Ocular traumas in working age adults in Finland - Helsinki Ocular Trauma Study

TFOS lifestyle: Impact of societal challenges on the ocular surface

Societal factors associated with ocular surface diseases were mapped using a framework to characterize the relationship between the individual, their health and environment. The impact of the COVID-19 pandemic and mitigating factors on ocular surface diseases were considered in a systematic review. Age and sex effects were generally well-characterized for inflammatory, infectious, autoimmune and trauma-related conditions. Sex and gender, through biological, socio-economic, and cultural factors impact the prevalence and severity of disease, access to, and use of, care. Genetic factors, race, smoking and co-morbidities are generally well characterized, with interdependencies with geographical, employment and socioeconomic factors. Living and working conditions include employment, education, water and sanitation, poverty and socioeconomic class. Employment type and hobbies are associated with eye trauma and burns. Regional, global socio-economic, cultural and environmental conditions, include remoteness, geography, seasonality, availability of and access to services. Violence associated with war, acid attacks and domestic violence are associated with traumatic injuries. The impacts of conflict, pandemic and climate are exacerbated by decreased food security, access to health services and workers. Digital technology can impact diseases through physical and mental health effects and access to health information and services. The COVID-19 pandemic and related mitigating strategies are mostly associated with an increased risk of developing new or worsening existing ocular surface diseases. Societal factors impact the type and severity of ocular surface diseases, although there is considerable interdependence between factors. The overlay of the digital environment, natural disasters, conflict and the pandemic have modified access to services in some regions.

Predictors of Long-term Ophthalmic Complications after Closed Globe Injuries Using the Intelligent Research in Sight (IRIS®) Registry

Purpose

To identify clinical factors associated with the need for future surgical intervention following closed globe ocular trauma.

Design

Retrospective cohort study.

Subjects Participants and/or Controls

Patients in the American Academy of Ophthalmology Intelligent Research in Sight (IRIS®) Registry with a diagnosis of closed globe ocular trauma occurring between 2013 and 2019, identified using International Classification of Disease, 10th Revision and Systematized Nomenclature of Medicine codes.

Methods

Diagnosis codes were used to identify multiple concomitant diagnoses present on the date of closed globe ocular trauma. Survival analyses were performed for each outcome of interest, and linear regression was used to identify clinical factors associated with the risk of surgical intervention.

Main Outcome Measures

Outcomes included retinal break treatment, retinal detachment (RD) repair, retinal break treatment or RD repair, glaucoma surgery, and cataract surgery.

Results

Of the 206 807 patients with closed globe ocular trauma, 9648 underwent surgical intervention during the follow-up period (mean, 444 days): 1697 (0.8%) had RD repair, 1658 (0.8%) had retinal break treatment, 600 (0.3%) had glaucoma surgery, and 5693 (2.8%) had cataract surgery. Traumatic cataract was the strongest risk factor for cataract surgery (hazard ratio, 13.0; 95% confidence interval, 10.8-15.6), traumatic hyphema showed highest risk for glaucoma surgery (7.24; 4.60-11.4), and vitreous hemorrhage was the strongest risk factor for retinal break treatment and detachment repair (11.01; 9.18-13.2 and 14.2; 11.5-17.6, respectively) during the first 60 days after trauma date. Vitreous hemorrhage was a risk factor for cataract surgery at > 60 days after trauma date only. Iris-angle injury was the strongest risk factor for glaucoma surgery > 60 days after trauma, while vitreous hemorrhage remained the strongest factor for retinal break treatment and detachment repair at > 60 days. Traumatic hyphema was a risk factor for all surgical outcomes during all follow-up intervals.

Conclusions

Diagnosis of concomitant traumatic cataract, vitreous hemorrhage, traumatic hyphema, and other risk factors may increase the likelihood of requiring surgical intervention after closed globe ocular trauma.

Epidemiological features and management of eye burn patients in Wuxi, China

Background

The current study aimed to analyse epidemiological data on eye burns in Wuxi, China, for the years 2015–2021, and to provide insight into the development of appropriate prevention strategies.

Methods

A retrospective study was conducted on 151 hospitalised patients with eye burns. Data collected included gender, age, the monthly distribution of incidence, cause of eye burn, the site of eye burn, the type of surgery, visual outcome, the length of hospital stay and the cost of hospital admission. Statistical analysis was performed using SPSS V.19.0 and Graph Pad Prism V.9.0.

Results

In a total of 151 eye burn patients, 130 were males (86.09%) and 21 were females (13.91%). The proportion of patients classified as grade III was the greatest (46.36%). The average age of our hospitalised patients with eye burns was 43.72 years and the average length of hospital stay was 17 days. The number of injuries was highest in September (14.6%). Among eye burn patients, workers and farmers became the most common occupations (62.91%, 12.58%). The most frequent cause of burns was alkali burns (19.21%), followed by acid burns (16.56%). When admitted to the hospital, patients’ average vision was 0.06, and 49% of them had a poor vision (<0.3, ≥0.05).

Conclusion

With an investigation of 7-year hospitalisation data, the current study provided a fundamental reference for epidemiological features and management of eye burns in Wuxi, China, which could contribute to the development of treatment and prevention strategies.

Work-related head injury and industry sectors in Finland: causes and circumstances

OBJECTIVE

Despite the continuous development of occupational safety, the prevalence of work-related head injuries is excessive. To promote prevention, we conducted a study evaluating the risks and pathways that precede head injuries in different economic activity sectors.

METHODS

In Finland, more than 90% of employees are covered by inclusive statutory workers' compensation. We obtained data on occupational head injuries in 2010-2017 from an insurance company database. The European Statistics on Accidents at Work (ESAW) variables represented the characteristics of the accidents and the injury. We analysed the risk factors, contributing events and injury mechanisms in 20 industry sectors, based on the Statistical Classification of Economic Activities in the European Community (NACE).

RESULTS

In the 32,898 cases, the most commonly affected area was the eyes (49.6%). The highest incidence of head injuries was in construction (15.7 per 1000 insurance years). Construction, manufacturing, and human health and social work activities stood out due to their distinctive ESAW category counts. 'Working with hand-held tools' [risk ratio (RR) 2.23, 95% confidence interval (CI) 2.14-2.32] in construction and 'operating machines' (RR 3.32, 95% CI 3.01-3.66) and 'working with hand-held tools' (1.99, 1.91-2.07) in manufacturing predicted head injury. The risk related to parameters of violence and threats in health and social work activities was nearly ninefold the risk of other sectors.

