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Liu X, Ji MM, Jin L, Zeng AP. Microsurgical Vitrectomy with Pars Plana Incision for the Removal of Posterior Segment Intraocular Foreign Bodies. J Ophthalmol 2024; 2024:3270197. [PMID: 38495222 PMCID: PMC10944342 DOI: 10.1155/2024/3270197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 06/24/2023] [Accepted: 03/02/2024] [Indexed: 03/19/2024] Open
Abstract
This study describes a pars plana incision surgical technique combined with 23 or 25-gauge vitrectomy in the management of intraocular foreign bodies (IOFBs) and to assess its anatomical and functional results. Sixteen patients with ocular trauma complicated with IOFB were enrolled in our study. The mean preoperative visual acuity was 2.01 ± 0.55 LogMAR, and the mean postoperative visual acuity at the final visit was improved to 0.91 ± 0.58 LogMAR (p < 0.001). Until the last follow-up, all IOFBs were successfully removed and anatomic success was obtained. Complications, such as endophthalmitis, silicone oil-dependent, and ocular hypotonia, were not observed. Microsurgical vitrectomy with modified pars plana incision is a safe and effective procedure in the treatment of retained IOFB, especially associated with transparent lens and posterior segment injury.
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Affiliation(s)
- Xin Liu
- Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Meng Meng Ji
- Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Ling Jin
- Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Ai Ping Zeng
- Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
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Mura M, Iannetta D, Pellegrini M, Engelbrecht LA, Sarti L, Parmeggiani F, Badawi A, Dhibi H, Al Sulaiman S. Long-term functional and structural outcomes after large chorioretinectomy for ruptured globe following blunt trauma. Int J Retina Vitreous 2023; 9:52. [PMID: 37653531 PMCID: PMC10472549 DOI: 10.1186/s40942-023-00492-7] [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: 07/06/2023] [Accepted: 08/18/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND The purpose of this study was to present a modified surgical technique involving pars plana vitrectomy with large chorioretinectomy for eyes with rupture of the globe due to severe ocular blunt trauma. METHODS This retrospective study included consecutive patients with rupture of the globe due to blunt trauma who were treated at the King Khaled Eye Specialist Hospital (Riyadh, Saudi Arabia). All patients underwent 25-gauge pars plana vitrectomy with large chorioretinectomies involving all the tissue around the posterior scleral wounds. Outcome measures included best-corrected visual acuity (BCVA), anatomical success and globe survival, rates of complications. RESULTS 15 eyes of 15 patients were included. Mean BCVA was 2.88 ± 0.13 logMAR at presentation, and significantly improved to 0.83 ± 0.28 logMAR (P < 0.001), with 10 patients (67%) achieving a final BCVA ≥ 20/200. Anatomical success and globe survival were achieved in 11 (73%) and 15 (100%) of eyes, respectively. Postoperative complications included retinal detachment in 6 eyes (40%), epiretinal membrane in 6 (40%), hypotony in 4 (26%), PVR in 2 (13%). CONCLUSIONS Pars plana vitrectomy with large chorioretinectomy is an effective treatment for globe rupture following severe blunt trauma, yielding good visual outcomes and anatomical success rates.
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Affiliation(s)
- Marco Mura
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy.
- Vitreoretinal Division, King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia.
- St. Anna University Hospital, Via A. Moro 8, 44124, Cona (Ferrara), Italy.
