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McMaster D, Bapty J, Bush L, Serra G, Kempapidis T, McClellan SF, Woreta FA, Justin GA, Agrawal R, Hoskin AK, Cavuoto K, Leong J, Ascarza AR, Cason J, Miller KE, Caldwell MC, Gensheimer WG, Williamson TH, Dhawahir-Scala F, Shah P, Coombes A, Sundar G, Mazzoli RA, Woodcock M, Watson SL, Kuhn F, Colyer M, Gomes RSM, Blanch RJ. Early versus Delayed Timing of Primary Repair after Open-Globe Injury: A Systematic Review and Meta-analysis. Ophthalmology 2024:S0161-6420(24)00528-1. [PMID: 39218161 DOI: 10.1016/j.ophtha.2024.08.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Revised: 08/12/2024] [Accepted: 08/26/2024] [Indexed: 09/04/2024] Open
Abstract
TOPIC The timing of primary repair of open-globe injury is variable in major trauma centers worldwide, and consensus on optimal timing is lacking. CLINICAL RELEVANCE Surgery is the mainstay of open-globe injury management, and appropriate timing of surgical repair may minimize the risk of potentially blinding complications such as endophthalmitis, thereby optimizing visual outcomes. METHODS A systematic literature review was performed following Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines (International Prospective Register of Systematic Reviews identifier, CRD42023442972). The Cochrane Central Register of Controlled Trials, MEDLINE, Embase, and ISRCTN registries and ClinicalTrials.gov were searched from inception through October 29, 2023. Prospective and retrospective nonrandomized studies of patients with open-globe injury with a minimum of 1 month of follow-up after primary repair were included. Primary outcomes included visual acuity at last follow-up and the proportion of patients with endophthalmitis. Certainty of the evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach. RESULTS Fifteen studies met inclusion criteria, reporting a total of 8497 eyes. The most common injury types were penetrating and intraocular foreign body (IOFB). Meta-analysis found that primary repair less than 24 hours after open-globe injury was associated with 0.30 odds of endophthalmitis compared with primary repair conducted more than 24 hours after trauma (odds ratio, 0.39; 95% confidence interval [CI], 0.19-0.79; I2 = 95%; P = 0.01). No significant difference was found in reported visual outcomes between patients whose open-globe injuries were repaired more than, compared with less than, 24 hours after trauma (odds ratio, 0.89; 95% CI, 0.61-1.29; I2 = 70%; P = 0.52). All included studies were retrospective and nonrandomized, demonstrating an overall low certainty of evidence on GRADE assessment. DISCUSSION Only retrospective data exist around the effect of timing of open-globe repair, resulting in low certainty of the available evidence. However, this review of current evidence, predominantly including penetrating and IOFB injuries, suggests that primary repair performed less than 24 hours after open-globe injury is associated with a reduced endophthalmitis rate compared with longer delays, consistent with delay to primary repair increasing endophthalmitis risk. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
| | - James Bapty
- Portsmouth Hospitals University NHS Trust, Portsmouth, United Kingdom
| | - Lana Bush
- Neuroscience and Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom
| | - Giuseppe Serra
- Department of Medicine, University of Udine, Udine, Italy; Northern Hub for Veterans and Military Families Research, Northumbria University, Newcastle, United Kingdom
| | | | - Scott F McClellan
- Vision Center of Excellence, Research & Development Directorate (J-9), Defense Health Agency, Silver Spring, Maryland
| | - Fasika A Woreta
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Grant A Justin
- Uniformed Services University of the Health Sciences, Bethesda, Maryland; Department of Ophthalmology, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Rupesh Agrawal
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Republic of Singapore; Singapore Eye Research Institute, Singapore, Republic of Singapore; Lee Kong Chian School of Medicine, Singapore, Republic of Singapore; Duke NUS Medical School, Singapore, Republic of Singapore
| | - Annette K Hoskin
