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Liebman DL, Aboobakar IF. Traumatic Hyphema: Diagnostic and Management Considerations. Int Ophthalmol Clin 2024; 64:49-61. [PMID: 38525981 DOI: 10.1097/iio.0000000000000490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
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Alsarhani WK, AlShaker S, Lichter M, Chan CC. Spontaneous hyphema in a patient receiving acalabrutinib. CANADIAN JOURNAL OF OPHTHALMOLOGY 2023; 58:e211-e213. [PMID: 37192737 DOI: 10.1016/j.jcjo.2023.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 04/23/2023] [Indexed: 05/18/2023]
Affiliation(s)
| | - Sara AlShaker
- University of Toronto, Toronto, ON; College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Myrna Lichter
- University of Toronto, Toronto, ON; St. Michael's Hospital, Toronto, ON
| | - Clara C Chan
- University of Toronto, Toronto, ON; St. Michael's Hospital, Toronto, ON
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Khodeiry MM, Minkowski KA, Miri S, Greenfield DS, Lam BL. When my green eye turns brown: transient monocular heterochromia and vision loss due to uveitis-glaucoma-hyphema syndrome. CANADIAN JOURNAL OF OPHTHALMOLOGY 2023; 58:e214-e216. [PMID: 36965511 DOI: 10.1016/j.jcjo.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 01/26/2023] [Accepted: 03/06/2023] [Indexed: 03/27/2023]
Affiliation(s)
- Mohamed M Khodeiry
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL
| | - Kristin A Minkowski
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL
| | - Shahnaz Miri
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL
| | - David S Greenfield
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL
| | - Byron L Lam
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL.
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Justin GA, Woreta FA, Colyer MH, Auran JD, Pelton RW, Rapuano CJ, Menke AM. Ophthalmic Trauma Malpractice in the Ophthalmic Mutual Insurance Company Database. Eye (Lond) 2023; 37:109-119. [PMID: 35027708 PMCID: PMC9829717 DOI: 10.1038/s41433-021-01893-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 12/01/2021] [Indexed: 01/17/2023] Open
Abstract
PURPOSE To review ophthalmic trauma malpractice claims in the Ophthalmic Mutual Insurance Company (OMIC) database to determine the frequency and causes of litigation. METHODS A retrospective case series analysis of ophthalmic trauma claims from 2009 to 2019 was completed. Cases were selected only if the injury was secondary to trauma (e.g., fall, gunshot wound, paintball injury, etc.); iatrogenic traumatic surgical injuries were excluded. RESULTS 31 closed cases associated with 40 total claims related to ophthalmic trauma out of 2565 claims (1.56%) in the OMIC database were analysed. 13 of the 31 cases (41.9%) were decided for the plaintiff. In decisions for the plaintiff, the median settlement amount was $330,000 (range $125,000-$1,000,000). The most frequent initial diagnoses were corneal abrasion (n = 10), hyphema (n = 5) and open-globe injury (n = 5), and the most common final diagnoses were endophthalmitis (n = 8), intraocular foreign body (n = 7) and retinal detachment (n = 7). The most common causes of malpractice litigation were a delay in referral or follow-up (n = 11) and failure to get appropriate imaging (n = 8). In the 13 cases decided for the plaintiff, experts concluded nine did not meet standard of care. CONCLUSIONS Ophthalmic trauma malpractice claims are very uncommon in the United States, however, the payout is higher than non-trauma settlements, and approximately 40% of cases were decided for the plaintiff. Care could be improved with a careful history and complete ophthalmic examination (with dilated fundoscopy), imaging in appropriate patients, meticulous documentation, and early sub-specialist referral when the diagnosis or management plan was unclear.
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Affiliation(s)
- Grant A Justin
- Department of Ophthalmology, Walter Reed National Military Medical Center, Bethesda, MD, USA.
- Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed, Bethesda, MD, USA.
| | - Fasika A Woreta
- Wilmer Eye Institute, Johns Hopkins Medical Institute, Baltimore, MD, USA
| | - Marcus H Colyer
- Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed, Bethesda, MD, USA
- Department of Ophthalmology, Madigan Army Medical Center, Tacoma, WA, USA
| | - James D Auran
- Department of Ophthalmology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | | | | | - Anne M Menke
- Ophthalmic Mutual Insurance Company, San Francisco, CA, USA
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Batchelor A, Lacy M, Hunt M, Lu R, Lee AY, Lee CS, Saraf SS, Chee YE. Predictors of Long-term Ophthalmic Complications after Closed Globe Injuries Using the Intelligent Research in Sight (IRIS®) Registry. OPHTHALMOLOGY SCIENCE 2022; 3:100237. [PMID: 36561352 PMCID: PMC9764252 DOI: 10.1016/j.xops.2022.100237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 09/08/2022] [Accepted: 10/18/2022] [Indexed: 11/06/2022]
Abstract
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.
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Affiliation(s)
- Ashley Batchelor
- Department of Ophthalmology, University of Washington, Seattle, Washington
| | - Megan Lacy
- Department of Ophthalmology, University of Washington, Seattle, Washington
| | - Matthew Hunt
- Department of Ophthalmology, University of Washington, Seattle, Washington,Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, Iowa
| | - Randy Lu
- Department of Ophthalmology, University of Washington, Seattle, Washington
| | - Aaron Y. Lee
- Department of Ophthalmology, University of Washington, Seattle, Washington,Roger and Angie Karalis Johnson Retina Center, Seattle, Washington
| | - Cecilia S. Lee
- Department of Ophthalmology, University of Washington, Seattle, Washington,Roger and Angie Karalis Johnson Retina Center, Seattle, Washington,Correspondence: Cecilia S. Lee, MD, MS, Department of Ophthalmology, University of Washington, 325 Ninth Avenue, Box 359608, Seattle, WA 98104.
| | - Steven S. Saraf
- Department of Ophthalmology, University of Washington, Seattle, Washington,Roger and Angie Karalis Johnson Retina Center, Seattle, Washington
| | - Yewlin E. Chee
- Department of Ophthalmology, University of Washington, Seattle, Washington,Roger and Angie Karalis Johnson Retina Center, Seattle, Washington
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Nie YH, Zhang Y, Li F, Wang Q, Xu AM, Chen Z. Incidence of and Risk Factors for Postoperative Hyphema After 23-Gauge Pars Plana Vitrectomy for Proliferative Diabetic Retinopathy. Int J Gen Med 2021; 14:7277-7284. [PMID: 34737621 PMCID: PMC8560055 DOI: 10.2147/ijgm.s332485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 10/13/2021] [Indexed: 11/15/2022] Open
Abstract
Purpose We aim to investigate the incidence, clinical course, and risk factors for developing postoperative hyphema after 23-gauge pars plana vitrectomy (PPV) for patients with proliferative diabetic retinopathy (PDR) without neovascularization of the iris or angles and neovascular glaucoma (NVG). Methods This retrospective study included 155 consecutive eyes from 124 patients with at least three-month follow-up who underwent PPV for PDR without neovascularization of the iris or angles and NVG. Demographic data, surgery notes, postoperative hyphema assessment, intraocular pressure (IOP), and the surgical outcome were recorded. Results Postoperative hyphema occurred in 18 of 155 eyes (11.6%), with 14 of those having hyphema on day 1, and 4 having hyphema on days 7–20. Of the 18 eyes, only 3 (16.7%) had normal IOP, and immediate intraocular hypertension was observed in 15 (83.3%). Seven eyes required anterior chamber paracentesis and five needed anterior chamber irrigation. The average time for absorption of the hyphema was 13.1 days, and IOP was controlled in all cases. There was a significant correlation between membrane removal and the development of hyphema (OR = 5.65 and 95% CI: 1.190–25.203; p = 0.013). No recurrence of hyphema was observed. In patients with hyphema, the final best corrected visual acuity (BCVA) was 1.75 ± 0.84 logMAR, which improved significantly compared to the initial BCVA of 2.20 ± 0.65 logMAR (t = 3.893; p = 0.001), and the final anatomic success rate was 100%. Conclusion The development of hyphema is not uncommon after PPV for patients with PDR without neovascularization of the iris or angles and NVG, and membrane removal is a risk factor for postoperative hyphema. The timely management of hyphema ensures that hyphema does not affect the visual recovery or the final anatomical success.