| | - Danilo Iannetta
- Ophthalmology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Marco Pellegrini
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - Leonore A Engelbrecht
- Vitreoretinal Division, King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia
| | - Laura Sarti
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | | | - Abdulrahman Badawi
- Vitreoretinal Division, King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia
| | - Hassan Dhibi
- Vitreoretinal Division, King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia
| | - Sulaiman Al Sulaiman
- Vitreoretinal Division, King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia
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Si S, Su W, Wang L, Ji Y, Chen A, Hu Y. A novel predictive model for phthisis bulbi following facial hyaluronic acid cosmetic injection. BMC Ophthalmol 2023; 23:244. [PMID: 37259051 DOI: 10.1186/s12886-023-02992-4] [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: 10/04/2022] [Accepted: 05/23/2023] [Indexed: 06/02/2023] Open
Abstract
PURPOSE To observe long-term prognosis of anterior segment ischemia (ASI) following hyaluronic acid (HA) injection, propose a severity grading system for ASI and a predictive model for phthisis bulbi (PB) based on long-term secretion dysfunction of ciliary process. METHODS This is a retrospective case-control study. All enrolled 20 patients were divided into two groups and followed for at least 6 months to observe the formation and transformation characteristics of ASI and long-term prognosis based on the degrees of ciliary function damage. RESULTS The severity of ASI following HA injection could be subdivided into 4 grades according to the degrees of ciliary function damage, comprising ASI grades 0, 1, 2 and 3. In 20 patients, ophthalmoplegia at 1-month follow-up, ASI within 1 month, ASI at 1-month follow-up, hypotony within 6 months were all significantly more common in study group than in control group (60% vs. 0%, P = 0.011; 100% vs. 20%, P = 0.001; 100% vs. 0%, P < 0.001; 80% vs. 0%, P = 0.001, respectively). Sensitivity, specificity and the area under the receiver operating characteristic curve (AUC) for predicting subsequent PB at 2-year follow-up through the co-occurrence of ophthalmoplegia at 1-month follow-up and hypotony within 6 months was 100%, 100% and 1.00, respectively. CONCLUSIONS The new grading system for ASI and novel predictive model for PB we proposed could predict the long-term prognosis and probability of subsequent PB due to ASI following HA injection through several dynamic assessments within 6 months. LEVEL OF EVIDENCE Level IV, observational prognostic study.
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Affiliation(s)
- Shancheng Si
- Eye Center, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, 102218, China
| | - Wei Su
- Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, 102218, China
| | - Lei Wang
- Eye Center, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, 102218, China
| | - Yicong Ji
- Eye Center, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, 102218, China
| | - Anming Chen
- Eye Center, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, 102218, China
| | - Yuntao Hu
- Eye Center, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, 102218, China.
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Epidemiological Characteristics of Pediatric Ocular Trauma in China: A Multicenter Retrospective Hospital-Based Study. J Ophthalmol 2022; 2022:4847027. [PMID: 35847351 PMCID: PMC9279087 DOI: 10.1155/2022/4847027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 06/15/2022] [Indexed: 11/24/2022] Open
Abstract
Purpose The objective of the study was to obtain the incidence characteristics of pediatric ocular trauma in mainland China and provide some feasible suggestions of prevention. Methods The patients with pediatric ocular injuries, who were (≤14) hospitalized between January 1, 2019, and December 31, 2020, were included. Patient demographics (age and sex), injury natural characteristics (causes, site, and types), geographic location, and interval of hospital admission were analyzed. Results A total of 13525 cases were identified, and 1973 (14.6%) occurred in children (male accounts 70.9%) with a mean (SD) age of 6.5 (3.4) years. Cases among minors in 2020 dropped by 8.3% compared to 2019, while the former vulnerability to eye injuries has been shifted from the outdoors to home (51.4%, 1015/1973). The main causes of injury are flying objects (31.9%), traffic injury (23.5%), and blunt injury (21.8%), which lead to the main types of injury such as penetrating injury (48.3%), rupture of the globe (18.1%), and contusion trauma (13.1%). If the VA after injury is above CF, the VA after discharge is more likely to be above CF (OR 18.3, 11.9–28.1; p < 0.001). Similarly, age (OR 2.0, 1.3–3.1; p=0.001) and intraocular pressure after injury (OR 0.9, 0.9–1.0; p=0.009) also affect the intraocular pressure at discharge. Conclusions In mainland China, the main injury types are penetrating injury and rupture of the globe with home being the most dangerous place. Prevention strategies should focus on parents' education and protective measures indoors. Visual acuity after injury can be used as a predictor of visual acuity after treatment.