- Save Sight Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Lions Eye Institute, University of Western Australia, Perth, Australia
| | - Kara Cavuoto
- Bascom Palmer Eye Institute, University of Miami, Miami, Florida
| | | | | | - John Cason
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Kyle E Miller
- Uniformed Services University of the Health Sciences, Bethesda, Maryland; Department of Ophthalmology, Navy Medical Center Portsmouth, Portsmouth, Virginia
| | - Matthew C Caldwell
- Department of Ophthalmology, San Antonio Uniformed Services Health Education Consortium, San Antonio, Texas
| | - William G Gensheimer
- White River Junction Veterans Administration Medical Center, White River Junction, Vermont; Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Tom H Williamson
- Department of Engineering and Biological Sciences, University of Surrey, Surrey, United Kingdom; Department of Ophthalmology, St Thomas' Hospital, London, United Kingdom
| | | | - Peter Shah
- Birmingham Institute for Glaucoma Research, Birmingham, United Kingdom; Ophthalmology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Andrew Coombes
- Department of Ophthalmology, The Royal London Hospital, London, United Kingdom
| | - Gangadhara Sundar
- Department of Ophthalmology, National University Hospital, Singapore, Republic of Singapore
| | - Robert A Mazzoli
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Malcolm Woodcock
- Worcestershire Acute Hospitals NHS Trust, Worcester, United Kingdom
| | - Stephanie L Watson
- Save Sight Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Sydney Eye Hospital, Sydney, Australia
| | - Ferenc Kuhn
- Helen Keller Foundation for Research and Education, Birmingham, Alabama; Department of Ophthalmology, University of Pécs Medical School, Pécs, Hungary
| | - Marcus Colyer
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Renata S M Gomes
- Northern Hub for Veterans and Military Families Research, Northumbria University, Newcastle, United Kingdom; BRAVO VICTOR, London, United Kingdom
| | - Richard J Blanch
- Neuroscience and Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom; Ophthalmology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, United Kingdom.
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Blanch RJ, McMaster D, Patterson TJ. Management of open globe injury: a narrative review. Eye (Lond) 2024:10.1038/s41433-024-03246-3. [PMID: 39085596 DOI: 10.1038/s41433-024-03246-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 06/04/2024] [Accepted: 07/11/2024] [Indexed: 08/02/2024] Open
Abstract
Open globe injuries are a significant global cause of visual loss, including unilateral and bilateral blindness. Prognosis is predicted by injury severity, with lower presenting visual acuity and more posterior injuries associated with poor visual outcomes, although even the most severely injured eyes with no perception of light vision may regain some visual function. In addition to severity of the primary injury, the secondary injuries and complications causing poor outcomes include proliferative vitreoretinopathy (PVR) and endophthalmitis. Endophthalmitis is common after open globe injury, affecting up to 16.5% of patients. Systemic antibiotic prophylaxis is commonly used, with a limited evidence base, while intraocular antibiotics are less commonly used but have stronger supporting evidence of efficacy. Endophthalmitis rates are also reduced by prompt primary repair, which may also support recovery of visual acuity. PVR is not prevented or treated by any pharmacologic interventions in current clinical practice, but the incidence of post-traumatic PVR may be reduced by early vitrectomy within the first 4-7 days after injury. Ocular trauma training is often limited in Western ophthalmic surgical training programmes, and patients with ocular trauma often require the input of multiple subspecialists. In this context, it is important that patients have an overview and coordination of the different aspects of their care, with ownership by one lead clinician.
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Affiliation(s)
- Richard J Blanch
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK.
- Research and Clinical Innovation, Royal Centre for Defence Medicine, Birmingham, UK.
