mitomycin C (MMC) to prevent proliferative vitreoretinopathy (PVR) in eyes with open globe trauma.

METHODS

Prospective non-comparative interventional case series of 16 consecutive eyes with perforating and deep choroidal impact foreign body injuries presenting over a 2-year period. Patients underwent vitrectomy with intraocular application of MMC at the site of the chorioretinal injury and were followed-up for 1 year. The primary outcome measure was the rate of postoperative PVR. Secondary outcome measures were number of vitreoretinal surgeries (VRS) required, best corrected visual acuity (BCVA), final anatomical success rate and globe survival rate (GSR).

RESULTS

Patients underwent VRS at a mean time of 8.5 ± 4.6 days after the injury. Postoperative PVR developed in 2 (13 %) eyes and required only one additional VRS each. One other eye underwent further peeling of an epimacular membrane. BCVA improved from mean LogMAR 3.08 ± 0.72 preoperatively to 0.66 ± 0.79 at 1 year. All 10 eyes without a macular injury had a final BCVA of LogMAR 0.40 or better. The final anatomical success rate was 94% and GSR rate was 100%. There were no complications related to the intraocular use of MMC.

CONCLUSIONS

Vitrectomy and intraocular application of Mitomycin C may have a potential role in reducing the rate of post traumatic PVR and improving anatomical and functional outcomes in eyes with perforating and deep choroidal impact foreign body injuries.

Enucleations and Eviscerations for Combat Ocular Trauma Performed During Operations Iraqi and Enduring Freedom: 2001 to 2011

PURPOSE

To describe the demographics and clinical outcomes of patients who underwent posttraumatic enucleation or evisceration during Operations Iraqi Freedom (OIF) and Enduring Freedom (OEF) from 2001 to 2011.

METHODS

The Walter Reed Ocular Trauma Database is a retrospective case series of US Servicemembers and Department of Defense civilians who had combat ocular injuries in OIF and OEF. Data regarding posttraumatic enucleations and eviscerations performed during OIF and OEF were extracted. The main outcomes analyzed were the number of enucleations and eviscerations performed, location of the surgery, laterality, and graft type. The secondary outcome measures included: mechanism of injury and Ocular Trauma Score classification.

RESULTS

One hundred nine enucleations and eviscerations were performed on the 890 eyes (12.24%). Sixty-three (57.80%) primary enucleations, 36 (33.03%) secondary enucleations, 5 (4.59%) postretinal detachment repair enucleations, and 5 (4.59%) primary eviscerations were completed. The surgeries were completed at a combat support hospital (57; 52.3%), or Walter Reed Army Medical Center (49; 45.0%). All surgeries were unilateral except in 2 patients. The most common graft type used was silicone (n = 56; 51.38%). Improvised explosive devices caused 76 (69.72%) eye injuries. Ocular Trauma Score were recorded as 56 (51.38%) between 0 and 44, 44 (40.37%) between 45 and 65, and unknown in 9 (8.26%).

CONCLUSION

Posttraumatic enucleation or evisceration due to devastating ocular trauma is required in about 15% of ophthalmic patients in modern combat trauma. The psychosocial impact on veterans who have required an enucleation or evisceration from combat trauma has been poorly studied and requires further review.

Traumatic hyphaema in children: a retrospective and prospective study of outcomes at an Australian paediatric centre

Objective

This study aims to evaluate the presenting characteristics, management, outcomes and complications for paediatric traumatic hyphaema in Western Australia.

Methods and Analysis

A retrospective review of medical records was conducted for consecutive patients ≤16 years of age admitted for traumatic hyphaema to Princess Margaret Hospital for Children (Perth, Australia) between January 2002 and December 2013 (n=82). From this sample, a cohort whose injury occurred ≥5 years prior attended a prospective ocular examination (n=16). Hospital records were reviewed for patient demographics, injury details, management, visual outcomes and complications. The prospective cohort underwent examination for visual and structural outcomes.

Results

Most injuries (72%) resulted from projectile objects. Angle recession was present in 53% and was associated with projectiles (p=0.002). Most eyes (81%) achieved a final visual acuity of 0.3 logarithm of the minimum angle of resolution (logMAR) (20/40) or better. Age ≤5 years and posterior segment injury were significant predictors of final visual acuity poorer than 0.3 logMAR. At ≥5 years post-trauma, injured eyes had greater intraocular pressure (IOP) (p=0.024) and anterior chamber depth (ACD) (p=0.022) compared with sound eyes. IOP asymmetry was associated with angle recession (p=0.008) and ACD asymmetry (p=0.012).

