Angle Recession Research Articles

Finite Element Analysis of Mechanical Ocular Sequelae from Badminton Shuttlecock Projectile Impact

PurposeWith the growing popularity of badminton worldwide, the incidence of badminton-related ocular injuries is expected to rise. The high velocity of shuttlecocks renders ocular traumas particularly devastating, especially with the possibility of permanent vision loss. This study investigated the mechanism behind ocular complications though simulation analyses of mechanical stresses and pressures upon shuttlecock impact. DesignComputational simulation study ParticipantsNone MethodsA 3-dimensional human eye model was reconstructed based on the physiological and biomechanical properties of various ocular tissues. FEA simulations involved a frontal collision with a shuttlecock projectile at 128.7 km/h (80 mph). Intraocular pressure changes and tissue stress were mapped and quantified in the following ocular structures: the limbus, ciliary body, zonular fibers, ora serrata, retina, and optic nerve head. Main Outcome MeasuresIntraocular pressure and tissue stress ResultsUpon shuttlecock impact, compressive force was transferred to the anterior pole of the cornea, propagating posteriorly to the optic nerve head. Deflection of forces anteriorly contributed to refractory oscillations of compressive and tensile stress of ocular tissue. Initial impact led to a momentary (< 1 ms) spike in intraocular pressure 5.66 MPa (42.5 x 103 mmHg) that radially distributed for a very brief instance (< 1 ms) of pressure at the trabecular meshwork of the iridocorneal angle of 1.25 MPa (9.4 x 103 mmHg). The lens had a maximal posterior displacement of 1.5 mm with peak zonular fiber tensile strain of 52%. The limbus, ciliary body, and ora serrata had a peak tensile stress of 5.16 MPa, 1.90 MPa, and 0.62 MPa, respectively. Compressive force from the sclera concentrated at the optic nerve head for a peak stress of 5.97 MPa while peak pressure from vitreous humor was 7.99 MPa. ConclusionShuttlecock impact led to a very brief, substantial rise in pressure and stress significant for tissue damage and subsequent complications, such as secondary glaucoma, angle recession, lens subluxation, hyphema, or retinal dialysis. Our findings offer valuable mechanistic insights into how ocular structures are affected by shuttlecock projectile impact to inform clinical assessments and treatment strategies, while highlighting the importance of protective eyewear in racket sports.

Celebration to Consequence: Case Report of Late Onset Ocular Effects of Firework Injuries

Firework-related injuries, particularly ocular trauma, pose a significant public health concern during cultural celebrations. We explore the case of a 20-year-old male who sustained firework-induced ocular trauma at the age of seven, subsequently developing traumatic cataract and glaucomatous optic atrophy. The patient presented with decreased vision and pain in the left eye (LE), 13 years post-injury. He underwent cataract surgery nine years after the incident, with subsequent development of glaucomatous optic atrophy. Examination revealed visual acuity impairment, exotropia, and pupil abnormalities in the LE, along with scleral thinning and corneal opacity. Posterior segment evaluation showed optic nerve cupping and hemorrhages. Gonioscopy indicated angle recession and synechiae in the LE. Optical coherence tomography revealed retinal nerve fiber layer defects. Elevated intraocular pressure in the LE was successfully managed with anti-glaucoma medication. Firework-related ocular trauma can lead to long-term complications, including traumatic cataract and glaucomatous optic atrophy. Timely cataract surgery and vigilant follow-up are essential for early detection and management of secondary glaucoma. Regulatory measures to mitigate firework-related injuries are imperative to prevent such incidents and preserve visual health.

Clinical characteristics, etiologies, co-injuries, and visual outcomes of eyelid lacerations

