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Thomas CN, Bernardo-Colón A, Courtie E, Essex G, Rex TS, Blanch RJ, Ahmed Z. Effects of intravitreal injection of siRNA against caspase-2 on retinal and optic nerve degeneration in air blast induced ocular trauma. Sci Rep 2021; 11:16839. [PMID: 34413361 PMCID: PMC8377143 DOI: 10.1038/s41598-021-96107-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 08/05/2021] [Indexed: 11/11/2022] Open
Abstract
Ocular repeated air blast injuries occur from low overpressure blast wave exposure, which are often repeated and in quick succession. We have shown that caspase-2 caused the death of retinal ganglion cells (RGC) after blunt ocular trauma. Here, we investigated if caspase-2 also mediates RGC apoptosis in a mouse model of air blast induced indirect traumatic optic neuropathy (b-ITON). C57BL/6 mice were exposed to repeated blasts of overpressure air (3 × 2 × 15 psi) and intravitreal injections of siRNA against caspase-2 (siCASP2) or against a control enhanced green fluorescent protein (siEGFP) at either 5 h after the first 2 × 15 psi ("post-blast") or 48 h before the first blast exposure ("pre-blast") and repeated every 7 days. RGC counts were unaffected by the b-ITON or intravitreal injections, despite increased degenerating ON axons, even in siCASP2 "post-blast" injection groups. Degenerating ON axons remained at sham levels after b-ITON and intravitreal siCASP2 "pre-blast" injections, but with less degenerating axons in siCASP2 compared to siEGFP-treated eyes. Intravitreal injections "post-blast" caused greater vitreous inflammation, potentiated by siCASP2, with less in "pre-blast" injected eyes, which was abrogated by siCASP2. We conclude that intravitreal injection timing after ocular trauma induced variable retinal and ON pathology, undermining our candidate neuroprotective therapy, siCASP2.
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Affiliation(s)
- Chloe N Thomas
- Neuroscience and Ophthalmology, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- School of Biomedical Sciences, Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | | | - Ella Courtie
- Neuroscience and Ophthalmology, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Ophthalmology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Gareth Essex
- Neuroscience and Ophthalmology, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Tonia S Rex
- Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Ophthalmology and Visual Sciences, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Richard J Blanch
- Neuroscience and Ophthalmology, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
- Ophthalmology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
- Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, UK.
- Centre for Trauma Sciences Research, University of Birmingham, Birmingham, B15 2TT, UK.
| | - Zubair Ahmed
- Neuroscience and Ophthalmology, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
- Centre for Trauma Sciences Research, University of Birmingham, Birmingham, B15 2TT, UK.
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Hussain SF, Raza Z, Cash ATG, Zampieri T, Mazzoli RA, Kardon RH, Gomes RSM. Traumatic brain injury and sight loss in military and veteran populations- a review. Mil Med Res 2021; 8:42. [PMID: 34315537 PMCID: PMC8317328 DOI: 10.1186/s40779-021-00334-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 06/23/2021] [Indexed: 01/14/2023] Open
Abstract
War and combat exposure pose great risks to the vision system. More recently, vision related deficiencies and impairments have become common with the increased use of powerful explosive devices and the subsequent rise in incidence of traumatic brain injury (TBI). Studies have looked at the effects of injury severity, aetiology of injury and the stage at which visual problems become apparent. There was little discrepancy found between the frequencies or types of visual dysfunctions across blast and non-blast related groups, however complete sight loss appeared to occur only in those who had a blast-related injury. Generally, the more severe the injury, the greater the likelihood of specific visual disturbances occurring, and a study found total sight loss to only occur in cases with greater severity. Diagnosis of mild TBI (mTBI) is challenging. Being able to identify a potential TBI via visual symptoms may offer a new avenue for diagnosis.