CONCLUSION

The risks and pathways preceding head injuries varied considerably. The highest head injury rates were in construction and manufacturing. Violence emerged as a major risk factor in human health and social work activities.

Work-Related Injuries among Insured Construction Workers Presenting to a Swiss Adult Emergency Department: A Retrospective Study (2016-2020)

Occupational injuries are one of the main causes of Emergency Department visits and represent a substantial source of disability or even death. However, the published studies and reports on construction-occupational accidents in Switzerland are limited. We aimed to investigate the epidemiology of fatal and non-fatal injuries among construction workers older than 16 years of age over a 5-year period. Data were gathered from the emergency department (ED) of Bern University Hospital. A retrospective design was chosen to allow analysis of changes in construction accidents between 2016-2020. A total of 397 patients were enrolled. Compared to studies in other countries, we also showed that the upper extremity and falling from height is the most common injured body part and mechanism of injury. Furthermore, we were able to show that the most common age group representing was 26-35 years and the second common body part injured was the head, which is a difference from studies in other countries. Wound lacerations were the most common type of injury, followed by joint distortions. By stratifying according to the season, occupational injuries among construction workers were found to be significant higher during summer and autumn. As work-related injuries among construction workers are becoming more common, prevention strategies and safety instructions must be optimized.

A CASE OF TRAUMATIC SOFT CONTACT LENS DISLOCATION INTO THE VITREOUS SPACE AFTER CORNEAL PERFORATION IN A PHAKIC EYE: A NOVEL INDICATION FOR MEMBRANEBLUE-DUAL

PURPOSE

To describe a case of traumatic soft contact lens dislocation into the vitreous space after a large-sized corneal perforation with a clout nail, causing aniridia but leaving the crystalline lens intact.

METHODS

A case report of a 44-year-old male patient with a corneal perforation.

RESULTS

The patient presented with a traumatic corneal perforation after a large clout nail impacted on his left eye. Aniridia and inferior zonulolysis were seen, but the crystalline lens was perfectly clear. Because computed tomography imaging and B-scan ultrasonography showed no signs of intraocular foreign body, a vitrectomy was performed seven days after primary repair to allow for proper wound closure. During vitrectomy, a completely intact soft contact lens was found in the vitreous cavity. The soft contact lens was stained with MembraneBlue-Dual (D.O.R.C., the Netherlands) to enhance visualization and ensure complete removal by the vitreous cutter.

CONCLUSION

MembraneBlue-Dual can be used to facilitate complete removal of a clear and otherwise difficult to see corneal contact lens from the vitreous cavity. This case also demonstrates the importance of exploratory vitrectomy in all trauma cases with posterior segment involvement, even when imaging modalities show no signs of intraocular foreign bodies.

Eye Injuries Caused by Wooden Projectiles in Finland

INTRODUCTION

Eye injuries can cause decreased vision or even blindness, and predispose to future complications. Wood as an independent cause of eye injuries has infrequently been the focus of the studies. The aim of this study is to report the current population-based epidemiology, treatment, use of resources and outcomes of eye injuries caused by sticks, branches, and other wooden projectiles in Finland.

METHODS

The study included all patients injured by wooden projectiles with ocular or orbital traumas over a 1-y period. Patients were treated at the Helsinki University eye hospital, which covers a population of 1.5 million. The follow-up time was 3 mo.

RESULTS

Wooden projectiles caused 67 eye injuries and compromised 6% of all eye traumas during 1 y. Of the patients, males predominated (76%) and 22% were children under 17 y. Injury was most likely in spring (36%) and in males aged 51 to 67 y. The most common activity to cause injury was playing (27%), but in relation to time spent in each activity, the highest risk for eye injury was in gardening. Diagnoses were mild superficial trauma (54%), blunt ocular trauma (37%), eyelid wound (4%), orbital fracture (3%), and open globe trauma (1%). Permanent disability was estimated for 10% and a need for lifelong follow-up was estimated for 37%. Eleven patients needed major surgeries.

CONCLUSIONS

Wooden projectiles often cause serious eye injuries, permanent disability, and a need for lifelong follow-up. Caution is required to protect the eyes when playing with sticks and during gardening, forest work, and woodwork.

Global Current Practice Patterns for the Management of Open Globe Injuries

PURPOSE

To determine global current practice patterns for the management of open globe injuries and identify areas of variation.

DESIGN

Cross-sectional survey.

METHODS

An online survey assessed global management paradigms for open globe injuries from August 2020 to January 2021. Responses were collected from experts at eye trauma centers and emergency departments worldwide who manage ≥1 open globe injury per month. The survey assessed the use/selection of antibiotics and steroids, procedural and imaging decisions, and admission practices for open globe injuries.

RESULTS

Responses were received from representatives of 36 of 42 institutions (85.7%), of which 33 (78.6%) had sufficient trauma volume to be included. Included responses were distributed across North America (n=12, 36.4%), Asia (n=12, 36.4%), South America (n=4, 12.1%), Africa (n=3, 9.1%), Europe (n=1, 3.0%), and Australia (n=1, 3.0%). Preoperative systemic antibiotics for open globe injuries were administered by 75.8% (n = 25/33) of institutions, while 30.3% (n = 10/33) administered preoperative topical antibiotics. Intraoperative ophthalmic antibiotics for open globe injuries were used by 54.5% (n = 18/33) of experts. Most institutions also administered postoperative systemic antibiotics (n = 23 [69.7%]) and topical steroids (n = 29 [87.9%]), although specific medication choices diverged. At 19 responding centers (61.3% of the 31 that had trainees), residents participated in surgical repairs. Many institutions discharged patients after repair, but 54.5% (n = 18/33) of locations routinely admitted them for observation.

CONCLUSIONS

Preferred management practices for open globe injuries vary widely. To ensure the highest standard of care for all patients, evidence-based international guidelines for the treatment of these injuries are needed.

Resource use and economic burden of eye injuries in Southern Finland

Objective

To estimate resource use and the costs of eye injuries in 2011–2012 in the Helsinki University Eye Hospital (HUEH), which covers 1.6 million people in Southern Finland.

Methods

This population-based study consisted of all new patients (1,151) with eye injuries in one year. The data were from hospital records, internal HUEH accountancy, and prospectively from questionnaires. The costs of direct health care, transportation, and lost productivity were obtained and estimated for the follow-up period of three months. The estimated future costs were discussed.