Background: Eyelid trauma may be accompanied by open globe injury, canalicular injury, hyphema, angle recession, or retinal detachment. Therefore, a detailed assessment should be performed during the associated ophthalmological examinations. We assessed the demographic and clinical characteristics, etiologies, co-injuries, and visual outcomes in patients with eyelid lacerations. Methods: This retrospective, cross-sectional study included individuals 18 years of age and older who underwent repair of an eyelid injury at our tertiary referral center between January 2021 and March 2023. Patients with known structural eyelid disorders or previous ocular surgery were excluded. Demographic and clinical data, including injury site and type, mechanism of injury, and presence of additional ocular injuries, were noted. Best-corrected visual acuity (BCVA) was recorded as the logarithm of the minimum angle of resolution (logMAR) notation at the initial and final follow-up visits. Results: Of 195 included patients with a mean (standard deviation [SD]) age of 42.5 (5.6) years, 164 (84.1%) were men. The most common etiology was accidental (n = 70, 35.9%) and almost half of these injuries occurred at the workplace (n = 32 out of 70, 45.8%). Nine patients (4.6%) had no co-injury, 47 (24.1%) had imaging evidence of orbital bone fractures, 25 (12.8%) had nasolacrimal system involvement, and 11 (5.6%) had an open globe injury. The right upper eyelid (n = 62, 31.8%) was the most commonly affected site. Tissue loss was observed in 77 (39.5%) patients; however, no grafting was required. Five patients (2.6%) underwent lateral canthotomy to improve tissue apposition. On initial examination, 24 patients (12.3%) had traumatic myogenic ptosis, 13 (6.7%) had traumatic aponeurotic ptosis, and ptosis persisted in 7 of these 37 patients (18.9%) 6 months after laceration repair. We observed significant improvement in BCVA at the final follow-up visit (P &lt; 0.001); at the preoperative and final visits, mean (SD) BCVA measurements were 0.21 (0.15) and 0.12 (0.07) logMAR, respectively. Conclusions: Eyelid injuries are more common in men, and the most common etiology is accidental. These injuries occur most commonly in the workplace. Isolated eyelid lacerations are rare. Early ocular assessment and prompt management ensure better visual outcomes. We recommend preventive safety precautions for workplaces to reduce the incidence of avoidable injuries. Identifying risk factors in further population-based studies could prevent loss of labor in a productive population. Further multicenter, nationwide, longitudinal studies could estimate the actual burden and prognosis of ocular trauma, particularly that of eyelid lacerations.

Universal slit-lamp mounted indentation gonioscopy tool for angle evaluation: An innovative device.

In the field of ophthalmology, slit-lamp gonioscopy has long been a cornerstone for examining anterior chamber angles and diagnosing conditions such as angle closure, secondary causes of raised intraocular pressure, neovascularization of angle, angle recession, angle tumors, and foreign bodies. However, the conventional approach for goniophotography is a demanding procedure requiring juggling a gonioscopy lens in one hand and a smartphone in the other. Balancing a gonioscopy lens with one hand makes it difficult to adjust and focus the image in busy clinical settings. This article introduces a groundbreaking solution to this problem - a universal slit-lamp-mounted gonioscope ingeniously repurposed from discarded materials, that is, indirect goniophotography (IndiGo). This novel system simplifies the process of both gonioscopy and goniophotography, allowing ophthalmologists to easily assess anterior chamber angles and capture high-quality images. These images can be swiftly shared with glaucoma specialists worldwide for digital analysis. Not only does this approach enhance examination efficiency, but also it fosters sustainability in ophthalmic diagnostics.

ANGLE RECESSION, THE SEQUELA OF EIGHT-BALL HYPHEMA AFTER SPRAYED BY FIRE HYDRANT: A CASE REPORT

Introduction : Hyphema results from damage to the blood vessels of the iris or anterior ciliary body after blunt trauma, and in 56–100% of cases can occur angle recession.&#x0D; Case Illustration : A 40-year-old man complaints of pain and blurred left eye after being sprayed by a high-pressure fire hydrant five hours before coming to the emergency room. Visual acuity was 20/20 and hand movement in right and left eye, IOP is 13 mmHg and 18 mmHg in both eyes. Subconjunctival bleeding, conjunctival and pericorneal injections were found with punctate fluorescein test in the left eye. The cornea was edema and the anterior chamber was full of hyphema. Five days after being hospitalized and treated with topical atropine, antibiotics, and steroid in combination with oral tranexamic acid, the visual acuity was 5/6.5 and the hyphema was resolved. The IOP elevated after 1-6 weeks of follow-up in the outpatient clinic then timolol eyedrops were given. Gonioscopy showed widening of CBB, torn iris processus 2 clock hours in the inferior quadrant. The antiglaucoma medication was stopped due to the controlled IOP in the end episode of the treatment.&#x0D; Discussion : Angle recession involves a tear between the longitudinal and circular muscle fibres of the ciliary body. Medication is needed to control the IOP, while surgical management only indicated in cases where medical treatment fails to control the IOP and risk of progressive visual loss.&#x0D; Conclusion : Angle recession can occur after blunt eye trauma with hyphema and IOP control is needed to prevent the development of secondary glaucoma.