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Chen H, Yang J, Wang C, Feng X, Feng K, Ma Z. Novel Suturing Methods for the Management of Traumatic Choroidal Avulsion in Globe Injuries. Front Med (Lausanne) 2022; 8:801068. [PMID: 35111782 PMCID: PMC8801457 DOI: 10.3389/fmed.2021.801068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 12/20/2021] [Indexed: 11/13/2022] Open
Abstract
PurposeTo explore the long-term efficacy of novel choroidal suturing methods including trans-scleral mattress suturing (TSS) and intraocular suturing (IOS) in the treatment of choroidal avulsion.DesignProspective cohort, hospital-based study.MethodsA total of 24 patients who were diagnosed with choroidal avulsion were enrolled in this study. The demographic characteristics, baseline information of trauma, best-corrected visual acuity (BCVA), and intraocular pressure (IOP) were collected before surgery, and the anatomic abnormities of the globe were recorded before or during surgery. All patients were diagnosed with choroidal avulsion and underwent choroid suturing treatment during vitrectomy, postoperative functional variables including BCVA and IOP, anatomic variables including retinal and choroidal reattachment rate, and silicone oil migration rate, which were recorded at the regular follow-ups at least 1 year after surgery.ResultsAll patients with open globe injury involved zone III, 70.8% of the patients presented with two quadrants of the avulsed choroid, and 29.2% with one quadrant involved; moreover, all patients had complications with retinal detachment (RD), of which 58.3% of patients had closed funnel retinal detachment. TSS was applied in nineteen patients and IOS in five patients. Postoperatively, a significant improvement on LogMAR BCVA was observed at each follow-up from 3.57 ± 0.69 before surgery to 2.82 ± 0.98 at the last follow-up (p < 0.05), and the proportion of no light perception (NLP) was also reduced from 69.6 to 37.5%. IOP was markedly elevated from 6.4 ± 4.1 mmHg preoperatively to 11.3 ± 4.3 mmHg at the last follow-up (p < 0.05). Choroidal reattachment was achieved in 91.7% of patients; two patients were observed with silicone oil migration at 3 months after surgery and underwent drainage of suprachoroidal silicone oil and sclera buckling. Meanwhile, retinal attachment was observed in 95.8% of patients, only one patient developed partial RD due to postoperative proliferative vitreoretinopathy, and secondary vitrectomy was performed; all patients were observed with complete retinal and choroidal attachment at the last follow-up. Eventually, four patients were silicone oil-free, and 20 patients were silicone oil-dependent.ConclusionsChoroidal suturing proved to be an effective method to fix the avulsed choroid, which greatly improved the BCVA and maintained the IOP, and efficiently increased the choroidal and retinal reattachment rate and preservation of the eyeball.
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Affiliation(s)
- Huijin Chen
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Beijing, China
| | - Jiarui Yang
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Beijing, China
| | - Changguan Wang
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Beijing, China
| | - Xuefeng Feng
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Beijing, China
| | - Kang Feng
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Beijing, China
| | - Zhizhong Ma
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Beijing, China
- *Correspondence: Zhizhong Ma
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Qin ZX, He Y, Xu YF, Yu T, Liu Y, Wu N. Pediatric ocular trauma with pars plana vitrectomy in Southwest of China: clinical characteristics and outcomes. Int J Ophthalmol 2021; 14:1321-1326. [PMID: 34540606 DOI: 10.18240/ijo.2021.09.05] [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: 11/14/2020] [Accepted: 02/19/2021] [Indexed: 11/23/2022] Open
Abstract
AIM To investigate the clinical characteristics and predictive factors of pediatric ocular trauma patients with vitrectomy. METHODS Pediatric ocular trauma patients (aged 14y or younger) who received vitrectomy in Southwest Hospital between January 2007 and December 2017 were reviewed retrospectively. Age, gender, mechanism of injury, final visual acuity (VA), and prognostic factors were analyzed. RESULTS A total of 139 eyes in 139 pediatric patients were included in the study. The mean age was 7.4±3.7 years old and the male-to-female ratio was 5:1. There were 104 (74.8%) open globe injuries and 35 (25.2%) closed globe injuries. The top one traumatic eye injuries were penetrating injuries occur through sharp metal objects (43.9%). After vitrectomy, 116 patients had favorable anatomic outcome at the last follow-up, and 30 eyes (21.6%) achieved VA of 20/200 or better. Following univariate analysis, we found zone III injuries (P=0.021), poor initial VA (P=0.005), endophthalmitis (P=0.024), and recurrent retinal detachment (P<0.001) were poor prognostic factors for pediatric ocular trauma. After Logistic regression analysis, the poor initial VA (odds ratio: 8.276, 95%CI: 1.597-42.897, P=0.012) and recurrent retinal detachment (odds ratio: 6.455, 95%CI: 2.372-17.562, P<0.001) were significantly correlated with unfavorable vision outcome in pediatric ocular trauma. CONCLUSION The treatment of vitrectomy for severe ocular trauma results in favorable anatomic outcomes, but VA improvement is not as good as anatomic outcomes. Initial VA and recurrent retinal detachment are the independent prognostic indicators for unfavorable visual outcome of severe pediatric ocular trauma.