Results

During the follow-up, the total cost was 2,899,000 Euros (EUR) (= EUR 1,870,300/one million population), including lost productivity (EUR 1,415,000), direct health care (EUR 1,244,000), and transportation (EUR 240,000). The resources used included 6,902 days of lost productivity, 2,436 admissions and transportations, 314 minor procedures, 313 inpatient days, 248 major surgeries, and 86 radiological images. One open globe injury was the costliest (EUR 13,420/patient), but contusions had the highest overall cost (EUR 1,019,500), due to their high occurrence and number of follow-ups.

Conclusions

Eye injuries cause a major burden through high costs of direct health care and lost productivity: the imminent costs were EUR 1,870,000/one million population, and the future costs were estimated to EUR 3,741,400/one million population. Prevention remains the main factor to consider for better cost-efficiency.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00417-021-05399-3.

Mechanism and prognostic indicators for explosion-related eye trauma: eye injury vitrectomy study

PURPOSE

To explore the clinical features, surgical interventions and prognosis of injured eyes following explosion and to develop the risk factors for poor prognosis.

METHODS

A nested case-control study. To the date of 31 December 2018, 99 explosion-related eye globes were selected from the Eye Injury Vitrectomy Study database, which is a multicenter prospective cohort study and began in 1990s. All cases selected underwent vitreoretinal surgery or enucleation and were followed up for at least 6 months. Clinically meaningful preoperative variables and outcomes were used to develop logistic regression models.

RESULTS

The unfavourable outcomes were defined as silicone oil-filled eyes, phthisis bulbi, enucleation and anatomically restored eyes whose final BCVA is worse than initial vision after 6 months of follow-up. The proportion of unfavourable outcomes was 92.0%, 60.9% and 66.7% in large festive fireworks, detonator and beer bottle groups respective. The anatomic and visual outcome of injured eyes with combined injury of blast wave and projectile were worse than that of ruptured eyes (Fisher's exact = 0.041). The extrusion of iris/lens (OR = 3.20, p = 0.015), PVR-C (OR = 6.08, p = 0.036) and choroid damage (OR = 5.84, p = 0.025) is independent risk factors of unfavourable prognosis for explosion-related eye trauma.

CONCLUSION

The extrusion of iris/lens, PVR-C and choroid damage is the independent risk factors for unfavourable outcomes in explosion-related eye trauma. There is a unique injury mechanism in explosion-related eye trauma.

SUMMARY STATEMENT

Through the nested case-control study, the extrusion of iris/lens, PVR-C, and choroid damage are the independent risk factors for unfavorable outcomes in explosion-related eye trauma. The mechanism of open globe mixture and close globe mixture in explosion-related eye trauma need more cases and participating units to explore together in the future.

Characteristics of work-related eye trauma in construction and manufacturing industries

CLINICAL RELEVANCE

Knowledge of work-related eye trauma in the construction and manufacturing industries will facilitate planning of policies and practices to protect against such occurrences.

BACKGROUND

The aim of this study was to compare demographic, epidemiological, and clinical characteristics of work-related eye trauma in workers in the construction and manufacturing industries.

METHODS

Medical board disability reports of subjects who experienced work-related eye trauma were investigated in this retrospective comparative study. Subjects were separated into two groups - construction and manufacturing - and the demographic, epidemiologic, and clinical characteristics within the two groups were compared.

RESULTS

The construction group included 138 eyes of 132 subjects and the manufacturing group included 82 eyes of 77 subjects. Demographic characteristics of the groups were similar (p > 0.05). The number of work-related eye trauma incidents was found as decreased during winter in construction (p < 0.001), but a similar trend was not found in manufacturing (p > 0.05). Head traumas as reason for work-related eye trauma (p < 0.001), and concomitant systemic diseases including bone fracture and traumatic brain injuries (p < 0.001 and p = 0.012) were significantly associated with eye trauma in manufacturing. Open globe injury was more common in construction (p = 0.046), and chemical injury was more common in manufacturing (p < 0.001). Retinal detachment was more prevalent in construction (p = 0.042). Hand motion or worse final visual acuity was more prevalent in manufacturing (p = 0.007) and the final visual acuity better than 6/60 was more prevalent in construction (p = 0.045).

CONCLUSION

Chemical injuries are more common in manufacturing, whereas open globe injuries and retinal detachments occur more frequently in construction. Permanent low vision and blindness are more commonly associated with work-related eye trauma in manufacturing.

Epidemiology, economic and humanistic burdens of Ocular Surface Chemical Injury: A narrative review

Ocular surface chemical injury (OSCI) is a common type of ocular emergency that can potentially cause significant and permanent visual impairment. However, the global prevalence, demographic factors, socioeconomic burden, and psychological impact of OSCI have not been well investigated or reported. This review aims to provide a comprehensive overview of these aspects, highlight gaps in the literature, and advocate key strategies in reducing the incidence of OSCI. OSCI was responsible for 0.1-15% of all ocular emergency presentations, with an estimated incidence of 5.1-50 per 100,000 population-year. Young working adult men were the most at-risk group, though high rates of OSCI were also observed in young children in developed countries, especially from detergent pods. Low- and middle-income countries were noted to have higher proportions of assault-related and pediatric OSCI cases, often with more severe presentations. Direct and indirect costs for some hospitalized patients led to loss of all personal and household income after the injury. Emergency department costs in the United States were estimated at $106.7 million over four years and costs of treating long term complications such as glaucoma were estimated to be as high as $93,003 over five years. Significant negative impacts on visual and health-related quality of life and psychological well-being have been reported after injury, with higher rates of anxiety, depression, and psychological distress compared to the general population.

Prognostic factors and long-term outcomes of eye-globe perforation: Eye injury vitrectomy study

PURPOSE

To delineate anatomic and visual outcomes of injured eye globes with perforating, and to develop the prognostic indicators for perforating eyes.

METHODS

The case series study, from a multicenter prospective cohort database. To the date of December 31st, 2018, of 63 perforating globes were selected. All cases underwent vitreoretinal surgeries or enucleations, and were followed up for at least 6 months. Demographic characteristics, basic examination for traumatized eyes, and intraocular tissue damages were recorded by surgery-in-chief. At the follow-up visit, best corrected VA, intraocular pressure, the intraocular tamponade material, retinal anatomic outcome of eye-globes, and phthisis or enucleation were evaluated.