Üçüncü Basamak Sağlık Merkezinde Oküler Travmaya Bağlı Göz İçi Basıncı Yüksekliklerinin Tanı ve Tedavi Sürecinin Değerlendirilmesi: 1990-2018 yılları arası 28 yıllık analiz

AIM: To evaluate the etiological and demographic characteristics and treatment processes of patients with trauma-induced elevated intraocular pressure (IOP).&#x0D; MATHERIAL AND METHOD: We retrospectively analysed 191 patients with elevated IOP after trauma between 1990 and 2018. Demographic characteristics, type of trauma, cause of glaucoma, lens status, visual acuity, IOP, other ocular findings, medical and/or surgical treatments and follow-up periods were recorded.&#x0D; RESULTS: A total of 148 (77.5%) males and 43 (22.5%) females with a mean age of 29.68±19.47 years were analysed. Mean follow-up period was 158±23.73 months. The type of trauma was blunt in 171 patients (89.5%) and open in 20 patients (10.5%). The mean interval between trauma and IOP elevation was 78 days (3 days-5 years). Glaucoma was due to angle regression in 89 (46.6%), hyphema in 78 (40.8%), lens-related in 24 (12.6%) and other causes in 3 (1.54%) patients. Lens damage, lens-related IOP elevation and need for surgical intervention were more common after open injuries. 72% of the patients were able to achieve appropriate IOP with observation and medical treatment alone without surgery. Trabeculectomy was the most preferred effective surgical method in both trauma groups. &#x0D; CONCLUSION: The development of glaucoma after ocular trauma is an essential factor affecting visual prognosis. Early diagnosis and treatment might be challenging in proportion to the severity of ocular involvement. However, not all IOP elevations may cause glaucomatous damage, transient IOP elevations could be monitored without medication. In our study, the frequency of posttraumatic IOP elevation was higher in men and young people. This might be related to more trauma exposure in the indicated population. Blunt traumas cause IOP elevation more frequently. In contrast, the need for glaucoma surgery is more frequent after open injuries. Angle recession is the most common cause of posttraumatic glaucuma. Therefore, angle assessment is necessary in all possible cases. The status of the lens after trauma will affect the prognosis and choice of surgery. Regular follow-up is crucial for the detection of secondary glaucoma since IOP elevation may develop in the late post-traumatic period. &#x0D; &#x0D; Keywords: Ocular trauma, blunt trauma, angle recession glaucoma, traumatic glaucoma

Epidemiological profil of post contusive hyphaema experience of the paediatric ophthalmology department of Casablanca

Aims/Purpose: Hyphaema is defined as the presence of blood in the anterior chamber. It occurs after a contusive or perforating ocular trauma or in the aftermath of ocular surgery. The aim of our work is to analyse the clinical, therapeutic and evolutionary profile of post‐contusive hyphaema.Methods: A retrospective study was conducted on 66 children (33 eyes) admitted to the ophthalmologic emergency room for post‐contusive hyphaema followed and treated in the paediatric ophthalmology department of the 20 August hospital in Casablanca between January 2015 and January 2023.Results: There was a male predominance with 67% of boys affected. The average age was 9.5 years. The main cause of consultation was visual acuity (VA) loss in 49%. On examination, the initial VA was &lt;1/10 in 38% of cases, the ocular tone was &gt;20 in 30% of cases. Hyphaema was classified as stage I in 26.4%, stage II in 52%, stage III in 15.2%, stage IV in 6.4%. Post‐traumatic cataract was present in 50% of the cases, lens dislocation in 22% of the cases, angle recession in 6%. Intravitreal haemorrhage was present in 2 patients, berlin oedema in 3 patients. The treatment prescribed in all patients was strict rest, abundant drinks, oral and local corticotherapy and dilatation with atropine. In addition, a hypotonizing treatment was prescribed for the patients who presented an ocular hypertonia. The evolution was marked by the total resorption of the hyphaema in 90% of the cases. Surgical treatment (hyphaema lavage) in 10% of cases. The final VA was &gt;6/10 in 60% of cases. The most serious complication was haematocornea in 6% of cases.Conclusions: Frequent and serious condition in children that can jeopardize the functional prognosis of the eye. When the diagnosis is made, the management must be early in order to avoid complications.