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Affiliation(s)
- Yu-Hong Nie
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan, 430060, People's Republic of China
| | - Yu Zhang
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan, 430060, People's Republic of China
| | - Fan Li
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan, 430060, People's Republic of China
| | - Qiong Wang
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan, 430060, People's Republic of China
| | - A-Min Xu
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan, 430060, People's Republic of China
| | - Zhen Chen
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan, 430060, People's Republic of China
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Liu Y, Yang T, Yu J, Li M, Li J, Yan H. Creation of a New Explosive Injury Equipment to Induce a Rabbit Animal Model of Closed Globe Blast Injury via Gas Shock. Front Med (Lausanne) 2021; 8:749351. [PMID: 34631761 PMCID: PMC8495021 DOI: 10.3389/fmed.2021.749351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 08/25/2021] [Indexed: 11/13/2022] Open
Abstract
To establish a rabbit animal model of closed globe blast injury with an application of self-developed explosive injury equipment, we tend to explore the anatomic and pathological changes of eyes under different gas pressure. The device comprises of high-pressure air source compression pump, air channel, and gas shock. There were 36 healthy bluish blue rabbits exposed to one of five blast pressures (500, 1,000, 1,500, 2,000, and 5,000 Kpa). Slit lamp microscope, B-mode ultrasonography, fundus photography, optical coherence tomography (OCT), and intraocular pressure (IOP) examination were performed at 0-, 1-, 3-, and 7-days post exposure, while gross histopathology was assessed with H&E stain at 7 days. The contralateral eyes and non-blast exposed rabbits were used as controls. Definitive evidence of closed globe blast injury was obtained. Corneal edema and hyphema were observed in the models under all pressures with no full-thickness globe injury, or lens rupture, as the severity was pressure independent. There was no obvious retinal abnormality on B ultrasound or OCT scan, while light vitreous hemorrhage, commotio retinae, and heavy retinal pigmentation presented on one eye, respectively, in the eyes exposed to 5,000 Kpa. Increased retinal thickness with disorganizations on the retinal ganglion cell (RGC) layer and RGC apoptosis in groups under higher pressure (>500 Kpa). IOP of injured eyes were statistically decreased at day 1 and 7 post injury (p < 0.05). Conclusively, the rabbit animal model induced by self-developed equipment could mimic the clinical features of closed ocular blast injury successfully that was feasible and easy to operate. This will be a new rabbit animal model for investigating mechanisms and new therapeutic interventions of closed globe blast injury in the future.
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Affiliation(s)
- Yuanyuan Liu
- Department of Ophthalmology, Tianjin Medical University General Hospital, Tianjin Medical University, Tianjin, China
| | - Tiantian Yang
- Department of Ophthalmology, Tianjin Medical University General Hospital, Tianjin Medical University, Tianjin, China
| | - Jinguo Yu
- Department of Ophthalmology, Tianjin Medical University General Hospital, Tianjin Medical University, Tianjin, China
| | - Mengxuan Li
- Department of Ophthalmology, Tianjin Medical University General Hospital, Tianjin Medical University, Tianjin, China
| | - Jianan Li
- Department of Ophthalmology, Tianjin Medical University General Hospital, Tianjin Medical University, Tianjin, China
| | - Hua Yan
- Department of Ophthalmology, Tianjin Medical University General Hospital, Tianjin Medical University, Tianjin, China
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