RESULTS

Fifty injured eyes (79%) were caused by sharp objects and 13 eyes (21%) were injured by a missiles. Twenty-two injured eyes can be anatomically restored with final vision of more than 4/200 through vitreoretinal surgery. The PVR-C (OR = 5.67, P = 0.01), area of retinectomy more than 2 times of optic disk (OR = 5.16, P = 0.04), and macular damage (OR = 6.38, P = 0.01) were correlated with unfavorable outcomes.

CONCLUSION

The injured eyes with perforation can be saved through vitreoretinal surgery, the PVR-C, retinectomy more than 2 times of optic disk, and macular damage were independent risk factors for poor long-term prognosis.

Traumatic open globe injury—epidemiology, risk factors and visual outcome at the University Hospital Aachen

Background

Ocular trauma is still a major cause leading to enucleation. This study aims to analyze the visual outcome, epidemiology and risk factors of open globe injury (OGI) at the University Hospital Aachen, Germany.

Material and methods

A retrospective analysis of patient records involving traumatic OGI treated surgically between 2005 and 2015 was conducted. Age, gender, cause of accident, ocular trauma score, best corrected visual acuity (BCVA) at presentation and after treatment as well as location of injury were evaluated.

Results

Of 2272 eyes with trauma, 102 patients with OGI were identified, of which 65% were male and 35% were female. Women were significantly older than men (p < 0.001). The most common cause of injury was domestic syncopal episodes (47%). Work-related injuries occurred exclusively in men in 8.8%. A total of 16% had no light perception (NLP) at presentation, 69% of which improved post intervention to hand movement or better. Endophthalmitis was observed in 4% of all cases. Enucleation was needed mostly due to rupture. Location of OGI, pseudophakia and initial BCVA are risk factors for poor final BCVA. Patients’ BCVA did not improve further after three surgeries.

Conclusion

Traumatic OGI still poses a challenge in terms of treatment planning and prognostic outcome. A rise in elderly patients with multimorbidity represents a secondary obstacle to treatment. Patients with initial NLP can be treated with moderate success. Nevertheless, risk factors and ocular trauma score are unable to provide definitive therapy decisions. OGI should be assessed case by case, taking risk factors for OGI into account. Treating physicians should consider the ethical and economic reasons with regard to whether a high number of surgeries with possible comorbidities is justified.

Epidemiology and Clinical Patterns of Ocular Trauma at a Level 1 Trauma Center in Korea

BACKGROUND

To evaluate the patterns of distribution and clinical manifestations of ocular injuries referred to the level 1 trauma center of Pusan National University Hospital (PNUH) in Korea.

METHODS

We analyzed 254 of 4,287 patients who were referred to the Department of Ophthalmology at the level 1 trauma center of the PNUH, from January 2016 through December 2018. Data on the incidence of ocular injuries, sex, age, monthly and seasonal distribution, day and time of injury, side of injury, cause, residence of patients, referral time to an ophthalmologist and subsequent examination time, final visual acuity (VA), and complications were obtained from medical records and retrospectively reviewed. The patients were grouped according to their main diagnosis using the Birmingham Eye Trauma Terminology System (BETTS) and Ocular Trauma Score (OTS).

RESULTS

The incidence of ocular injuries with major trauma was higher in men (n = 207, 81.5%), the median age at time of injury was 54 years, and Pusan recorded the most cases. The incidences of ocular injury were 1.47/100,000, 1.57/100,000, 1.48/100,000 in 2016, 2017 and 2018, respectively. The most common cause was by a motorbike accident, followed by a pedestrian traffic accident and falls. According to the BETTS classification, open-globe injuries represented 4% of cases, closed-globe injuries represented 12.6%, and other injuries represented 83.1%. Open-globe injuries were significantly associated with low final VA (P = 0.01). In the OTS, 79.4% of patients received 4 or 5 points and 13.7% of patients received 1 or 2 points. The patients who received 1 or 2 points in the OTS score showed final VA below hand movement (P < 0.001), except for two patients. Lid laceration and low initial VA were highly correlated with poor final VA (P < 0.001).

CONCLUSION

This is the first study on the epidemiology and clinical manifestations in trauma patients with ocular injuries at a level 1 trauma center. The incidences of ocular injuries with major trauma were about 1.47-1.57/100,000. BETTS, OTS, lid laceration and initial VA were associated with final VA. We expect our study to provide a basis of data for the evaluation, prevention, and management of ocular injuries in patients with systemic trauma.

Epidemiology, Clinical Characteristics, and Visual Outcomes of Patients with Intraocular Foreign Bodies in Southwest China: A 10-Year Review

INTRODUCTION

Intraocular foreign bodies (IOFBs) are a serious subset of open-globe injury that can result in visual loss. This study analyzed the epidemiology, clinical characteristics, and visual outcomes of patients with IOFBs in Southwest China.

METHODS

This retrospective study comprised 1,176 patients with the primary diagnosis of IOFBs who resided in Sichuan Province over a 10-year period. All data were collected from medical records and analyzed statistically.

RESULTS

The annual incidence for IOFBs was 0.14 per 100,000 (95% confidence interval 0.12-0.16 per 100,000) people in Southwest China. In that period, IOFBs accounted for 22.3% of all open-globe injuries. Working-age male patients accounted for 79.1% of all IOFBs patients and there had significant differences in age distributions between genders (p < 0.001). Metallic IOFBs were the most common (74.6%) IOFB, but there were significant differences in the materials of IOFBs between adults and children of different age-groups (p < 0.001). At discharge, 277 (23.6%) patients had increased visual acuity (VA) and 95 (8.0%) had no light perception. Initial VA <20/200 (odds ratio [OR], 5.5; p < 0.001), increasing wound size (OR, 1.3; p = 0.004), IOFBs in the posterior segment (OR, 2.6; p = 0.002) and existing complications (traumatic cataract, endophthalmitis, retinal detachment, or retinal break) were independent risk factors for final VA <20/200.

CONCLUSION

The incidence of IOFBs in Southwest China differed from global statistics. Adults and children had different clinical characteristics. Thus, their prevention strategies should be different.

Description of the epidemiological characteristics of work-related eye injuries in Spain: a retrospective study

OBJECTIVE

To describe the epidemiological characteristics and trends of work-related eye injuries (WREIs) in Spain over a 10-year period by sex, age and occupational sector.