Demographics, Presenting Features, and Outcomes of Adult Patients with Ocular Trauma

Introduction. Ocular trauma is a common cause of permanent vision loss in adults. The combination of an accurate clinical examination and imaging offers the best prognostic indicators for patients and helps to navigate treatment modalities. This is a retrospective chart review of examination and imaging findings for ocular trauma and how they correlate with treatment course and visual acuity (VA) outcomes. Methods. Adult patients with ocular trauma presenting to a single institution between January 2013 and December 2020 were evaluated. Initial examination and imaging findings were compared for associations with each other and with VA outcomes. Results. 136 ocular traumas on 134 patients were included. The median presenting logMAR VA was 2.7 (interquartile range (IQR) 1.2–3.7) with 62% open globe injuries. The most commonly reported finding on initial CT scan was globe deformity (30%), on B‐scan was choroidal detachment (20%), and on ultrasound biomicroscopy was intraocular foreign body, ciliochoroidal effusions, or angle recession (21% each). Worse vision was observed for patients positive for retinal detachment on initial B‐scan compared to those negative for this finding at 6‐month (median logMAR 2.7 vs. 0.5; P &lt; 0.0001) and at final post‐injury evaluation (median logMAR 3.7 vs. 0.4; P &lt; 0.0001). Similarly, worse VA was observed for patients with choroidal detachment on initial B‐scan compared to those without this finding at 6‐month (median logMAR 1.4 vs. 0.5; P = 0.002) and at final post‐injury evaluation (median logMAR 2.0 vs. 0.4; P &lt; 0.0001). If positive conjunctiva/sclera examination findings were identified, 66% had positive findings on B‐scan, whereas if the conjunctiva/sclera examination findings were absent, 41% had positive findings on B‐scan (P = 0.005). If anterior chamber (AC) examination findings were positive, 59% had positive findings on B‐scan, whereas if the AC examination findings were absent, 37% had positive findings on B‐scan (P = 0.03). Discussion. The predictive value of examination findings in this study may offer insight as to long‐term visual prognosis. Positive B‐scan or CT findings should increase suspicion for open globe injuries.

Secondary iris cyst following ocular blunt trauma: A case report

We present an uncommon case of a post-traumatic iris cyst following blunt trauma with secondary glaucoma. A 19-yr-old male presented with hyphaema and redness in the right eye. Slit-lamp examination and ultrasound biomicroscopy were consistent with an inferior iris cyst. Intraocular pressure was raised, and angle recession was present in the nasal quadrant on gonioscopy which made us probe for blunt trauma history, which was present. With no other causative history or signs and ruling out ciliary body tumor using imaging, we made our diagnosis. Pressures were reduced with antiglaucoma medication. Though uncommon, blunt trauma should be considered as a cause after ruling out other causes, especially malignancy.

Post trabeculectomy hypotonous maculopathy: Miraculous result with autologous blood injection in a young lad

A 28-year-old male patient was referred to us for the management of hypotonous maculopathy developed post trabeculectomy for angle recession glaucoma. After examination, the patient was advised cycloplegics, oral and topical steroids, but maculopathy had not settled even after treatment for 3 weeks and so scleral patch grafting was done. Post grafting also macular folds persisted and a part of the graft was exposed and so amniotic membrane grafting was done, still hypotony persisted with the development of neurosensory detachments. The over-filtration hypotonus maculopathy finally resolved with peri bleb injection of autologous whole blood.

Bilateral Angle Recession and Chronic Post-Traumatic Glaucoma: A Review of the Literature and a Case Report.