- Department of Ophthalmology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
| | | | - Tim J Patterson
- Northern Ireland Medical and Dental Training Agency, Belfast, UK
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Viswanathan M, Gu W, Blanch RJ, Groves LL. Cataracts after Ophthalmic and Nonophthalmic Trauma Exposure in Service Members, U.S. Armed Forces. Mil Med 2024; 189:e1009-e1015. [PMID: 37930775 DOI: 10.1093/milmed/usad414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 08/11/2023] [Accepted: 10/06/2023] [Indexed: 11/07/2023] Open
Abstract
ABSTRACT IntroductionWe aimed to identify injury-related risk factors for secondary cataract incidence after eye and brain injury and polytrauma. We also examined the effect of direct and indirect eye injury management on cataract diagnosis and treatment. Prevention or mitigation strategies require knowledge of the causes and types of combat injuries, which will enable more appropriate targeting of resources toward prevention and more efficient management of such injuries. MATERIALS AND METHODS Data were gathered from the Military Health System using the Military Health System Management and Analysis Reporting Tool (M2) between 2017 and 2021 from inpatient and outpatient Service Members (SMs) (active duty and National Guard). The date of the first cataract diagnosis was tracked to estimate the annual incidence rate, and it was longitudinally linked to any prior diagnosis of ocular trauma (OT), traumatic brain injury (TBI), or polytrauma to calculate the relative risk. International Classification of Disease codes, 10th Revision, were used to identify those diagnosed with cataracts, TBI, and polytrauma. Defense and Veterans Eye Injury and Vision Registry data were used to examine SMs who sustained ocular injuries from 2003-2020 and who may have had cataract surgery following a cataract diagnosis. RESULTS The relative risk of traumatic cataract formation from OT, TBI, and polytrauma are 5.71 (95% CI, 5.05-6.42), 2.32 (95% CI, 2.03-2.63), and 8.95 (95% CI, 6.23-12.38), respectively. Traumatic cataracts in SMs more commonly result from open-globe injuries (70%) than closed-globe injuries (30%). By specific sub-injury type, traumatic cataracts occur most frequently from intraocular foreign bodies (22%). More than 400 patients in the cohort suffered from TBI and traumatic cataracts, more than 300 from OT and cataracts, and more than 20 from polytrauma and cataracts. The battlefield is the riskiest environment for trauma exposure, with 62% of OT occurring in combat. There was a statistically significant difference between the mean visual acuity value before cataract surgery (M = 1.17, SD = 0.72) and the mean visual acuity value after cataract surgery (M = 0.44, SD = 0.66, P < .001). CONCLUSION Traumatic cataracts often occur in SMs who sustain ocular injuries. New to the literature is that relationships exist between traumatic cataract formation and nonglobe trauma, specifically TBI and polytrauma. Ocular injury calls for an ophthalmic examination. A low threshold should exist for routine ocular exam consultation in the setting of TBI and polytrauma. Separately, polytrauma patients should undergo a review of systems questions, particularly questions about the ocular and visual pathways. A positive response to screening warrants further investigation of possible ocular pathology, including traumatic cataract formation. Cataract surgery is an effective treatment in improving the vision of SMs who suffer from traumatic cataracts. Constant effort must be made to limit occurrences of occupation-related traumatic cataracts.
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Affiliation(s)
- Mariia Viswanathan
- Vision Center of Excellence, Defense Health Agency, Research and Engineering, Bethesda, MD 20889-5629, USA
| | - Weidong Gu
- Vision Center of Excellence, Defense Health Agency, Research and Engineering, Bethesda, MD 20889-5629, USA
| | - Richard J Blanch
- Academic Department of Military Surgery and Trauma, Royal Centre for Defense Medicine, Birmingham B15 2GW, UK
- Ophthalmology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2GW, UK
- Neuroscience and Ophthalmology, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TH, UK
| | - Lucas L Groves
- Blanchfield Army Community Hospital, US Army, Fort Campbell, KY 42223, USA
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Patterson TJ, McKinney D, Ritson J, McLean C, Gu W, Colyer M, McClellan SF, Miller SC, Justin GA, Hoskin AK, Cavuoto K, Leong J, Ascarza AR, Woreta FA, Miller KE, Caldwell MC, Gensheimer WG, Williamson T, Dhawahir-Scala F, Shah P, Coombes A, Sundar G, Mazzoli RA, Woodcock M, Kuhn F, Watson SL, Gomes RSM, Agrawal R, Blanch RJ. The Use of Preoperative Prophylactic Systemic Antibiotics for the Prevention of Endopthalmitis in Open Globe Injuries: A Meta-Analysis. Ophthalmol Retina 2023; 7:972-981. [PMID: 37406735 DOI: 10.1016/j.oret.2023.06.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 06/26/2023] [Accepted: 06/27/2023] [Indexed: 07/07/2023]
Abstract