DESIGN AND SETTINGS

A descriptive, retrospective and longitudinal study based on data from workers insured by a labour insurance company in Spain from 2008 to 2018 was presented. The study considered the ratio of the number of WREI per 100 000 population and the relative risk of suffering an ocular injury. WREIs were characterised by sex, age and occupational sector of injured workers.

PRIMARY AND SECONDARY OUTCOME MEASURES

Ratio of the number of WREI.

PARTICIPANTS

In Spain, all workers are insured by a labour insurance company that provides cover in the event of work-related accidents. In this study, we have included all workers insured by one of these insurance companies, IBERMUTUA, with workers in all areas of Spain.

RESULTS

The study included 50 265 WREI in the company over the 10-year period. Most of the injuries occurred in males (44 445; 88.4%), in 35-44 age group (15 992; 31.8%) and in industry workers (18 899; 42.6%). The average incidence was 429.75 per 100 000 workers insured and 4273.36 per 100 000 IBERMUTUA accidents (related and not related to eyes). Males, 16-24 age group and industry occupational sector group, have the highest incidence for WREI. The incidence of WREI decrease over the study period in all variables. Males have 6.56 (95% CI 6.38 to 6.75) times more risk of suffering WREI than females. 16-24 age group have 1.77 (95% CI 1.71 to 1.83) times more risk than in the group of workers older than 55. Finally, industry workers have 7.73 (95% CI 7.55 to 7.92) times more risk than services workers.

CONCLUSIONS

The risks of suffering WREI is higher for males, younger and less experienced workers, and for those who works in a manual task.

Iris and Lens Trauma - Iris Reconstruction

Iris and lens injuries entail a large spectrum and occur in closed and open globe injuries. Depending on accompanying ocular trauma (e.g. corneal involvement) as well as on the extend of the injuries several different surgical options are available ranging from suturing techniques to special individualized implants. The aim of this article is to present and discuss current treatment options for lens and iris trauma in regards to typical cases.

Types of ocular injury and their antecedent factors: A systematic review and meta-analysis

BACKGROUND

Ocular injuries are an important workplace hazard that can lead to vision loss, decreased functioning, and socioeconomic costs. The aim of this systematic review is to identify types of occupational ocular injuries and examine factors associated with these injuries.

METHODS

Four health sciences databases (Ovid Medline, Embase, PsycINFO, and CINAHL) were reviewed to identify evidence pertaining to occupational ocular injuries. This systematic review was registered with PROSPERO (registration number: CRD42018089876) and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The PICO (Population/Intervention/Comparison/Outcome) tool was used to support, structure, and improve our search strategy.

RESULTS

Overall, 12 studies with quantitative Critical Appraisal Skills Programme grading scores were assessed in a systematic review and meta-analysis of ocular injuries in the workplace. The systematic review identified four main factors associated with occupational ocular injury: (a) use of eye protection at the time of the ocular injury, (b) being male, (c) exposure to biological or chemical occupational hazards, and (d) risk-taking behavior.

CONCLUSIONS

Differences in risk between countries of origin, occupational sectors, and dates of publication, suggest likely differences or changes in safety procedures. We recommend that employers ensure that safety equipment is tailored to the protection of their specific occupational hazards, and that employees are adhering to safety protocols.

Eye Injuries Epidemiology Description in a Working Population over 10 Years in Spain

Background: Several studies show a high percentage of eye injuries related to work compared to other origins. However, there are few studies that describe work-related eye injuries. Methods: A descriptive, retrospective, and longitudinal study that describes the characteristics of work-related eye injuries in a group of insured workers. Eye injuries were classified according to the International Classification of Diseases (ICD-10) and analyzed over 10 years (2008–2018). Results: Keratitis and conjunctivitis were the most prevalent injuries (26,674 (53.1%) and 15,906 (31.6%)). Keratitis and conjunctivitis also show the highest percentage of injury incidence per 100,000 insured workers in both sexes, any age group, and any occupation. The analysis of the cumulative percentage change and average annual percent change in incidences over ten years shows a decrease in the incidences of all injuries, except for other disorders of the eye and anexa. Conclusions: Most of the work-related eye injuries affect the most exposed eye structures in any line of work: the cornea and conjunctiva. Suitable protection of these eye structures will decrease the number of cases of work-related eye injuries.

TRAFFIC ACCIDENT-RELATED OPEN GLOBE INJURIES

PURPOSE

To evaluate the clinical characteristics and visual outcomes of patients with traffic accident-related open globe injuries, and to examine preoperative factors influencing the visual prognosis after pars plana vitrectomy, as compared with common open globe injuries.

METHODS

Patients with open globe injuries, who underwent pars plana vitrectomy, were identified. Patients' demographic and clinical data were entered into a computerized database for review and analysis; data included age, sex, initial visual acuity, duration between onset of injury and surgery, information about the type and cause of injury, wound location and length, presence of ocular complications, and final visual acuity.

RESULTS

Of the 355 open globe injuries, 14 were sustained during a traffic-related accident; the average age was 50.4 years (range: 20-85) and most (78.6%) were men. Of these 14 patients, 9 (64.3%) presented with rupture and 5 (35.7%) with laceration. Injuries were caused while driving (6 eyes; 42.9%), riding a bicycle (5 eyes; 35.7%), involved in car accident while walking (2 eyes; 14.3%), and riding a motorbike (1 eye; 7.1%). Initial visual acuity was significantly related to final visual acuity (P = 0.003, R = 0.80). The final visual acuity in patients with traffic accident-related open globe injuries was significantly better than that of the total group (P = 0.01).

CONCLUSION

Traffic accident-related open globe injuries had better visual outcomes than common open globe injuries. Visual outcomes in patients with traffic accident-related open globe injuries were related to the initial visual acuity. No eyes developed endophthalmitis in patients with traffic accident-related open globe injuries.

Demographic, clinical features, and outcomes of pediatric non-penetrating ocular foreign bodies

PURPOSE

Data regarding ocular foreign body (FB) in the pediatric population is sparse. The purpose of this study is to describe the demographic features and the outcomes of pediatric non-penetrating ocular FB.

METHODS

The charts of all children with non-penetrating ocular FB who presented at a tertiary medical center between 2011 and 2018 were retrospectively reviewed. Data analyzed included demographics, ocular FB site, the need for general anesthesia, or sedation for FB removal and clinical outcomes.