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Affiliation(s)
- Syeda F. Hussain
- Research & Innovation, Blind Veterans UK, 12-14 Harcourt Street, London, W1H 4HD UK
- Bravo Victor, Research, 12-14 Harcourt Street, London, W1H 4HD UK
| | - Zara Raza
- Research & Innovation, Blind Veterans UK, 12-14 Harcourt Street, London, W1H 4HD UK
- Bravo Victor, Research, 12-14 Harcourt Street, London, W1H 4HD UK
| | - Andrew T. G. Cash
- Research & Innovation, Blind Veterans UK, 12-14 Harcourt Street, London, W1H 4HD UK
- Bravo Victor, Research, 12-14 Harcourt Street, London, W1H 4HD UK
| | - Thomas Zampieri
- Blinded Veterans Association, 1101 King Street, Suite 300, Alexandria, Virginia 22314 USA
| | - Robert A. Mazzoli
- Department of Ophthalmology, Madigan Army Medical Center, 9040 Jackson Avenue, Tacoma, Washington, 98431 USA
| | - Randy H. Kardon
- Iowa City VA Health Care System and Iowa City VA Center for the Prevention and Treatment of Visual Loss, Iowa City, Iowa 52246 USA
- Department of Ophthalmology and Visual Sciences, The University of Iowa, Iowa City, Iowa 52242 USA
| | - Renata S. M. Gomes
- Research & Innovation, Blind Veterans UK, 12-14 Harcourt Street, London, W1H 4HD UK
- Bravo Victor, Research, 12-14 Harcourt Street, London, W1H 4HD UK
- Northern Hub for Veterans and Military Families Research, Department of Nursing, Midwifery and Health, Faculty of Health and Life Sciences, Northumbria University, Newcastle, NE7 7XA UK
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3
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Sia RK, Ryan DS, Brooks DI, Kagemann JM, Bower KS, French LM, Justin GA, Colyer MH. The Impact of Combat Ocular Trauma and Traumatic Brain Injury on Vision- and Health-Related Quality of Life Among U.S. Military Casualties. Mil Med 2021; 187:209-215. [PMID: 34117765 DOI: 10.1093/milmed/usab233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 05/14/2021] [Accepted: 06/03/2021] [Indexed: 11/12/2022] Open
Abstract
PURPOSE The purpose of this study was to assess visual and health-related quality of life (QOL) among U.S. military service members who sustained combat ocular trauma (COT) with or without associated traumatic brain injury (TBI). METHODS This was a single-center, prospective observational study of U.S. service members (n = 88) with COT who were treated at Walter Reed National Military Medical Center. Participants completed the National Eye Institute Visual Function Questionnaire (VFQ-25) at enrollment and at follow-up (>1 year) and supplemental surveys: Neurobehavioral Symptom Inventory, the Medical Outcomes 36-item Short Form Survey (SF-36), and Mayo-Portland Adaptability Inventory. RESULTS Initial and follow-up VFQ-25 showed a statistically significant increase in median scores for near activities (initial: 75.0, follow-up 83.3; P = .004) and peripheral vision (initial: 50.0, follow-up: 75.0; P = .009) and in composite scores (initial: 79.5, follow-up: 79.8; P = .022). Comparing those who did (n = 78) and did not (n = 8) have a TBI history, there were no significant differences in median change in VFQ-25 composite scores (with TBI: 2.3 vs. no TBI: 10.7; P = .179). Participants with a TBI history had a significantly lower median SF-36 General Health score (with TBI: 67.5 vs. no TBI: 92.5; P = .009). CONCLUSIONS Vision-related QOL of COT patients is generally good in the long term. However, those with both COT and a history of TBI conditions showed significantly worse functioning in several domains than those without TBI. As TBI is a common finding in COT, this association is an important factor impacting this population's overall clinical presentation and daily functions.