Ocular trauma affects millions of people worldwide and is a leading cause of secondary glaucoma. Angle recession is the main cause of post-traumatic glaucoma after blunt eye trauma, and it is usually unilateral. The aim of this paper is to investigate the possible causes of angle recession with a bilateral presentation. Airbag activation during traffic accidents is a likely cause to be ruled out, along with repeated head or eye trauma, due to contact sports or a history of physical abuse. These aspects can aid in early detection, appropriate management, and improved outcomes for patients with ocular trauma. Finally, we report the case of a 75-year-old Caucasian man who developed a bilateral angle recession after an airbag impact, with advanced glaucoma in the right eye and ocular hypertension in the left eye. To our knowledge, this is the first case in the literature of chronic post-traumatic glaucoma probably caused by an airbag.

Ocular Hypertension and Glaucoma after Traumatic Angle Recession: A Case Series

Ocular hypertension and glaucoma can occur after blunt trauma to the eye. Careful gonioscopic examination of the anterior chamber angle will reveal angle recession with widened ciliary body. We describe three cases of blunt trauma to the eye resulting in raised intraocular pressure (IOP)with and without damage to the optic disc. Two of these patients with high IOP were controlled medically while third patient required surgical intervention. The risk of high IOP after trauma can occur earlier or in the later part of the life. Patients with history of blunt injury to the eye should therefore be educated and counselled to get their eyes periodically examined for an early diagnosis of increased IOP

Clinical Spectrum of Indirect Traumatic Optic Neuropathy in South Indian Subjects Observational Study

Purpose: To report the aetiology, visual outcome, and clinical features of indirect traumatic Optic Neuropathy (TON) patients from the tertiary eye care center in South India. Methods: It is a retrospective and observational study. Details of age, gender, number of days of presentation after injury, Snellen visual acuity at presentation and last follow-up, visual evoked potentials, visual field findings using the Humphrey visual field analyser, associated ocular complications, and mode and time of treatment were obtained from the medical records of all indirect TON patients. Results: Indirect TON patients are mainly young males (94%) and road traffic accident (RTA) (65%) is the main cause of TON, followed by falls (19%) and sport-related activities (11%). Visual acuity loss was severe in more than 50% of the subjects and only 16%% of the patients showed improvement in visual acuity greater than one line. Pattern visual evoked potentials and visual fields are recordable only in 15% of the subjects. Commonly associated ocular complications in indirect TON patients were orbital fracture (43%), lid tear (16%), sub-conjunctival haemorrhage (13.5%), and angle recession (13.5%). Three out of four patients who received methylprednisolone and oral steroids within a week showed an improvement in visual acuity of greater than three lines, while just one patient out of four who received the same medication after a week improved visual acuity of three lines. Conclusion: RTA (road traffic accidents) is the most common cause of indirect TON and mainly young males were the affected individuals. IVMP along with oral steroids within a week, would help TON patients for reasonable visual recovery. Presenting Visual acuity of &gt; 6/600 and recordable pattern VEPs would be the prognostic factors for good visual outcomes in indirect TON patients.

Clinical features of early-onset pediatric traumatic glaucoma and predictive factors for the need of early glaucoma surgery.

To assess the clinical presentation of pediatric patients having early traumatic glaucoma and to analyze early predictors for the need of filtration surgery. Patients with early traumatic glaucoma after close globe injury (CGI) from January 2014 to December 2020 were retrospectively reviewed. Clinical features, treatment provided (medical and surgical), and visual outcomes were documented. Patients were divided into two groups based on the management required: group A- trabeculectomy and group B- medication + minor surgery. A total of 85 patients were studied after applying the necessary inclusion and exclusion criteria. Out of these, 46 underwent trabeculectomy for the control of intraocular pressure (IOP) and the remaining 39 were managed with antiglaucoma medications. Significant male predominance of 9.6:1 was observed. Patients presented to the hospital after a mean duration of 8.5 days posttrauma. Wooden objects were most commonly responsible for trauma. Mean best corrected visual acuity at presentation was 1.91 log of minimum angle of resolution (logMAR). Mean IOP at presentation was 40 mmHg. The common anterior segment finding were severe anterior chamber (AC) reaction (63.5%), followed by angle recession (56.4%). Severe AC reaction (P = 0.0001) and corneal microcystic edema (P = 0.04) were significant predictive factors for early need of trabeculectomy. Need of trabeculectomy was higher in patients with severe AC reaction and corneal microcystic edema. The threshold to perform trabeculectomy should be lower, as glaucoma is often relentless, severe, and may result in irreversible vision loss.