RESULTS

Three hundred and fifty-two children (58.8% boys) with a mean age of 7.7 ± 3.7 years were included. Two hundred and fifty-one (71.3%) children presented on the same day of injury. Patients with developmental delay presented more often with restlessness than patients without developmental delay (p < 0.0001). One hundred and forty-six (41.5%) of FBs were found on the conjunctiva, 128 (36.4%) under the eyelid, and 62 (17.6%) on the cornea. In 19 (4.5%) cases, general anesthesia or sedation was required for FB removal. A multivariate analysis identified young age (OR 0.976, 95% CI 0.961-0.992, p = 0.003), corneal FB (OR 50.84, 95% CI 10.08-256.37, p < 0.0001), and developmental delay (OR 18.56, 95% CI 1.22-283.45, p = 0.036), as significant predictors for the need of general anesthesia or sedation. Among patients with corneal FB, in two (3.2%) cases, the corneal FB was complicated by infectious keratitis, resulting in mild corneal scar.

CONCLUSION

The rate of general anesthesia for non-penetrating ocular FB removal in children is low. Children presenting with non-penetrating ocular FB have good prognosis without long-term complications.

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.

Damage to the eye and optic nerve in seriously traumatized patients with concomitant head injury: analysis of 84,627 cases from the TraumaRegister DGU® between 2002 and 2015

BACKGROUND

To determine the prevalence and characteristics of prechiasmatic visual system injuries (VSI) among seriously injured patients with concomitant head trauma in Europe by means of a multinational trauma registry.

METHODS

The TraumaRegister DGU® was searched for patients suffering from serious trauma with a Maximum Abbreviated Injury Scale (AIS) ≥ 3 between 2002 and 2015 in Europe. After excluding cases without significant head injury defined by an AIS ≥ 2, groups were built regarding the existence of a concomitant damage to the prechiasmatic optic system comprising globe and optic nerve. Group comparisons were performed with respect to demographic, etiological, clinical and outcome characteristics.

RESULTS

2.2% (1901/84,627) of seriously injured patients with concomitant head trauma presented with additional VSI. These subjects tended to be younger (mean age 44.7 versus 50.9 years) and were more likely of male gender (74.8% versus 70.0%) compared to their counterparts without VSI. The most frequent trauma etiologies were car accidents in VSI patients (28.5%) and falls in the control group (43.2%). VSI cases were prone to additional soft tissue trauma of the head, skull and orbit fractures as well as pneumocephalus. Primary treatment duration was significantly longer in the VSI cohort (mean 23.3 versus 20.5 days) along with higher treatment costs and a larger proportion of patients with moderate or severe impairment at hospital discharge despite there being a similar average injury severity at admission in both groups.

CONCLUSIONS

A substantial proportion of patients with head injury suffers from additional VSI. The correlation between VSI and prolonged hospitalization, increased direct treatment expenditures, and having a higher probability of posttraumatic impairment demonstrates the substantial socioeconomic relevance of these types of injuries.

Clinical characteristics of patients hospitalized for ocular chemical injuries in Shanghai from 2012 to 2017

Purpose

To summarize the clinical characteristics of patients with ocular chemical injuries and evaluate their potential relationship with the visual outcome by analyzing the medical records of these patients from January 1, 2012, to December 31, 2017.

Methods

This is a retrospective case series study. Patient data included age, gender, occupational classification, location of ocular chemical injury, initial and final best-corrected distance visual acuity (BCDVA), intraocular pressure (IOP), nature and chemical phase, distribution and severity of chemical injury, management methods, and complications. All variables were evaluated for their potential relationship with visual outcome.

Results

A total of 160 patients were hospitalized with ocular chemical injuries. Majority of the patients were factory workers and arrived at the consultation room less than 24 h after injury. The most common ocular injury setting, classification of severity, causative chemical, chemical phase, and complications were workplace, grade II, unknown and mixed substance, liquid, and elevated IOP, respectively. The risk factors for poor final BCDVA were identified as older age, poor initial BCDVA, and irrigation 24 h after injury (P < 0.001, P < 0.001, and P = 0.011, respectively).

Conclusions

We elaborate the clinical characteristics and outcomes of patients with ocular chemical injuries in Jinshan District, Shanghai. A comprehensive education program should be established and the use of protective eyewear should be promoted to prevent occupation-related ocular chemical injuries.

Work tool-related eye injuries: Helsinki Ocular Trauma Study

Purpose

To quantify and characterize the epidemiology, treatments, long-term outcome, and use of resources for work tool-related eye injuries and their severity.

Methods

We included all new patients with a work tool-related eye injury treated at the Helsinki University Eye Hospital in 1 year. The data were from hospital records, examinations, and patient questionnaires. The follow-ups were at 3 months and 6 years.

Results

Work tools caused 3% (37/1151) of all eye injuries. The mean age was 37 and 84% were men. Most injuries (84%) occurred at work (17) or at home (15). There were 14 minor injuries, 12 contusions, 9 open globe injuries (OGI), and 2 eyelid wounds. The annual incidence of work tool-related eye injuries was 2.4/100,000 and hospitalization 0.6/100,000. At 6-year follow-up, we re-examined 18 patients and 17 were interviewed by phone. Four patients were blinded. We recorded 690 sick leave days and 43 major operations. No traumatic glaucoma was diagnosed. Fifteen patients needed lifelong follow-up. Permanent impairment occurred in 30% (11) of work tool-related eye injuries, from whom, nine were caused by manual tools. Work tools comprised 10% of the permanently impaired, but 2.5% of the non-permanently impaired cases among all eye injuries (1151).

Conclusion

The proportional difference between the permanently impaired and the non-permanently impaired was higher in work tool-related eye injuries than other causes reported in previous Helsinki Ocular Trauma Studies. High-risk injuries were mainly caused by manual tools and nails and resulted in OGI.