Conclusion

Poorer visual outcomes are associated with younger age at injury and posterior segment injury. Angle recession and ACD asymmetry are associated with IOP asymmetry 5-12 years after injury.

Effect of time to primary repair on final visual outcome after open globe injury

BACKGROUND/AIM

Historic data suggest that open globe injuries should be repaired within 12-24 hours to reduce the risk of endophthalmitis. However, endophthalmitis is uncommon when systemic antibiotic prophylaxis is given. It is not clear whether delayed primary repair impacts visual outcomes in other ways or what is the optimum time to repair. We aimed to examine the effect of time to primary repair on visual outcomes.

METHODS

This is a retrospective comparative case series including all open globe injuries presenting to the Birmingham Midland Eye Centre between 1 January 2014 and 15 March 2016. Presenting features, mechanism of injury, visual acuity at 6-12 months and demographic data were examined.

RESULTS

56 open globe injuries were repaired, of which sufficient data for analysis were available on 52 cases. The mean time to primary repair was 1 day after injury (range 5 hours to 7 days). Final visual acuity at 6-12 months was related to the presenting visual acuity and the Ocular Trauma Score and to the time between injury and primary repair, with a reduction in predicted visual acuity of logarithm of the minimum angle of resolution of 0.37 for every 24 hours of delay (95% CI 0.14 to 0.6).

DISCUSSION

Open globe injuries should be repaired promptly. Presenting visual acuity remains the strongest predictor of outcome; however, delay to primary repair also reduced final visual acuity, and any significant delay from injury to repair is likely to negatively impact final visual outcome.

Pediatric open-globe injury in a university-based tertiary hospital

BACKGROUND

To investigate epidemiology, etiology, and outcomes after repair of pediatric open-globe injury.

METHODS

We retrospectively reviewed medical records of patients ⩽18 years who underwent primary open-globe repair.

RESULTS

A total of 213 patients were identified. Male-female ratio was 1.44:1. Type of injury was penetration in 157 (74.4%) cases, rupture in 52 (24.4%) cases, and perforation in 2 (0.9%) cases. Knife injuries were the most common cause, affecting 38/196 (19.4%), followed by metallic object in 37/196 (18.9%) patients, glass in 26/196 (13.3%) patients, and pen or pencil in 24/196 (12.8%). Predictors of good visual outcome defined as (⩾20/40) were good initial visual acuity (⩾20/40; p < 0.0001), time from injury to arrival at the emergency room >24 h (p = 0.038), size of wound less than 10 mm (p < 0.0001), absence of iris prolapse (p < 0.0001), deep anterior chamber at presentation (p < 0.0001), absence of hyphema (p = 0.043), intact lens (p < 0.0001), and no retinal detachment during follow-up (p < 0.0001). A total of 27 (12.7%) cases were documented to have retinal detachment at any time during follow-up period. Predictors of retinal detachment were perforation and rupture (p < 0.0001), whereas penetration was not associated with development of retinal detachment, size of the wound ⩾10 mm (p < 0.0001), initial visual acuity ⩽20/200 (p < 0.0001), lens injury (p < 0.0001), and development of endophthalmitis (p < 0.027). Eight (3.7%) eyes had the clinical diagnosis of posttraumatic endophthalmitis.

CONCLUSIONS

The most common type of injury was penetration and the most common tool was knife. Visual outcome was affected by the initial presentation. Retinal detachment was a significant predictor of a worse final visual outcome.

Visual and ocular morbidity in severe open-globe injuries presenting to a regional eye centre in New Zealand

IMPORTANCE

Open-globe injuries (OGI) are a leading cause of monocular blindness world-wide with considerable cost to the individual and society.

BACKGROUND

To characterize the epidemiology, severity and outcomes of OGI treated at a major ophthalmology centre in New Zealand.

DESIGN

Retrospective study.

PARTICIPANTS

A total of 385 eyes of 381 patients over a 10-year period.

METHODS

Eligible patients were identified using diagnosis and surgery codes on hospital discharge summaries. Clinical notes were reviewed to determine patient demographics, injury details, treatments and outcomes.

MAIN OUTCOME MEASURES

Complications of injury, visual acuity at 3 months and final follow-up, and final status of the eye.