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Affiliation(s)
- Rose K Sia
- Warfighter Refractive Eye Surgery Program and Research Center at Fort Belvoir, Fort Belvoir Community Hospital, Fort Belvoir, VA 22060, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, MD 20817, USA
| | - Denise S Ryan
- Warfighter Refractive Eye Surgery Program and Research Center at Fort Belvoir, Fort Belvoir Community Hospital, Fort Belvoir, VA 22060, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, MD 20817, USA
| | - Daniel I Brooks
- Department of Research Programs, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
| | - Janice M Kagemann
- Henry M. Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, MD 20817, USA.,Department of Surgery, Uniformed Services University of Health Sciences, Bethesda, MD 20814, USA
| | - Kraig S Bower
- The Wilmer Eye Institute, Johns Hopkins University, Lutherville, MD 21093, USA
| | - Louis M French
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
| | - Grant A Justin
- Department of Surgery, Uniformed Services University of Health Sciences, Bethesda, MD 20814, USA.,Ophthalmology Service, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
| | - Marcus H Colyer
- Department of Surgery, Uniformed Services University of Health Sciences, Bethesda, MD 20814, USA.,Ophthalmology Service, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
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Shah FQ, Asif J, Syed TQ. Perforating ocular trauma due to shotgun pellet - Clinical profile and visual outcome. Indian J Ophthalmol 2021; 69:1224-1229. [PMID: 33913865 PMCID: PMC8186650 DOI: 10.4103/ijo.ijo_2715_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Purpose: The aim of this study was to determine visual and anatomical outcome of perforating injuries due to shotgun pellet. Methods: This was a prospective observational study carried out between July 2016 and Jan 2019 at a tertiary care referral center in Srinagar, Jammu and Kashmir. A total of 172 eyes with perforating injuries of 170 patients were included in the study and were followed up for 6 months with best-corrected visual acuity, slit-lamp examination for status of anterior chamber and lens, fundus examination for status of retina and media, intraocular pressure measurements, and OCT (optical coherence tomography) and FFA (fundus fluoresceine angiography) in selected cases. The relative improvement of visual acuity after treatment was interpreted by applying paired two-tailed t tests. Prognostic significance of other variables was calculated using Chi-square and Chi-square for linear trend tests, for two dependent outcome variables of good outcome and poor outcome. Results: WHO category 4 visual impairment was found in 66 (38.4%) eyes, whereas category 0 was found in 24 (14%) of eyes. Retina was found to be attached 99 (57.6%) of study eyes. Conclusion: Perforating injury is a severe form of ocular trauma with grave consequences in terms of functional and anatomical outcome.
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Affiliation(s)
- Faisal Qayoom Shah
- Department of Ophthalmology, Government Medical College, Karan Nager, Srinagar, Jammu and Kashmir, India
| | - Jasmine Asif
- Department of Ophthalmology, Government Medical College, Karan Nager, Srinagar, Jammu and Kashmir, India
| | - Tariq Qureshi Syed
- Department of Ophthalmology, Government Medical College, Karan Nager, Srinagar, Jammu and Kashmir, India
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Hamzeh A, Ayoub R, Issa S, Alhalabi N, Sawaf B, Mohsen F, Issa H, Mohsen MA, Khattab MN, Thomas G, Aljammal MB, Shibani M, Alzabibi MA, Ismail H, Hamzeh F, Almoree O, Al-Moujahed A, Saba S. War-related ocular injuries in Damascus during the Syrian Crisis. Injury 2021; 52:299-304. [PMID: 33408056 DOI: 10.1016/j.injury.2020.11.069] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 11/13/2020] [Accepted: 11/28/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND . Ocular injuries constitute a major cause of visual morbidity, and they have a significant socioeconomic impact worldwide. We aimed to document the types and causes of Syrian War related ocular injuries in Damascus, Syria. METHODS . Medical records were retrospectively reviewed to evaluate all patients in Al-Mouwasat University Hospital and Damascus Hospital, whose ocular injuries were caused by war-related activities during the period extending between January of 2016 and December 2017. RESULTS . 150 eye injuries in 127 patients were reviewed, in which 46 (31%) were bilateral and 87 (58%) were open globe injuries. The leading cause of the observed ocular injuries was improvised explosive devices (IED) [37 eyes (41%)]. The majority of patients presented with an initial best corrected visual acuity (BCVA) of "light perception" (LP) to "hand movement" (HM) [51 eyes (34%)]. Information on the final BCVA was available for 69 injured eyes only, and it was "no light perception" (NLP) in 20 eyes (29%). CONCLUSION . Explosive weaponry is the main culprit in most war-related ocular injuries in Syria. The high incidence of open globe injuries caused many of the cases to be severe in nature. Education on the precautionary measures that protect the eyes such as the use of combat eye protection during wartimes ought to be enforced, so that future ocular injuries can be prevented.