Clinical Profile and Visual Outcome of Traumatic Glaucoma Patients Following Closed Globe Injury in the Rural Part of Eastern Uttar Pradesh at a Tertiary Eye Care Centre: A Retrospective Cohort Study

Introduction: Glaucoma is a significant cause of ocular morbidity following ocular trauma, particularly Closed Globe Injury (CGI), which frequently leads to elevated Intraocular Pressure (IOP). This type of trauma can result in various tissue damages such as radial sphincter tears, iridodialysis, angle recession, cyclodialysis, trabecular meshwork tears, zonule separation, or peripheral retinal dialysis. Damage in these areas can lead to early or delayed onset glaucoma. Aim: To evaluate the clinical profile, assess visual outcomes, and analyse management strategies in post-traumatic glaucoma with CGI. Materials and Methods: The retrospective cohort study was conducted at a tertiary eye care centre in Department of Ophthalmology, Regional Institute of Ophthalmology (RIO), Sitapur, Uttar Pradesh, India. from January 2020 to December 2022. Retrospective data of patients presenting with CGI and developing elevated IOP (&gt;21 mmHg) were collected. Only patients with a minimum follow-up of three months were included. Various parameters, including demographics, IOP, Best-Corrected Visual Acuity (BCVA), and the effects of medical and surgical treatments on IOP and BCVA, were analysed. The Ocular Trauma Score (OTS) was also calculated. Statistical analysis was performed using Microsoft excel and Statistical Package for Social Sciences software version 21.0, with a significance level of 5%. Continuous variables were described as mean±Standard Deviation (SD), and an unpaired t-test was used for comparisons between pre- and postmanagement visual acuity and IOP. Results: Out of 259 eyes with ocular trauma, 93 (35.90%) were diagnosed with CGI and developed elevated IOP. The most common causes of elevated IOP were hyphema (37.63%) and angle recession mechanisms (32.25%). The median IOP at presentation was 35 mmHg (range: 12 to 71 mmHg) and decreased to 16.5 mmHg (range: 4 to 52 mmHg) at the last follow-up (p-value &lt;0.001). Surgical management was required in 30 (32.25%) eyes, with 13 (13.97%) eyes undergoing trabeculectomy. Conclusion: Post-traumatic IOP elevation occurred in 93 (35.90%) eyes with CGI, and 13.97% of these eyes required glaucoma filtering surgery for IOP control. Overall, medical management was necessary in 67.74% of eyes, while 32.25% required surgical intervention. Eyes with posterior segment involvement had poor visual acuity. Poor baseline vision and vitreo-retinal involvement increased the risk of a poor visual outcome.

Selective laser trabeculoplasty (SLT) in eyes with angle recession glaucoma

AbstractPurpose: To describe the results of selective laser trabeculoplasty (SLT) in eyes with angle recession glaucoma.Methods: a retrospective case series of 8 eyes of 8 patients with history of non‐penetrating injury to the eye resulted in angle recession glaucoma. All eyes underwent SLT. Post‐treatment, the best‐corrected visual acuity (BCVA), intraocular pressure (IOP), number of glaucoma medications, additional need for intervention, and complications were recorded. Success of treatment was defined as an IOP reduction of 20% or reduction in medications and maintaining target IOP without further intervention during follow up period of more than 3 months.Results: Mean patient age was 44 years, 6 males and 2 females. Mean pre‐ and post‐SLT IOP were 20.31 ± 3.59 and 15.04 ± 3.13 mmHg, respectively. IOP decreased significantly in all follow‐up visits. SLT treatment resulted in decreased IOP by 21% in 2 patients and by 25% with reduced medication burden in 4 patients and reduced medication burden in 2 patients who stopped glaucoma medication with no significant change in IOP (from 10 to 14 mmHg) at last follow up visit at 45 months.Conclusions: SLT is a safe procedure that cloud be a reasonable alternative management in angle recession glaucoma when patients are unwilling to try medical or surgical intervention.