TOPIC This study reports the effect of systemic prophylactic antibiotics (and their route) on the risk of endophthalmitis after open globe injury (OGI). CLINICAL RELEVANCE Endophthalmitis is a major complication of OGI; it can lead to rapid sight loss in the affected eye. The administration of systemic antibiotic prophylaxis is common practice in some health care systems, although there is no consensus on their use. METHODS PubMed, CENTRAL, Web of Science, CINAHL, and Embase were searched. This was completed July 6, 2021 and updated December 10, 2022. We included randomized and nonrandomized prospective studies which reported the rate of post-OGI endophthalmitis when systemic preoperative antibiotic prophylaxis (via the oral or IV route) was given. The Cochrane Risk of Bias tool and ROBINS-I tool were used for assessing the risk of bias. Where meta-analysis was performed, results were reported as an odds ratio. PROSPERO registration: CRD42021271271. RESULTS Three studies were included. One prospective observational study compared outcomes of patients who had received systemic or no systemic preoperative antibiotics. The endophthalmitis rates reported were 3.75% and 4.91% in the systemic and no systemic preoperative antibiotics groups, a nonsignificant difference (P = 0.68). Two randomized controlled trials were included (1555 patients). The rates of endophthalmitis were 17 events in 751 patients (2.26%) and 17 events in 804 patients (2.11%) in the oral antibiotics and IV (± oral) antibiotics groups, respectively. Meta-analysis demonstrated no significant differences between groups (odds ratio, 1.07; 95% confidence interval, 0.54-2.12). CONCLUSIONS The incidences of endophthalmitis after OGI were low with and without systemic antibiotic prophylaxis, although high-risk cases were excluded in the included studies. When antibiotic prophylaxis is considered, there is moderate evidence that oral antibiotic administration is noninferior to IV. FINANCIAL DISCLOSURE(S) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
- Tim J Patterson
- Northern Ireland Medical and Dental Training Agency (NIMDTA), Belfast
| | - David McKinney
- Northern Ireland Medical and Dental Training Agency (NIMDTA), Belfast
| | - Jonathan Ritson
- Cambridge University Hospitals NHS Trust, Cambridge, United Kingdom; Royal Centre for Defence Medicine, Birmingham, United Kingdom
| | - Chris McLean
- Epsom and St Helier University Hospitals NHS Trust, Carshalton, United Kingdom
| | - Weidong Gu
- Vision Center of Excellence, Research & Development Directorate, J-9, Defence Health Agency, Silver Spring, Maryland
| | - Marcus Colyer
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Scott F McClellan
- Vision Center of Excellence, Research & Development Directorate, J-9, Defence Health Agency, Silver Spring, Maryland
| | - Sarah C Miller
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Grant A Justin
- Uniformed Services University of the Health Sciences, Bethesda, Maryland; Duke Eye Center, Duke University Hospitals, Durham, North Carolina
| | - Annette K Hoskin
- The University of Sydney, Save Sight Institute, Discipline of Ophthalmology, Sydney Medical School, Sydney, New South Wales, Australia; Lions Eye Institute, University of Western Australia, Perth, Australia
| | - Kara Cavuoto
- Bascom Palmer Eye Institute, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida
| | - James Leong
- The University of Sydney, Save Sight Institute, Discipline of Ophthalmology, Sydney Medical School, Sydney, New South Wales, Australia; The University of Sydney, Save Sight Institute, Faculty of Medicine and Health, Sydney, NSW, Australia
| | - Andrés Rousselot Ascarza
- Consultorios Oftalmológicos Benisek-Ascarza, Ciudad Autónoma de Buenos Aires, C1115ABB Buenos Aires, Argentina
| | - Fasika A Woreta
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kyle E Miller
- Uniformed Services University of the Health Sciences, Bethesda, Maryland; Department of Ophthalmology, Navy Medical Center Portsmouth, Portsmouth, Virginia
| | - Matthew C Caldwell
- Department of Ophthalmology, San Antonio Uniformed Services Health Education Consortium, San Antonio, Texas
| | - William G Gensheimer
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; White River Junction Veterans Administration Medical Center, White River Junction, Vermont
| | - Tom Williamson
- Department of Ophthalmology, St Thomas Hospital, London, United Kingdom
| | | | - Peter Shah
- Birmingham Institute for Glaucoma Research, Birmingham, United Kingdom; Ophthalmology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Andrew Coombes
- Department of Ophthalmology, The Royal London Hospital, Barts Health NHS Trust, Whitechapel Road, London, United Kingdom
| | - Gangadhara Sundar
- Department of Ophthalmology, National University Hospital, Singapore
| | - Robert A Mazzoli
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Malcolm Woodcock
- Worcestershire Acute Hospitals NHS Trust, Worcester, United Kingdom
| | - Ferenc Kuhn
- Helen Keller Foundation for Research and Education, Birmingham, Alabama
| | - Stephanie L Watson
- The University of Sydney, Save Sight Institute, Faculty of Medicine and Health, Sydney, NSW, Australia
| | - Renata S M Gomes
- BRAVO VICTOR, Research & Innovation, London, United Kingdom; Northern Hub for Veterans and Military Families Research, Northumbria University, Newcastle, United Kingdom
| | - Rupesh Agrawal
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore; Singapore Eye Research Institute, Singapore; Lee Kong Chian School of Medicine, Singapore; Duke NUS Medical School, Singapore
| | - Richard J Blanch
- Ophthalmology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Neuroscience & Ophthalmology, Institute of Inflammation & Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom; Ophthalmology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, United Kingdom.