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Affiliation(s)
- Ammar Hamzeh
- Department of Ophthalmology, Faculty of Medicine, Damascus University, Damascus, Syria
| | - Rita Ayoub
- Department of Surgery, American University of Beirut Medical Center (AUBMC), Beirut, Lebanon
| | - Sameh Issa
- Department of Ophthalmology, Faculty of Medicine, Damascus University, Damascus, Syria
| | - Nawras Alhalabi
- Department of Ophthalmology, Faculty of Medicine, Damascus University, Damascus, Syria; Faculty of Medicine, Syrian Private University, Damascus, Syria
| | - Bisher Sawaf
- Faculty of Medicine, Syrian Private University, Damascus, Syria; Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Fatima Mohsen
- Faculty of Medicine, Syrian Private University, Damascus, Syria
| | - Hazem Issa
- Department of Ophthalmology, Faculty of Medicine, Damascus University, Damascus, Syria
| | | | | | - Gabriel Thomas
- Faculty of Medicine, Syrian Private University, Damascus, Syria
| | - Mhd Basher Aljammal
- Department of Ophthalmology, Faculty of Medicine, Damascus University, Damascus, Syria
| | - Mosa Shibani
- Faculty of Medicine, Syrian Private University, Damascus, Syria
| | | | - Hlma Ismail
- Faculty of Medicine, Syrian Private University, Damascus, Syria
| | - Farah Hamzeh
- Department of Ophthalmology, Faculty of Medicine, Damascus University, Damascus, Syria
| | - Osama Almoree
- Department of Ophthalmology, Damascus Hospital, Damascus, Syria
| | - Ahmad Al-Moujahed
- Byers Eye Institute, Department of Ophthalmology, Stanford University, Palo Alto, CA, United States
| | - Salim Saba
- Department of Surgery, American University of Beirut Medical Center (AUBMC), Beirut, Lebanon.
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6
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De Niear MA, Law JJ, Breazzano MP, Mawn LA. Blunderbuss: Ocular and Orbital Injuries Due to Muzzle-Loading Firearms. Ophthalmic Plast Reconstr Surg 2021; 37:72-76. [PMID: 32467521 DOI: 10.1097/iop.0000000000001709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Injury to the eye and/or orbital and adnexal structures associated with antiquated muzzle-loading firearms has not, to our knowledge, been characterized with the exception of a single case report. METHODS A retrospective chart review of 7 patients treated at Vanderbilt University Medical Center from 2003 to 2017 who sustained traumatic injuries to the ocular and/or orbital structures secondary to the discharge of muzzle-loading firearms. The study was approved by the Vanderbilt Institutional Review Board. RESULTS In 6/7 cases, injuries occurred secondary to the muzzle-loading firearm exploding due to dysfunction or misuse. Foreign material deriving from the firearm was retained in 3/7 patients. Initial examination of the orbit and adnexa revealed 5/7 individuals sustaining orbital fractures and 6/7 with facial lacerations (including 2 with eyelid lacerations); none had evidence of a lacrimal duct injury. Three patients suffered globe injuries (1 closed-globe and 2 open-globe). Visual acuity at last follow-up was ≥20/20 in 12/14 eyes examined. Surgical intervention was required in the treatment of 4/7 individuals (including 3/7 requiring intervention for sustained orbital fractures). No individuals were wearing eye protection at the time of injury. All individuals survived their injuries. CONCLUSIONS The operation of muzzle-loading firearms poses a unique risk of injury to the operator. The resultant injuries in this case series were primarily due to the explosion of the firearm, which subsequently appear similar to orbital and ocular blast injuries caused by explosive weapons. Orbital injuries and more potentially more devastating ocular injuries may have been prevented by protective eyewear.