RESULTS

The estimated annual incidence of OGI was 2.8 per 100 000. Working-age males predominated but age at injury ranged from 9 months to 90 years. Maori and Pacific peoples were over-represented. Injuries were severe with 58.7% presenting with vision of hand movements or worse. Penetrating injuries (56.4%) were most common, followed by globe ruptures (35.6%). Major complications included retinal detachment (15.8%), enucleation/evisceration (9.1%), phthisis bulbi (9.9%), endophthalmitis (2.6%) and sympathetic ophthalmia (0.26%). Despite the injury severity, 46% of eyes achieved final BCVA of ≥6/12. The Ocular Trauma Score (OTS) was a useful prognostic tool for stratifying severity of injury and predicting visual outcome (Fisher's exact test P < 0.001).

CONCLUSIONS AND RELEVANCE

The incidence and severity of OGI in NZ are comparable to global statistics. Surgical repair can effectively recover vision, predicted well by the OTS. We identified at-risk groups to target with education and prevention strategies.

Prognostic factors for open-globe injuries: variables for poor visual outcome

PURPOSE

To determine prognostic factors for open-globe Injuries (OGI).

METHODS

Open-globe injuries referred to a tertiary referral clinic in Turkey between January 1998 and January 2016 were retrospectively analyzed. Univariate and multivariate logistic regression analyses were conducted to find out the most important variables for poor visual outcome.

RESULTS

Six hundred and thirty-three patients were studied with an average age of 24.37 ± 11.1 years (range 1-80).The male/female ratio was 18.6/1. Most of the cases (48.2%) were conflict related, whereas the rate of work, accidental, and sports related cases were (33.1%), (17.9%) and (0.01%), respectively. Final visual acuity (VA) ranged from no perception of light (23%) to 200/200 (17.1%). The number of cases with a final VA > 20/200 were 388 (49.3%). Initial visual acuity < 20/200, ocular trauma score category 1, zone 3 injury, additional vitrectomy surgery, and lens damage were found to be the main variables related with poor visual outcome in multivariate logistic regression analysis.

CONCLUSION

Besides ocular trauma score category and initial VA; zone of injury, additional surgeries, and initial lens damage had negative effects on visual outcome in OGI.

Ophthalmic Injuries Related to Maxillofacial Trauma Due to Urban Warfare

: Midfacial trauma commonly causes ocular injuries of varying degrees. Eye injuries account for approximately 10% of all battle injuries. Severity of injuries may range from a subconjunctival haemorrhage to optic nerve injury and globe laceration and rupture.

AIM OF STUDY

Is to evaluate the associated ophthalmic injuries in maxillofacial trauma due to war and to emphasize the need for proper ophthalmic examination to exclude and manage any associated ophthalmic injuries.

MATERIALS AND METHODS

A total of 66 patients with maxillofacial trauma due to war were considered in this study and underwent classification of the fractures to know patterns of fractures and to specify the ophthalmic injuries which might be associated with each fracture. Referral to ophthalmologist was considered to determine the exact nature of ophthalmic injuries. Results by a maxillofacial surgeon and ophthalmologist were evaluated.

RESULTS

Midfacial trauma particularly those associated with zygomatic bone fracture was highly significant due to blast and bullets can lead to serious ophthalmic injuries. This was related to 57% of ophthalmic injuries. The related ocular injuries which were subconjunctival hemorrhage and the rupture or lacerated eye globe found to be highly significant war injuries while the preretinal hemorrhage and diplopia were significant.

CONCLUSION

A thorough proper ophthalmic examination should be carried out for every patient with these fractures and suspected cases should be placed under close observation so that immediate and active treatment can be taken if necessary.

Intraocular Foreign Body Trauma in Operation Iraqi Freedom and Operation Enduring Freedom: 2001 to 2011

PURPOSE

We update the incidence of intraocular foreign bodies (IOFB) in soldiers admitted to Walter Reed Army Medical Center from 2001 to 2011 after sustaining combat injuries in Operation Iraqi Freedom and Operation Enduring Freedom.

DESIGN

This consecutive retrospective case series included 890 eyes of 652 patients.

METHODS

Data were collected in the Walter Reed Ocular Trauma Database. Inclusion criteria were any American soldier or Department of Defense civilian with an IOFB injured in Operation Iraqi Freedom/Operation Enduring Freedom. Closed globe injuries with orbital foreign bodies, injury outside of a combat zone, or non-Department of Defense civilian trauma were the exclusion criteria.