Etiology and Visual Prognosis in Open Globe Injuries: Results of A Tertiary Referral Center in Turkey

We aimed to analyse the clinical characteristics of OGI and evaluate the correlation between baseline ocular trauma score (OTS) and visual outcomes in cases with OGI. The charts of 257 OGI patients who had at least six months of follow-up were reviewed retrospectively. Demographics, data about the etiology, localization and size of the OGI, baseline and final best-corrected visual acuity (BCVA) were noted. At the time of approval OTS was calculated and compared with final BCVA. All analysis was performed in both entire study population and our pediatric subgroup. A total of 261 eyes of 257 patients with a mean age of 34.9 ± 19.8 years were enrolled. Globe injury with a mean size of 6.7 ± 4.5 mm was within zone I in 46.7% of the eyes. Older age (p < 0.001, OR = 1.029, 95% CI = 1.015-1.043), higher baseline logMAR BCVA scores (p < 0.001, OR = 4.460, 95% CI = 2.815-7.065), bigger wound size (p < 0.001, OR = 1.159, 95% CI = 1.084-1.240), relative afferent pupillary defect (RAPD) positiveness (p < 0.001, OR = 0.021 95% CI = 0.005-0.087), lower OTS (p < 0.001, OR = 27.034, 95% CI = 6.299-116.021), presence of concomitant retinal detachment (p < 0.001, OR = 0.157, 95% CI = 0.080-0.306), and endophthalmitis (p = 0.045, OR = 0.207, 95% CI = 0.044-0.962) were found to be related to poor visual prognosis. Cases with OGI caused by a sharp object (p = 0.007, OR = 0.204, 95% CI = 0.065-0.641) and those injured by a glass (p = 0.039, OR = 0.229, 95% CI = 0.056-0.931) had more favorable final vision. This study highlights that baseline BCVA, wound size, RAPD, retinal detachment, and OTS were the most significant markers for poor visual outcomes in both the entire population and pediatric subgroup. In cases with OGI, OTS was also found effective in predicting visual prognosis.

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.

A Controlled Impact of Optic Nerve as a New Model of Traumatic Optic Neuropathy in Mouse

Purpose

Traumatic optic neuropathy (TON) is the most feared visual consequence of head and ocular trauma in both military and civilian communities, for which standard treatment does not exist. Animal models are critical for the development of novel TON therapies as well as the understanding of TON pathophysiology. However, the models currently used for TON have some limitations regarding consistency and mirroring the exact pathological progression of TON in closed ocular trauma. In this study, we modified the model of controlled cortical impact and adapted it for studying TON.

Methods

We defined new standardized procedures to induce TON in mice, wherein the optic nerve is reproducibly exposed to a graded controlled impact of known velocity to produce a graded deficit in retinal ganglion cell (RGC) electrophysiological functions.

Results

The key results of validating this newly modified model, “controlled orbital impact (COI),” included (1) the injury parameters (velocity as well as contusion depth and time), which were quantifiable and manageable to generate a wide range of TON severities; (2) a reproducible endpoint of diminished positive scotopic threshold response (pSTR) has been achieved without the interference of surgical variability and destruction of surrounding tissues; (3) the contralateral eyes showed no significant difference to the eyes of naïve mice, allowing them to be used as an internal control to minimize interindividual variability among mice; and (4) the occurrence of injury-associated mortality and/or ocular comorbidity was rare.

Conclusions

Taken together, this model overcomes some limitations of prior TON mouse models and provides an innovative platform to identify therapeutic targets for neuroprotection and/or neurorestoration following traumatic ocular injury.

Manifestações oculares em trabalhadores portuários: prevalência e fatores associados

Resumo Objetivo: Conhecer a prevalência de manifestações oculares em trabalhadores portuários e identificar fatores associados. Métodos: Estudo transversal em um Porto marítimo do extremo Sul do Brasil. Participaram 232 trabalhadores. Para coleta dos dados utilizou-se entrevista estruturada. Foi utilizado teste t de Student para amostras independentes, a fim de comparar as médias dos trabalhadores com manifestações oculares, por meio dos qualificadores em grau no mínimo moderado (presença de manifestações oculares) e aqueles sem manifestações oculares ou grau leve (ausência de manifestações oculares). O teste de Mann-Whitney foi utilizado no caso de assimetria. O teste do qui-quadrado de Pearson ou o teste exato de Fisher foram usados para comparar proporções e a análise de Regressão de Poisson foi usada para controlar os fatores de confusão. Resultados: A prevalência de manifestações oculares autorreferidos foi 92,2%. As manifestações oculares foram: coceira/prurido (49,1%), irritação (41,4%), ardor (39,2%), lacrimejamento (34,9%), sensação de cansaço (32,3%), alteração na pigmentação ocular (26,7%), dor (17,7%), ressecamento dos olhos (14,2%) e sensação de pressão atrás dos olhos (9,9). A utilização de filme para envelopar mercadoria contribuiu para maior prevalência de manifestações oculares. Já a utilização de luvas como equipamento de proteção individual auxiliou na menor prevalências dessas manifestações. Conclusão: Acredita-se que os achados do presente estudo possam subsidiar a avaliação clínica do enfermeiro na abordagem de trabalhadores portuários, assim como direcionar o planejamento e a implementação de cuidados socioambientais condizentes com as necessidades de saúde desses e de outros trabalhadores.

Epidemiological Characteristics of Work-Related Ocular Trauma among the Carpenters in Medan, Indonesia

BACKGROUND

Medan is the capital of North Sumatera Province and the most industrialised area of North Sumatera. One of the largest industries in Medan is the wooden industry. Ocular trauma is often happened in Medan and causes a serious problem.

AIM

This study aimed to analyse the correlation between ocular trauma among the carpenters and the using of eye protection during work and educational level.

METHODS

This study is conducted among the carpenters that work in the wooden industry. There were 30 carpenters that being observed about age, educational level and working hours and the using of eye protection during work that might be related to ocular trauma. All carpenters completed a comprehensive examination and interview.

RESULTS

The most common age range of ocular trauma was between 26-45 years (56.7%), and all were male. Most of the traumatised carpenters educational level had a higher educational level (50%), and workers that had traumatised works more than 8 hours a day (66.7%). From this study, there was a significant correlation between ocular trauma among the carpenters and age (p = 0.047), and working hours (p = 0.039).

CONCLUSION

No significant correlation between ocular trauma among the carpenters and the using of eye protection during work (p = 0.464), and educational level (0.925) was found. Furthermore to anticipate the high rate of worked-related ocular trauma required labour regulations that cover the age of recruitment workers and working hours a day. Work safety regulation protects the workers from work-related ocular trauma.

Clinical characteristics and outcomes of open globe injuries in Japan

PURPOSE

To describe the epidemiology and clinical outcomes of open globe injuries (OGIs) in Japan over 10 years, and examine preoperative factors influencing the visual prognosis after surgery.

STUDY DESIGN

Retrospective, observational, multicenter case-series study.

METHODS

Patients' data were entered into a computerized database for review and statistical analyses. The following parameters were assessed; age, gender, initial and final visual acuity, duration between onset and surgery, presence of lens in the eye, characteristics of injury, presence of ocular complications, and number of surgeries.