STUDY ON PATTERN OF SECONDARY GLAUCOMA IN RURAL HOSPITAL

Introduction: Glaucoma is a chronic, progressive optic neuropathy leading to loss of visual function. It is the second most common cause of blindness. Aim: To study the pattern of secondary glaucoma and to identify their known risk factors and its aetiology. Methods: A observational, descriptive cross-sectional study was conducted at a tertiary care hospital in rural set-up. A total of 45 patients with raised IOP having suspected secondary glaucoma were evaluated. Evaluation was done on the basis of detailed history and clinical examination including visual acuity, anterior segment examination, intraocular pressure, gonioscopy and fundus evaluation. Results: The mean age at presentation was 65.46±13.72 years with 60% (27) males and 40% (18) females. Diabetes mellitus was seen in 22.2% (10), long term steroid use in 2.22% (1). Out of 45 patients 46.66% (21) had lens induced glaucoma, 26.66% (12) had pseudoexfoliatory glaucoma, 2.22% (1) had steroid induced glaucoma, 2.22% (1) had pigmentary glaucoma, 35.56% (4) had neovascular glaucoma, 4.44% (2) had inflammatory glaucoma, 2.22% (1) had angle recession glaucoma, 4.44% (2) had pseudophakic glaucoma and 2.22% (1) had malignant glaucoma. The mean IOP was 42.75±9.98 mm Hg at the time of presentation. Vision was PL -ve in 8.88% (4), PL + and PR faulty in 15.55% (7), PL + PR + in 60% (27) and less than 6/36 in 15.55% (7). On funduscopy 13.32% (6) had glaucomatous optic atrophy, 6.66% (3) had advanced glaucomatous disc changes, 6.66% (3) had normal findings and in 73.26% (33) it was not visualized due to hazy media. Gonioscopy showed that 26.64% (12) had open angle out of which 2.22% (1) had pigmentation (sampaolesi’s line), 4.44% (2) had neovascularisation of the angle, 2.22% (1) had angle recession and in 66.6% (30) gonioscopy was not possible due to corneal edema and pain. Conclusion: All 45 patients were evaluated clinically and it was found that secondary glaucoma was most common in 61-70 years with male predominance. The most common type was lens induced type followed by pseudoexfoliatory type.

Clinical Audit on Badminton-Related Ocular Injuries in a Tertiary Hospital in Malaysia.

Background Badminton-related ocular injuries are among the commonest causes of blunt trauma to the eye, which can lead to significant damage to the ocular structures. This study aimed to assess the clinical presentations, complications, and visual outcomes of patients who sustained ocular injuries related to badminton treated in a single tertiary center in Malaysia. Materials and methods A retrospective clinical audit was conducted in Hospital Universiti Sains Malaysia (HUSM), Malaysia, involving patients diagnosed with ocular injuries related to badminton, either as players or spectators, between January 1, 2003 and December 31, 2017. The demographic data, mechanism of injury, and clinical presentation were recorded. In addition, visual acuity, anterior and posterior segment, and intraocular pressure (IOP) measurements were recorded at the initial presentation and at the present recruitment period. Management at the initial presentation was also obtained and recorded. The final visual outcome and complications were based on the finding of the most recent follow-up. Visual acuity was categorized as follows: mild or no visual impairment (6/18 or better), moderate and severe visual impairment (<6/18 and worse). Results A total of 23 patients (23 eyes) were included in this clinical audit. The average age was 24 years, with a range of 6-56 years, with the highest incidence occurring at the age of 20 years old and younger. The majority of the injuries were sustained during the single-player game. All the injuries were caused by shuttlecock hits. In 18 cases (78%), the trauma was caused by an opponent, in four cases (17%) by a partner, and in one case involving a bystander. Most of the patients in this series were not using any protective eyewear while playing the game 96% (22). Most injuries (22 eyes) involved the anterior segment, with hyphaema as the commonest clinical presentation. The mean IOP at presentation was 23.5 (11.2) mmHg. Angle recession was detected as early as one-week post initial presentation in 17 eyes. Commotio retinae (5 eyes) and vitreous hemorrhage (4 eyes) were the common posterior segment findings. There were eight eyes with visual acuity of worse than 6/18 at the initial presentation, but only three eyes had poor final visual acuity. There was a statistically significant improvement in visual acuity at the last follow-up compared to the initial presentation (Fisher's exact test) (p=0.032). Conclusion Ocular injuries related to badminton is common and cause a detrimental effect on the long-term visual outcome. Traumatic hyphaema and commotio retinae are the most common presenting signs related to poor visual outcomes. Therefore, protective eyewear and promoting awareness of badminton-related ocular injuries are essential to prevent monocular blindness in young adults.