MAIN OUTCOME MEASURES

Primary outcome measures were final visual outcome and the number, size, and location of IOFBs. Secondary outcome measures included surgical procedures, use of eye protection, associated complications, source of injury and Ocular Trauma Score.

RESULTS

There were 890 eye injuries in 652 patients evacuated to Walter Reed Army Medical Center between 2001 and 2011. IOFBs were found in 166 eyes of 149 patients (18.6%; 95% confidence interval [CI], 16.2%-21.3%). Most patients had a single IOFB (80.7%). An IOFB was positively associated with Ocular Trauma Score grade 1 or 2 (0-65) injuries (odds ratio [OR], 1.58; 95% CI, 1.07-2.38; P = 0.01). There were 130 eyes (78.33%) that had recorded time from initial visual acuity to final visual acuity and it ranged from 8 to 2421 days (mean, 433.24 days). Thirty-eight (25.16%; 95% CI, 18.89%-32.67%) eyes had no change in visual acuity, 98 (64.90%; 95% CI, 57.00%-72.07%) had improved visual acuity, and 15 (9.93%; 95% CI, 6.01%-15.84%) had decreased visual acuity. IOFB was not found to predict final visual acuity of <20/200 in multivariate analysis when other injury features were known (P = 0.1). Pars plana vitrectomy was completed on 124 eyes (74.70%). Removal of IOFB was performed in 118 eyes (71.08%; average of 31.67 days after initial injury) with a delayed procedure occurring after primary closure and antibiotics owing to a lack of surgical capacity in Iraq and Afghanistan. Retinal detachment occurred in 48 eyes (28.92%) and proliferative vitreoretinopathy in 44 eyes (26.5%).

CONCLUSIONS

IOFBs occur frequently in combat ocular trauma and are significantly associated with more severe injuries. However, IOFBs were not found to be a significant risk factor for visual acuity of <20/200.

Clinical Features and Surgical Outcomes of Posterior Segment Intraocular Foreign Bodies in Children in East China

Purpose

To report the long-term follow-up results of posterior segment intraocular foreign body (IOFB) removal in children and to determine the prognostic factors for visual outcome.

Methods

Design: retrospective, noncomparative, interventional case series; a single tertiary care center study. Participants or samples: eleven eyes (11 patients) under 16 years of age with posterior segment IOFB injuries from May 2014 to November 2017. Main outcome measures: clinical features of injury, visual acuity, and complications.

Results

The mean age was 6.8 years, and the mean follow-up was 20.2 months. The main IOFB sources were accidental penetration of the eye by materials in the playground (6 cases) or by pencil lead at school (4 cases). The mean IOFB size was 3.8 (range 1–6) mm. At the last visit, the visual acuities were 20/40 or better in 40.0% of patients and better than 20/200 in 70.0%. Poor visual outcome was correlated with intraoperative rhegmatogenous retinal detachment (P=0.0083). Postoperative complications included elevated transient intraocular pressure, retinal redetachment, and secondary glaucoma.

Conclusions

The clinical features of pediatric posterior segment IOFBs suggest insufficient awareness of such injuries both on the playground and at school. Visual outcomes from surgical treatment were relatively favorable in this series.

Visual outcomes and prognostic factors in open-globe injuries

BACKGROUND

Ocular trauma is an important cause of visual loss worldwide. Improvements in our knowledge of the pathophysiology and management of ocular trauma during the past 30 years, in conjunction with advances in the instrumentation and techniques of ocular surgery, have improved the efficacy of vitreoretinal surgery in injured eyes. The aim of the current study was to determine the visual outcomes and prognostic factors of open-globe injuries in the Japanese population.

METHODS

Retrospective study of 59 eyes of 59 patients presented with open globe injuries between September 2008 and March 2014 at Nagasaki University Hospital was conducted. Demographic factors including age, gender, and clinical data such as cause of injury, presenting visual acuity (VA), location of injury, type of injury, lens status, presence of intraocular foreign body, types of required surgeries, and final VA were recorded. According to the classification of Ocular Trauma Classification Group, wound location was classified into three zones. Chi-square test was used to compare presented data.