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Affiliation(s)
- Zuo-Xin Qin
- Southwest Hospital/Southwest Eye Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China.,Key Lab of Visual Damage and Regeneration & Restoration of Chongqing, Chongqing 400038, China
| | - Yan He
- Southwest Hospital/Southwest Eye Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China.,Key Lab of Visual Damage and Regeneration & Restoration of Chongqing, Chongqing 400038, China
| | - Yu-Fei Xu
- Southwest Hospital/Southwest Eye Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China.,Key Lab of Visual Damage and Regeneration & Restoration of Chongqing, Chongqing 400038, China
| | - Tao Yu
- Southwest Hospital/Southwest Eye Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China.,Key Lab of Visual Damage and Regeneration & Restoration of Chongqing, Chongqing 400038, China
| | - Yong Liu
- Southwest Hospital/Southwest Eye Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China.,Key Lab of Visual Damage and Regeneration & Restoration of Chongqing, Chongqing 400038, China
| | - Nan Wu
- Southwest Hospital/Southwest Eye Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China.,Key Lab of Visual Damage and Regeneration & Restoration of Chongqing, Chongqing 400038, China
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Feng K, Yao Y, Wang Z, Nie H, Pang X, Chen H, Jiang Y, Hu Y, Ma Z. Mechanism and prognostic indicators for explosion-related eye trauma: eye injury vitrectomy study. Acta Ophthalmol 2021; 99:e956-e962. [PMID: 33417310 DOI: 10.1111/aos.14713] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 10/23/2020] [Accepted: 11/15/2020] [Indexed: 01/13/2023]
Abstract
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.
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Affiliation(s)
- Kang Feng
- From the Peking University Third Hospital Peking University Eye Center Beijing Key Laboratory of Restoration of Damaged Ocular Nerve Beijing China
| | - Yi Yao
- Chinese PLA General Hospital Beijing China
| | - Zhi‐Jun Wang
- Department of Ophthalmology China‐Japan Friendship Hospital Beijing China
| | - Hong‐Ping Nie
- Department of Ophthalmology Peking University First Hospital Beijing China
| | - Xiu‐Qin Pang
- Department of Ophthalmology Tongren Hospital Capital University of Medical Sciences Beijing China
| | - Hui‐Jin Chen
- From the Peking University Third Hospital Peking University Eye Center Beijing Key Laboratory of Restoration of Damaged Ocular Nerve Beijing China
| | - Yan‐Rong Jiang
- Department of Ophthalmology Peking University People’s Hospital Beijing China
| | - Yun‐Tao Hu
- Tsinghua University Affiliated Beijing Tsinghua Changung Hospital Beijing China
| | - Zhi‐Zhong Ma
- From the Peking University Third Hospital Peking University Eye Center Beijing Key Laboratory of Restoration of Damaged Ocular Nerve Beijing China
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Prognostic factors and long-term outcomes of eye-globe perforation: Eye injury vitrectomy study. Injury 2021; 52:286-291. [PMID: 33032800 DOI: 10.1016/j.injury.2020.09.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 09/19/2020] [Accepted: 09/29/2020] [Indexed: 02/02/2023]
Abstract
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.
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Sun Z, Zhuang X, Xu G, Jiang R. Clinical analysis of posterior segment injury in left-behind children in China. BMC Ophthalmol 2020; 20:40. [PMID: 32005139 PMCID: PMC6993498 DOI: 10.1186/s12886-020-1317-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 01/17/2020] [Indexed: 11/23/2022] Open
Abstract
Background We aimed to evaluate the severity and prognosis of posterior segment injury between left-behind children (LBC) and guarded children (NLBC). Methods A retrospective, controlled analysis of a case series was performed. Patients diagnosed with posterior segment injury in Department of vitreous and retinal, the Affiliated Ophthalmology and Otolaryngology Hospital of Fudan University were included in this study. Patients were divided into two groups, including LBC group (n = 48) and NLBC group (n = 44). All the children underwent 25G transconjunctival sutureless pars plana vitrectomy. Results Compared with NLBC, LBC had delayed treatment, worse baseline vision and visual prognosis, lower OTS rating, more times of vitrectomies, more complicated surgical procedures, and higher rate of lens removal and silicone oil tamponade. Conclusions Due to lack of care and delayed treatment, posterior segment ocular trauma in the LBC was more severe, more common complicated with infectious endophthalmitis, and had worse visual prognosis. It was urgent to enforce the guardianship in LBC.