Micropulse diode laser therapy in refractory glaucoma

PurposeDescription of safety and efficacy of micropulse Transscleral cyclophotocoagulation as a treatment option for refractory glaucoma. MethodsThis is a prospective study including 39 eyes of 31 patients followed for refractory glaucoma, who benefited from transscleral cyclophotocoagulation using a microplused laser. The main indication for the procedure was increased ocular pressure refractory to quadritherapy in various types of glaucoma. The patients were treated using iridex Cyclo G6 laser with a Micropulse P3 infrared probe with a wavelength of 810 ​nm. The parameters for the procedure were a duration of 90 ​s per hemisphere with a power of 2000 mW and an energy of 180 ​J. Both the upper and lower hemispheres were treated in the same procedure, sparing the 3 o'clock and 9 o'clock meridians, and all the patients benefited from a single treatment session. The following parameters were evaluated: ocular pain and overall tolerance; visual acuity; and the evolution of IOP postoperatively up to 9 months. ResultsThe glaucoma subtypes treated are as follows: primary open-angle glaucoma (n ​= ​05), chronic angle-closure glaucoma (n ​= ​13), neovascular glaucoma (n ​= ​07), aphakic glaucoma (n ​= ​06), malignant glaucoma (n ​= ​04), post-traumatic angle recession (n ​= ​02), and inflammatory glaucoma (n ​= ​02). The mean pre-operative intraocular pressure was 42.3 ​± ​5.2 ​mmHg and the mean post-operative intraocular pressure at 9 months was 16.9 ​± ​1.9 ​mmHg. The reduction in IOP was 49.9%. The average number of intraocular pressure-lowering medications used prior to surgery was four, and the average number of medications used at the 9-month post-operative visit was 2.0 ​± ​1.2 (70.3% of patients were on dual therapy). The overall success rate was 60.5%. ConclusionsMicropulse transscleral cyclophotocoagulation appears to be a safe and efficient treatment for refractory glaucoma. Its indications should therefore be broadened and proposed early in various situations.

Reversed scleral tunnel technique for repair of iridodialysis after blunt force trauma: a retrospective clinical study

BackgroundTo investigate the efficacy and safety of reversed scleral tunnel technique for repairing iridodialysis after blunt force trauma.MethodsA total of 51 eyes of 51 patients with iridodialysis undergoing surgery were included in this study. Patients were divided into 2 groups: group A (the reversed scleral tunnel technique) and group B (the control group). Before the procedure and at 1, 3, and 6 months afterward, data on the patients’ age, gender, treatments, diagnosis, mechanism of injury, best-corrected visual acuity (BCVA), intraocular pressure (IOP), degree of iridodialysis, lens status, concomitant ocular damage, number of sutures, complications, and follow-up time were collected and compared between the 2 groups.ResultsIridodialysis was repaired and the pupil shape was restored to nearly round in all eyes. Standard phacoemulsification or lens removal was performed in all eyes. A final BCVA ≥20/60 was achieved in 13 eyes (48.1%) in Group A and 13 eyes (54.2%) in Group B. The IOP remained stable during the follow-up period in all eyes except 2 eyes (7.4%) in Group A and 3 eyes (12.5%) in Group B with angle recession. There were no statistically significant differences in BCVA and IOP between group A and group B. Intraoperatively, A significantly lower percentage of extensive subconjunctival hemorrhage occurred in Group A compared to Group B (1 eye versus 24 eyes, χ2 = 47.1, P = 0.00). Hyphema was observed in 2 eyes (7.4%) in Group A and 1 eye (4.2%) in Group B. Postoperatively, two eyes (7.4%) in Group A and 2 eyes (8.3%) in Group B developed retinal detachment. No other complications were noted during the follow-up period.ConclusionsThe reversed scleral tunnel technique is a safe and effective approach for repairing iridodialysis after blunt force trauma with few complications, favorable cosmetic and visual outcomes.