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Thomas CN, Bernardo-Colón A, Courtie E, Essex G, Rex TS, Blanch RJ, Ahmed Z. Effects of intravitreal injection of siRNA against caspase-2 on retinal and optic nerve degeneration in air blast induced ocular trauma. Sci Rep 2021; 11:16839. [PMID: 34413361 PMCID: PMC8377143 DOI: 10.1038/s41598-021-96107-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 08/05/2021] [Indexed: 11/11/2022] Open
Abstract
Ocular repeated air blast injuries occur from low overpressure blast wave exposure, which are often repeated and in quick succession. We have shown that caspase-2 caused the death of retinal ganglion cells (RGC) after blunt ocular trauma. Here, we investigated if caspase-2 also mediates RGC apoptosis in a mouse model of air blast induced indirect traumatic optic neuropathy (b-ITON). C57BL/6 mice were exposed to repeated blasts of overpressure air (3 × 2 × 15 psi) and intravitreal injections of siRNA against caspase-2 (siCASP2) or against a control enhanced green fluorescent protein (siEGFP) at either 5 h after the first 2 × 15 psi ("post-blast") or 48 h before the first blast exposure ("pre-blast") and repeated every 7 days. RGC counts were unaffected by the b-ITON or intravitreal injections, despite increased degenerating ON axons, even in siCASP2 "post-blast" injection groups. Degenerating ON axons remained at sham levels after b-ITON and intravitreal siCASP2 "pre-blast" injections, but with less degenerating axons in siCASP2 compared to siEGFP-treated eyes. Intravitreal injections "post-blast" caused greater vitreous inflammation, potentiated by siCASP2, with less in "pre-blast" injected eyes, which was abrogated by siCASP2. We conclude that intravitreal injection timing after ocular trauma induced variable retinal and ON pathology, undermining our candidate neuroprotective therapy, siCASP2.
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Affiliation(s)
- Chloe N Thomas
- Neuroscience and Ophthalmology, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- School of Biomedical Sciences, Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | | | - Ella Courtie
- Neuroscience and Ophthalmology, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Ophthalmology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Gareth Essex
- Neuroscience and Ophthalmology, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Tonia S Rex
- Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Ophthalmology and Visual Sciences, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Richard J Blanch
- Neuroscience and Ophthalmology, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
- Ophthalmology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
- Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, UK.
- Centre for Trauma Sciences Research, University of Birmingham, Birmingham, B15 2TT, UK.
| | - Zubair Ahmed
- Neuroscience and Ophthalmology, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
- Centre for Trauma Sciences Research, University of Birmingham, Birmingham, B15 2TT, UK.
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Blanch RJ, Mazzoli RA, Porter K. Ophthalmic Injuries in the Port Explosion in Beirut, Lebanon: Lessons for Provision of Ophthalmic Trauma Care and Major Incident Management. JAMA Ophthalmol 2021; 139:943-945. [PMID: 34351408 DOI: 10.1001/jamaophthalmol.2021.2707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Richard J Blanch
- Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, United Kingdom.,Department of Ophthalmology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom.,Royal Centre for Defence Medicine, Academic Department of Military Surgery and Trauma, Birmingham, United Kingdom
| | - Robert A Mazzoli
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Keith Porter
- Department of Trauma and Orthopaedics, University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom
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7
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Incidence of ocular blast injuries in modern conflict. Eye (Lond) 2020; 35:3451-3452. [PMID: 33311541 DOI: 10.1038/s41433-020-01359-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 11/26/2020] [Accepted: 11/27/2020] [Indexed: 11/08/2022] Open
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