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Gürelik G, Sül S, Üçgül AY. Intraocular mitomycin C use in the treatment and prophylaxis of proliferative vitreoretinopathy in severe traumatic retinal detachments. Eur J Ophthalmol 2020; 31:3284-3293. [PMID: 33233948 DOI: 10.1177/1120672120976038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To evaluate the anatomic and visual outcomes of a new intraocular mitomycin c (MMC) application technique in the treatment of severe traumatic retinal detachment (RD) with advance proliferative vitreoretinopathy (PVR). METHODS The records of 15 eyes of 14 patients who underwent vitreoretinal surgery and intraoperative MMC application were reviewed retrospectively. SURGICAL TECHNIQUE After performing complicated vitreoretinal surgical procedures (Pars plana vitrectomy, PVR membrane stripping, large retinotomy/retinectomies and intraocular foreign body removal if found etc. . .) retina was attached with perfluorocarbon liquid (PFCL) and partial fluid-air exchange. Endolaser was performed. PFCL was removed to the posterior borders of retinochoroidal wounds, breaks or retinectomy sites. The remaining PFCL was enough to cover and prevent MMC contact with the posterior vital structures including optic disc, macula and underlying RPE and major vascular arcades. Ciliary epithelium and other anterior segment structures were protected from MMC contact with the use of air in the rest of the eye. Then, a 10 µg/mL concentrated MMC solution was carefully injected above the PFCL bubble until it covered PVR or potential areas of PVR development and removed after 60 s. Finally, the remaining PFCL was removed and all eyes were filled with silicone oil. The patients were followed at least 6 months after silicone oil removal. Visual and anatomic outcomes were determined during follow-up period. RESULTS The mean follow-up time was 19.6 ± 6 months (range 12-27 months). About 100% retinal attachment was achieved with one vitreoretinal surgery during the follow-up period. PVR was not detected around the retinal breaks or retinotomy sites in any eye. Limited macular epiretinal membrane was detected in two eyes and subsequently peeled during silicone oil removal. Preoperative visual acuities were hand motions in seven eyes and light perception in eight eyes. Nine of 15 eyes had a visual acuity of ⩾0.1 during the follow-up period. The mean preoperative visual acuity was logMAR 2.16 ± 0.15 and postoperative visual acuity was 0.80 ± 0.50 (p = 0.001). There were no additional complications related to intraoperative MMC use during follow-up period. CONCLUSION Temporary intraocular MMC use in vitreoretinal surgery yielded good anatomic and visual outcomes after the treatment of traumatic RDs with PVR or those with high risk of PVR development. Furthermore, MMC application appeared to prevent further PVR development after vitreoretinal surgery.
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Affiliation(s)
- Gökhan Gürelik
- Department of Ophthalmology, Gazi University Medical School, Ankara, Turkey
| | - Sabahattin Sül
- Department of Ophthalmology, Muğla Sıtkı Koçman University, Muğla, Eyalet/Yerleske, Turkey
| | - Ahmet Yücel Üçgül
- Department of Ophthalmology, Gazi University Medical School, Ankara, Turkey
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Globe rupture: a single-center retrospective study of demographic patterns and outcomes. Sci Rep 2020; 10:19139. [PMID: 33154518 PMCID: PMC7645784 DOI: 10.1038/s41598-020-76121-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 10/23/2020] [Indexed: 12/03/2022] Open
Abstract
Globe rupture is one of the severe mechanisms of eye injury. This study aimed to describe an epidemiologic patterns and visual outcomes of the open globe injury from globe rupture at a tertiary referral centre. Medical records of 167 patients (173 eyes) were retrospectively reviewed. Overall, males were predominant (82%). Road traffic- (26.3%) and work- (23.4%) were the major contributors. However, falling was the main mechanism in the elderly aged over 60 years. At presentation, 91.4% of eyes had initial visual acuity (VA) of worse than 20/200. The mean (SD) VA in logarithm of the minimum angle of resolution (LogMAR) unit at final [1.8 (1.1)] was significantly improved from presenting VA [2.4 (0.6)] (p ˂ 0.001). Predictors for final VA of worse than 20/400 included poor initial VA, presence of relative afferent pupillary defect, and endophthalmitis. In conclusion, this study observed the peak incidence of globe rupture in young teen to early adult patients, with unique characteristics in each age group. Even with significant visual improvement following the treatments, profound visual loss was still a common consequence. Thus, the role of effective prevention along with a multidisciplinary team together with timely and prompt ophthalmic management should be emphasised.