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Affiliation(s)
- Matthew A De Niear
- Department of Ophthalmology & Visual Sciences, Vanderbilt Eye Institute, Vanderbilt University Medical Center
- Medical Scientist Training Program, Vanderbilt University School of Medicine
| | - James J Law
- Department of Ophthalmology & Visual Sciences, Vanderbilt Eye Institute, Vanderbilt University Medical Center
- Vanderbilt University School of Medicine
| | - Mark P Breazzano
- Department of Ophthalmology & Visual Sciences, Vanderbilt Eye Institute, Vanderbilt University Medical Center
- Vanderbilt University School of Medicine
- Department of Ophthalmology, Harkness Eye Institute, Columbia University College of Physicians & Surgeons, New York, New York
| | - Louise A Mawn
- Department of Ophthalmology & Visual Sciences, Vanderbilt Eye Institute, Vanderbilt University Medical Center
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A
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Thomas CN, Courtie E, Bernardo-Colón A, Essex G, Rex TS, Ahmed Z, Blanch RJ. Assessment of necroptosis in the retina in a repeated primary ocular blast injury mouse model. Exp Eye Res 2020; 197:108102. [PMID: 32522477 DOI: 10.1016/j.exer.2020.108102] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 05/29/2020] [Accepted: 06/01/2020] [Indexed: 10/24/2022]
Abstract
Primary blast injury (caused by the initial rapid increase in pressure following an explosive blast) to the retina and optic nerve (ON) causes progressive visual loss and neurodegeneration. Military personnel are exposed to multiple low-overpressure blast waves, which may be in quick succession, such as during breacher training or in combat. We investigated the necroptotic cell death pathway in the retina in a mouse repeated primary ocular blast injury (rPBI) model using immunohistochemistry. We further evaluated whether intravitreal injections of a potent necroptosis inhibitor, Necrostatin-1s (Nec-1s), protects the retina and ON axons by retinal ganglion cells (RGC) counts, ON axonal counting and optical coherence tomography (OCT) analysis of vitreous haze. Receptor interacting protein kinase (RIPK) 3, increased in the inner plexiform layer 2 days post injury (dpi) and persisted until 14 dpi, whilst RIPK1 protein expression did not change after injury. The number of degenerating ON axons was increased at 28 dpi but there was no evidence of a reduction in the number of intact ON axons or RNA-binding protein with multiple splicing (RBPMS)+ RGC in the retina by 28 dpi in animals not receiving any intravitreal injections. But, when intravitreal injections (vehicle or Nec-1s) were given there was a significant reduction in RBPMS+ RGC numbers, suggesting that rPBI with intraocular injections is damaging to RGC. There were fewer RGC lost after Nec-1s than vehicle injection, but there was no effect of Nec-1s or vehicle treatment on the number of degenerating axons. OCT analysis demonstrated no effect of rPBI on vitreous haze, but intravitreal injection combined with rPBI increased vitreous haze (P = 0.004). Whilst necroptosis may be an active cell death signalling pathway after rPBI, its inhibition did not prevent cell death, and intravitreal injections in combination with rPBI increased vitreous inflammation and reduced RBPMS+ RGC numbers, implying intravitreal injection is not an ideal method for drug delivery after rPBI.
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Affiliation(s)
- Chloe N Thomas
- Neuroscience and Ophthalmology, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK; School of Biomedical Sciences, Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Ella Courtie
- Neuroscience and Ophthalmology, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK; Ophthalmology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Gareth Essex
- Neuroscience and Ophthalmology, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Tonia S Rex
- Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Ophthalmology and Visual Sciences, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Zubair Ahmed
- Neuroscience and Ophthalmology, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
| | - Richard J Blanch
- Neuroscience and Ophthalmology, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK; Ophthalmology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, UK.
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8
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Tong J, Kedar S, Ghate D, Gu L. Indirect Traumatic Optic Neuropathy Induced by Primary Blast: A Fluid–Structure Interaction Study. J Biomech Eng 2019; 141:2733245. [DOI: 10.1115/1.4043668] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Indexed: 11/08/2022]
Abstract
Current knowledge of traumatic ocular injury is still limited as most studies have focused on the ocular injuries that happened at the anterior part of the eye, whereas the damage to the optic nerve known as traumatic optic neuropathy (TON) is poorly understood. The goal of this study is to understand the mechanism of the TON following the primary blast through a fluid–structure interaction model. An axisymmetric three-dimensional (3D) eye model with detailed orbital components was developed to capture the dynamics of the eye under the blast wave. Our numerical results demonstrated a transient pressure elevation in both vitreous and cerebrospinal fluid (CSF). A high strain rate over 100 s−1 was observed throughout the optic nerve during the blast with the most vulnerable part located at the intracanalicular region. The optic nerve deforming at such a high strain rate may account for the axonal damage and vision loss in patients subjected to the primary blast. The results from this work would enhance the understanding of indirect TON and provide guidance in the design of protective eyewear against such injury.