RESULTS

Out of the 59 patients, 46 were placed in the Light Perception (LP) group, and 13 were placed in the No Light Perception (NLP) group. Work-related trauma was the most common cause (27 eyes) followed by falls (19eyes). Work-related trauma was common in males (P = 0.004), while falls was significantly common in females (P = 0.00001). Zone III injuries had statistically significantly poor prognostic factor compared to other zones (P = 0.04). All cases of NLP group (100%) presented with rupture globe. Poor VA at first visit (P = 0.00001), rupture globe (P = 0.026), history of penetrating keratoplasty (PK) (P = 0.017), retinal detachment (RD) (P = 0.0001), vitreous hemorrhage (VH) (P = 0.044), and dislocation of crystalline lens (P = 0.0003) were considered as poor prognostic factors.

CONCLUSION

Poor VA at first visit, rupture globe, zone III injuries, history of penetrating keratoplasty, RD, VH, and dislocation of crystalline lens were found to be poor prognostic factors. PPV had a good prognostic value in open globe injuries associated with posterior segment involvement.

Pediatric ocular trauma caused by recreational drones: two case reports

Drones are increasingly being used by children and adults recreationally and commercially. The propeller blades when spinning at high speeds may cause serious harm to the eye and orbital structures. We report 2 cases of injuries to the eye and orbital structures caused by drones.

Prophylactic intravitreal antibiotics reduce the risk of post-traumatic endophthalmitis after repair of open globe injuries

PURPOSE

To investigate efficacy of prophylactic intravitreal antibiotics in reducing incidence of endophthalmitis after repair of open globe injuries. At King Abdulaziz University Hospital, a standard protocol of intravenous vancomycin and ceftazidime was used in all cases.

METHODS

Charts of 353 patients who presented between January 2010 and January 2014 with open globe injury were retrospectively reviewed. In addition, the standard protocol in this cohort included prophylactic intravitreal antibiotics in high-risk cases at time of primary repair. High-risk cases were identified based on the presence of one or more of the following risk factors: dirty wound, retained intra-ocular foreign body (IOFB), rural setting, delayed primary repair of >24 hr and ruptured lens capsule. Rate of endophthalmitis in this recent cohort was compared with that of a previous cohort admitted for primary repair between May 1996 and May 2008 (641 patients). In the previous cohort, protocol did not include prophylactic intravitreal antibiotics.

RESULTS

Rates of clinically suspected endophthalmitis and culture-positive endophthalmitis were higher in previous cohort (24 of 641 eyes; 3.7% and 12 of 641 eyes; 1.9%, respectively) compared to recent cohort (six of 353 eyes; 1.7% and two of 353 eyes; 0.6%, respectively). In high-risk groups, rates of suspected endophthalmitis and culture-positive endophthalmitis were higher in previous cohort (19 of 345 eyes; 5.5% and 12 of 345 eyes; 3.5%, respectively) compared to the recent cohort (five of 200 eyes; 2.5% and two of 200 eyes; 1.0%, respectively).

CONCLUSION

Prophylactic intravitreal antibiotics reduce risk of endophthalmitis after repair of open globe injuries.

Optical Coherence Tomography Examination of the Anterior Segment in a Case of Corneal Perforation and Lens Trauma by Chestnut Burr

Chestnut burrs, the thorny encapsulation of chestnut fruit, can sometimes cause corneal injuries and ulceration, with poor prognoses. We report a case of corneal perforation and damaged anterior lens capsule due to a chestnut burr, using anterior segment optical coherence tomography (AS-OCT). A 67-year-old woman with a chestnut burr injury in her right eye was referred to our hospital. Her right best-corrected visual acuity (BCVA) was 0.8. Slit-lamp examination and AS-OCT showed perforation involving the endothelial layer at the center of the cornea. The iris and anterior lens capsule were damaged. Cell infiltration was observed around the wound. Bacterial examination showed gram-positive cocci but no fungi. The patient was diagnosed with a corneal perforation and bacterial keratitis. Levofloxacin 1.5% and cefmenoxime treatments were initiated and a soft contact lens was placed to seal the wound. On day 3, there was no improvement in the corneal cell infiltration, but AS-OCT suggested that the inner wound had closed. A culture test revealed the presence of Propionibacterium acnes, which was sensitive to both levofloxacin and cefmenoxime. Therefore, we continued the same antibiotic treatment. On day 26, the opacification and cell infiltration at the center of the cornea had improved. AS-OCT showed healing of the corneal wound with reduction in the central corneal thickness. Her BCVA improved to 1.0. AS-OCT was a valuable tool to noninvasively observe wound shape and detect the presence of any intracorneal foreign bodies.