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Chen X, Zha Y, Du S, Yang X. Timely Use of Conventional Vitrectomy and Endoscope-Assisted Vitrectomy for Endophthalmitis Following Open Ocular Trauma: A Retrospective Study of 18 Patients. Med Sci Monit 2019; 25:8628-8636. [PMID: 31732711 PMCID: PMC6874835 DOI: 10.12659/msm.918017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background Endophthalmitis, or inflammation of the internal tissues of the eye, may follow trauma and results in loss of vision if not treated promptly. Vitrectomy is used to debride the inflamed vitreous. This retrospective study aimed to compare the outcome from conventional vitrectomy (CV) and endoscope-assisted vitrectomy (EAV) performed for endophthalmitis within five days and 10 days after open ocular trauma. Material/Methods The clinical data from 18 patients (18 eyes) with endophthalmitis caused by open ocular trauma were analyzed at a single center. CV or EAV was performed based on the degree of vision and the involvement of the vitreous cavity. Results Of the 18 patients with endophthalmitis, seven patients underwent EAV, and 11 patients underwent CV. The number of cases with preoperative corneal laceration, edema, bleeding, and formation of corneal nebular opacity was higher in the EAV group compared to the CV group. Four patients had retinal detachment, of which three patients were treated with EAV. Seventeen patients had their sight restored by a single vitrectomy procedure. In 10 cases, the culture of the vitreous fluid was positive for infection, and eight patients had Gram-positive Staphylococcus epidermidis infection. Follow-up showed that vitrectomy performed within five days (P=0.001) and 10 days (P=0.047) of open ocular trauma resulted in significant improvement of visual acuity. Conclusions Vitrectomy for endophthalmitis due to open ocular trauma performed within five days of injury restored visual acuity. EAV was shown to be an effective alternative to CV.
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Affiliation(s)
- Xing Chen
- The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China (mainland).,Department of Fundus Diseases and Ocular Trauma, Lixiang Eye Hospital of Soochow University, Suzhou, Jiangsu, China (mainland).,Department of Ophthalmology, Wuxi 9th Affiliated Hospital of Soochow University, Wuxi, Jiangsu, China (mainland)
| | - Youyou Zha
- Department of Fundus Diseases and Ocular Trauma, Lixiang Eye Hospital of Soochow University, Suzhou, Jiangsu, China (mainland)
| | - Shu Du
- Department of Fundus Diseases and Ocular Trauma, Lixiang Eye Hospital of Soochow University, Suzhou, Jiangsu, China (mainland)
| | - Xun Yang
- The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China (mainland).,Department of Fundus Diseases and Ocular Trauma, Lixiang Eye Hospital of Soochow University, Suzhou, Jiangsu, China (mainland)
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Hoskin AK, Watson SL, Mackey DA, Agrawal R, Keay L. Eye injury registries - A systematic review. Injury 2019; 50:1839-1846. [PMID: 31378543 DOI: 10.1016/j.injury.2019.07.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 07/18/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Registries are integral to monitoring, surveying, treating, preventing and prognosticating trauma. The quantity and quality of data must justify a change or intervention in treatment and/or preventive strategies and must be collected while balancing the cost and time invested in the registry. This review documents the quality, completeness and operational and funding models for ocular trauma registries worldwide. METHODS The databases CENTRAL, MEDLINE, EMBASE and Informit Health Collection were searched using key word and mesh terms for: "Eye injury, "Ocular trauma", "Eye injury prevention", "Eye protection", "Registry". To find relevant unpublished articles and theses, clinicaltrials.gov, Trip, MedNar and Google Scholar were searched using the key words "eye injury" OR "ocular trauma" AND "registry*". No date or language restrictions were applied. The quality of registry data was assessed against published measures including design, operation and data quality. RESULTS The electronic search retrieved 528 distinct published articles; 61 articles were assessed for eligibility. Of the 61 articles identified, 28 were eligible to be included in the review, with cross-referencing identifying a further 7 articles. The source of most articles on ocular trauma registries was the United States, followed by Germany and China. Patient follow-up was conducted in 31 studies, with 6 months being the most frequently reported period. Issues with data quality included incomplete data such as presence or absence of eye protection and initial visual acuity. Attrition bias was controlled by the United States Eye Injury Register with follow-up. Patients without follow-up data were removed for some studies and this may have introduced bias. CONCLUSION National, state and hospital-based ocular trauma registries have contributed significantly to our understanding of ocular trauma. The United States has the most frequently cited and well-resourced ocular trauma registries. It is anticipated that this review will guide the development of future registries for ocular trauma in order to inform evidence-based prevention strategies and, ultimately, improve visual outcomes. We recommend the development of a consensus guidelines for international ocular trauma registry that includes mechanism and context of injury and visual outcomes, to permit international comparison that can be implemented at low cost with secure data capture.