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Affiliation(s)
- Junfei Tong
- Department of Mechanical and Materials Engineering, University of Nebraska-Lincoln, Lincoln, NE 68588-0656 e-mail:
| | - Sachin Kedar
- Stanley Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, NE 68105-1119; Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE 68198-8440
| | - Deepta Ghate
- Stanley Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, NE 68105-1119
| | - Linxia Gu
- Department of Mechanical and Materials Engineering, University of Nebraska-Lincoln, Lincoln, NE 68588-0656
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9
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Abstract
: Midfacial trauma commonly causes ocular injuries of varying degrees. Eye injuries account for approximately 10% of all battle injuries. Severity of injuries may range from a subconjunctival haemorrhage to optic nerve injury and globe laceration and rupture. AIM OF STUDY Is to evaluate the associated ophthalmic injuries in maxillofacial trauma due to war and to emphasize the need for proper ophthalmic examination to exclude and manage any associated ophthalmic injuries. MATERIALS AND METHODS A total of 66 patients with maxillofacial trauma due to war were considered in this study and underwent classification of the fractures to know patterns of fractures and to specify the ophthalmic injuries which might be associated with each fracture. Referral to ophthalmologist was considered to determine the exact nature of ophthalmic injuries. Results by a maxillofacial surgeon and ophthalmologist were evaluated. RESULTS Midfacial trauma particularly those associated with zygomatic bone fracture was highly significant due to blast and bullets can lead to serious ophthalmic injuries. This was related to 57% of ophthalmic injuries. The related ocular injuries which were subconjunctival hemorrhage and the rupture or lacerated eye globe found to be highly significant war injuries while the preretinal hemorrhage and diplopia were significant. CONCLUSION A thorough proper ophthalmic examination should be carried out for every patient with these fractures and suspected cases should be placed under close observation so that immediate and active treatment can be taken if necessary.
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10
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Chaudhary R, Upendran M, Campion N, Yeung A, Blanch R, Morgan-Warren P, Gibb I, Nelson T, Scott R. The role of computerised tomography in predicting visual outcome in ocular trauma patients. Eye (Lond) 2015; 29:867-71. [PMID: 25853401 DOI: 10.1038/eye.2015.39] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Accepted: 02/09/2015] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Ocular blast injuries in the military setting are particularly associated with significant maxillofacial trauma and/or brain injury. The opportunity to perform a comprehensive ophthalmic evaluation is frequently limited in the acute multiple trauma scenario. We aim to describe the relationship between the clinical effects of acute ocular and orbital blast trauma with the findings on computerised tomography (CT). METHODS This was a retrospective consecutive case series of all soldiers with facial and/or suspected ocular injuries. A total of 80 eyes that had suffered blast injuries of varying severity were studied. Assessment of orbital and ocular CT images were performed by military consultant radiologists. A comparison was made with actual clinical findings. Statistical analysis was performed using Fisher's exact test. RESULTS No pathological findings were described in 37 of the 80 eyes imaged by orbital and ocular CT scans. Clinically, these eyes and orbits were all found to be intact, or had minor trauma. All foreign bodies and penetrating eye injuries were successfully diagnosed by CT. Absence of an orbital fracture did not rule out a globe injury. However, a corneal or scleral defect was less likely when an orbital fracture was absent. CONCLUSION The eye is a delicate structure prone to injury that requires urgent repair if breached. It is difficult to assess thoroughly in the unconscious or distressed patient. In this context, CT imaging is invaluable to be able to make a relatively confident prediction of clinical findings and decide upon the necessity for acute ophthalmic surgical intervention.
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Affiliation(s)
- R Chaudhary
- Department of Ophthalmology, Birmingham and Midland Eye Centre, City Hospital NHS Trust, Birmingham, UK
| | - M Upendran
- Department of Ophthalmology, Birmingham and Midland Eye Centre, City Hospital NHS Trust, Birmingham, UK
| | - N Campion
- Section of Neurotrauma and Neurodegeneration, School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, UK
| | - A Yeung
- Department of Ophthalmology, Birmingham and Midland Eye Centre, City Hospital NHS Trust, Birmingham, UK
| | - R Blanch
- Section of Neurotrauma and Neurodegeneration, School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, UK
| | - P Morgan-Warren
- Section of Neurotrauma and Neurodegeneration, School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, UK
| | - I Gibb
- Fort Blockhouse, Defence Centre for Imaging, Gosport, UK
| | - T Nelson
- Royal Centre for Defence Medicine, New Queen Elizabeth Hospital, Birmingham, UK
| | - R Scott
- 1] Department of Ophthalmology, Birmingham and Midland Eye Centre, City Hospital NHS Trust, Birmingham, UK [2] Royal Centre for Defence Medicine, New Queen Elizabeth Hospital, Birmingham, UK
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