RESULTS

The records of 374 eyes with OGI were enrolled. The average age of the patients was 56.8 ± 22.1 years, and the majority of patients were men (73.5%). Compared to the overall cohort, work-related OGI was the most common, associated with significantly better final visual acuity, whereas patients with fall-down OGI showed significantly worse final visual acuity (P < 0.05). Among the types of injury, both the initial and final visual acuity were significantly worse in the rupture group than in the laceration group. Multiple liner regression analyses revealed that the final visual acuity was significantly associated with initial visual acuity, type of injury (rupture), retinal detachment, and proliferative vitreoretinopathy.

CONCLUSION

To predict the visual outcome in patients with OGI, ophthalmologists need to pay attention not only to the initial visual acuity but also to initial ocular conditions, such as the presence of ocular complications.

Ocular trauma in the Finnish elderly - Helsinki Ocular Trauma Study

PURPOSE

To describe epidemiology, causes, treatments and outcomes of all ocular injuries in southern Finland among people aged 61 and older.

METHODS

All new ocular trauma patients, admitted to the Helsinki University Eye Hospital, during 1 year in 2011-2012. The data were from hospital records and prospectively from patient questionnaires. The follow-up time was 3 months.

RESULTS

The incidence for ocular injuries among the elderly was 38/100 000/year. From 118 patients 69% were men. The mean age was 70.9 years old (median 67). The hospitalization rate was 14%. Injury types were minor traumas (48%), contusions (22%), chemical injuries (10%), eyelid wounds (8%), open globe injuries (OGI; 7%) and orbital fractures (5%). The injuries occurred at home (58%), institutions (12%) and in other public places (12%). The main causes of ocular injury were falls (22%), sticks (19%), superficial foreign bodies (18%) and chemicals (12%). All OGI and 88% of contusions needed a lifelong follow-up. A permanent visual or functional impairment occurred in 15 (13%) patients. Of these 53% were OGI, 40% contusions and 7% chemical injuries. The causes of permanent injuries were falls (seven cases, 47%), work tools, sports equipment, sticks, chemicals and eyeglasses. The incidence for legal blindness was 2.3/100 000.

CONCLUSION

Minor trauma was the most frequent type, and home was the location of the most occurred eye injuries. Falls were the most frequent and serious cause, but behavioural causes were not significant. Preventive measures should be directed towards the main identified causes and risk factors of the eye injuries in the elderly.

Optical coherence tomography patterns and outcomes of contusion maculopathy caused by impact of sporting equipment

Background

To describe the patterns and outcomes of contusion maculopathy after ocular contusions resulting from accidental impact with sporting equipment.

Methods

We conducted a retrospective study of interventional case series. Patient Population: Twenty-one eyes of 21 patients who sustained blunt ocular trauma while playing a sport. Intervention/Observation Procedure(s): Surgery or observation by optical coherence tomography (OCT). Main Outcome Measure(s): The morphologic changes within the macula in the early stages after injury and changes in visual function in the early and recovery stages after injury.

Results

In the early stage, OCT visualized four injury patterns: type Ι, commotio retinae (14.3%, 3 eyes) with increased reflectivity of the ellipsoid zone and retinal pigment epithelium; type II, incomplete macular hole(38.1%, 8 eyes) with three structural changes, i.e., a partial V-shaped macular hole, a jar-shaped macular hole with retinal tissue at the bottom, and a connective bridge attached to retinal tissues; type III, full-thickness macular hole (33.3%, 7 eyes); and type IV, foveal hemorrhage (14.3%, 3 eyes). During recovery, OCT images of types Ι and II showed almost normal macular morphology with better visual acuity (mean ± SD,0.02 ± 0.1 and 0.14 ± 0.21logMAR.). In types III and IV, the visual prognosis was poor (0.52 ± 0.34 and 0.22 ± 0.16), OCT images showed retinal atrophy at the fovea despite vitrectomy and sulfur hexafluoride (SF6) gas tamponade.

Conclusion

Early OCT images identified four patterns of contusion maculopathy with different treatment outcomes. In types Ι and II, the visual function and retinal morphology remained intact. With types III and IV, respectively, the treatments of vitrectomy and SF6 gas tamponade for patients were effective.

Traumatic Cataract in Children in Eastern China: Shanghai Pediatric Cataract Study

Traumatic cataract is a main cause of visual impairment in pediatric populations and is preventable. Awareness of the causes and consequences of pediatric eye trauma play roles in health education and prevention of blindness. We conducted a retrospective chart review based on 5-year clinical data of pediatric traumatic cataract cases treated at the Eye and Ear, Nose and Throat Hospital of Fudan University, Shanghai, China. Clinical features including demographic data, injury mechanism, and causative agents were analyzed. A total of 321 eyes of 321 children (male, 74.1%) were included. Penetrating injury accounted for 76.6% of all injuries; 65% of children with such injuries underwent their first surgery on the day of injury. The average age at injury was 6.3 ± 3.7 years, while the peak age was from two to eight years. The main causes of ocular injury were sharp metal objects, toys, and wooden sticks. The causative agent changed with increasing age; however, scissors were the leading cause within almost all age groups. Cataract surgery significantly improved visual acuity in children with traumatic cataract. These findings add information regarding the characterization of pediatric traumatic cataract in China and can help guide safety education and preventative measures.

Work-Related Eye Injuries: A Relevant Health Problem. Main Epidemiological Data from a Highly-Industrialized Area of Northern Italy

The province of Modena is one of the most industrialized areas of Northern Italy. The medical records of the Ophthalmological Emergency Department (OED) of Modena University Hospital were studied: there were 13,470 OED accesses in 2014 and in 754 cases that an occupational eye injury occurred. The frequency of work-related eye injuries (3‰) was lower compared to other published studies, but the absolute number is still relevant, showing the need for more adequate prevention, especially in metal work, construction work, and agriculture, where the worst prognoses were observed. Intervention programs must be implemented as early as possible in the working life, considering that the frequency in younger workers is about double that of the oldest age class (3.5‰ vs. 1.8‰), and special attention should also be given to foreigners, who have a 50% higher injury risk. Furthermore, the planning of specific interventions for eye-injured workers may be useful, considering that a previous injury does not appear to encourage the adoption of preventive interventions, and a subgroup of eye-injured workers have a potential risk for new injuries. Finally, the data presented here indicates how OED records, integrated with specific occupational information, can be applied for studies on work-related eye injuries.