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Affiliation(s)
- Annette K Hoskin
- The University of Sydney, Save Sight Institute, Discipline of Ophthalmology, Sydney Medical School, Sydney, New South Wales, Australia; Lions Eye Institute. Nedlands, Western Australia, Australia; Department of Ophthalmology, University of Western Australian, Nedlands, Western Australia, Australia.
| | - Stephanie L Watson
- The University of Sydney, Save Sight Institute, Discipline of Ophthalmology, Sydney Medical School, Sydney, New South Wales, Australia
| | - David A Mackey
- Lions Eye Institute. Nedlands, Western Australia, Australia; Department of Ophthalmology, University of Western Australian, Nedlands, Western Australia, Australia
| | | | - Lisa Keay
- The School of Optometry and Vision Science, UNSW, Sydney, New South Wales, Australia; The George Institute for Global Health, UNSW, Sydney, New South Wales, Australia
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Ji YR, Zhu DQ, Zhou HF, Fan XQ. Epidemiologic characteristics and outcomes of open globe injury in Shanghai. Int J Ophthalmol 2017; 10:1295-1300. [PMID: 28861358 DOI: 10.18240/ijo.2017.08.18] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 03/24/2017] [Indexed: 12/27/2022] Open
Abstract
AIM To investigate the epidemiologic characteristics and outcomes of open globe injury in Shanghai. METHODS A retrospective study was conducted for 148 unilateral open globe injury cases presenting to a tertiary referral hospital of Shanghai. Electronic medical records were reviewed and phone surveys were conducted to collect and analyze 1) background of patient; 2) setting of injury and clinical signs at presentation; 3) treatment procedure and outcome; 4) quality of life after injury. RESULTS There were more male patients (77.03%) than females (22.97%), more temporary habitants (79.05%) than residents (20.95%). The subjects in this study presented a significantly lower constitutional status of education than that of the whole Shanghai population (P<0.001). Occupational injury was the first cause of injuries (39.86%), followed by home accident (20.27%), road accident (16.89%), violent behavior (16.89%) and outdoor injury (6.08%). The 143 subjects (96.62%) were not wearing spectacles at the time of injury. Of all patients, 77 subjects (52.03%) had the outcome of no vision (including enucleation). The classification and regression tree (CART) prognosis presents 59.58% sensitivity to predict visual survival correctly and 80.19% specificity to predict no vision correctly. The patients whose injured eye had no vision reported more reduction of life quality. CONCLUSION We found that male subject, temporary habitants, low educational status and no eyewear are risk factors of open globe injury in Shanghai. Occupational injury is the leading cause. CART analysis presents a certain agreement to the actual visual outcome. The injury imposes negative impact on quality of life especially in no vision cases. The education of eye protection may help to avoid the injury.
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Affiliation(s)
- Yong-Rong Ji
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Dong-Qing Zhu
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Hui-Fang Zhou
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Xian-Qun Fan
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
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Intraoperative B-scan ultrasonography and pars plana vitrectomy for severe open globe injury with hemorrhagic retinal and choroidal detachment. Graefes Arch Clin Exp Ophthalmol 2017; 255:2287-2291. [PMID: 28856428 DOI: 10.1007/s00417-017-3771-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 07/20/2017] [Accepted: 08/01/2017] [Indexed: 10/19/2022] Open
Abstract
PURPOSE Our purpose was to report the initial clinical experience of intraoperative B-scan ultrasonography in combination with 25-gauge pars plana vitrectomy for severe open globe injury with hemorrhagic retinal and choroidal detachment. METHODS Six eyes of six consecutive patients with severe open globe injury underwent intraoperative B-scan ultrasonography and 25-gauge pars plana vitrectomy at Osaka University Hospital in Japan. The feasibility of intraoperative B-scan ultrasonography, best-corrected visual acuity (BCVA), retinal reattachment, and intraoperative and postoperative complications were evaluated. RESULTS Five patients presented with a ruptured globe and one patient with double penetration. Preoperative best-corrected visual acuity was no light perception in four eyes and light perception in two eyes. All patients underwent intraoperative B-scan ultrasonography and 25-gauge pars plana vitrectomy within 12 h after open globe injury. Intraoperative B-scan ultrasonography was feasible in all cases and was useful for diagnosing choroidal hemorrhage (four eyes), massive subretinal hemorrhage (two eyes), and retinal detachment (five eyes). In addition, serial real-time B-scan imaging facilitated successful evacuation of the choroidal hemorrhage and massive subretinal hemorrhage by external drainage, resulting in opening of the vitreous space to allow subsequent pars plana vitrectomy without entry site-related complications. After surgery, all patients had successful retinal attachment, and there was no loss of light perception. CONCLUSION Intraoperative B-scan ultrasonography is technically feasible and may potentially improve the safety and efficacy of severe open globe injury repair.
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Kuhn F, Schrader W. Prophylactic chorioretinectomy for eye injuries with high proliferative-vitreoretinopathy risk. Clin Anat 2017. [DOI: 10.1002/ca.22906] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Ferenc Kuhn
- Helen Keller Foundation for Research and Education; Birmingham Alabama
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Chen X, Yao Y, Wang F, Liu T, Zhao X. A retrospective study of eyeball rupture in patients with or without orbital fracture. Medicine (Baltimore) 2017; 96:e7109. [PMID: 28614230 PMCID: PMC5478315 DOI: 10.1097/md.0000000000007109] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
To summarize the clinical features of eyeball rupture with or without orbital fracture and explore the differences between them.In all, 197 patients were observed, and the following data were recorded: sex, age, time of injury, place of injury, cause of trauma, zone of eye injury, intraocular content prolapse, surgical methods and the therapeutic process, visual acuity after injury, and the final best corrected visual acuity. The results were analyzed for statistically significant differences.There was no significant difference (P > .05) in the age, sex, or cause of injury. Patients with eyeball rupture with fracture had poorer vision than did those in the simple eyeball rupture group; eyeball rupture with fracture also had a higher probability of enucleation.In this study, the clinical results show that prognosis of eyeball rupture with orbital fracture is worse than that of eyeball rupture without orbital fracture.
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Affiliation(s)
| | - Yi Yao
- Department of Ophthalmology
| | | | | | - Xiao Zhao
- The First Department of Medical Oncology, The Chinese PLA General Hospital, Beijing, China
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A Possible Regression Equation for Predicting Visual Outcomes after Surgical Repair of Open Globe Injuries. J Ophthalmol 2017; 2017:1320457. [PMID: 28168043 PMCID: PMC5266804 DOI: 10.1155/2017/1320457] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 12/10/2016] [Accepted: 12/25/2016] [Indexed: 11/18/2022] Open
Abstract
Background. To analyze the effects of factors other than the ocular trauma score parameters on visual outcomes in open globe injuries. Methods. Open globe injuries primarily repaired in our hospital were reviewed. The number of surgeries, performance of pars plana vitrectomy (PPV), lens status, affected tissues (corneal, scleral, or corneoscleral), intravitreal hemorrhage, intraocular foreign body, glaucoma, anterior segment inflammation, loss of iris tissue, cutting of any prolapsed vitreous in the primary surgery, penetrating injury, and the time interval between the trauma and repair were the thirteen variables evaluated using linear regression analysis. Results. In total, 131 eyes with a mean follow-up of 16.1 ± 4.7 (12–36) months and a mean age of 33.8 ± 22.2 (4–88) years were included. The regression coefficients were 0.502, 0.960, 0.831, −0.385, and −0.506 for the performance of PPV, aphakia after the initial trauma, loss of iris tissue, penetrating injury, and cutting of any prolapsed vitreous in the primary surgery, respectively (P < 0.05 for these variables). Conclusions. The performance of PPV, aphakia after the initial trauma, and loss of iris tissue were associated with poor visual outcomes, whereas cutting any prolapsed vitreous in the primary repair and penetrating-type injury were associated with better visual outcomes.
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