Corneal Laceration Repair Research Articles

Ophthalmic surgical practice In Ilorin, Nigeria in the 1990s

The treatment of ocular morbidity to restore vision often requires surgery. This study was done to determine the frequency of such surgical interventions and the various types of ophthalmic surgery done at the University of Ilorin Teaching Hospital (UITH), Ilorin, Nigeria. A retrospective review of all ophthalmic surgical procedures done in UITH between January 1990 and December, 2000 was carried out. The records were obtained from the operating theatre's register. Data analysis was with SPSS version 10. Within the study period, 1398 ocular surgeries were performed. Cataract surgery was the commonest (54.5%) and mostly performed in the 50-69 years age group; repair of corneal laceration was next (6.9%). The third most common surgery was pterygium excision (6.7%), common in the 30-69 years age group. Trabeculectomy for glaucoma was in the fourth position (6.2%). Destructive surgery (evisceration, enucleation and exenteration) was performed more in the paediatric age group. Cataract blindness is curable by surgery; the progression of glaucoma could be arrested with surgery. Early surgical intervention in ocular trauma would not only restore anatomical integrity but functional ability of the eye. The cataract surgical output could be improved upon by organizing outreach program and peripheral eye clinics. Use of protective eye shields by susceptible individuals would minimize ocular morbidity from trauma. Prompt referral of children with potential blinding eye injury or treatable ocular tumour would reduce the incidence of destructive surgeries in children. Keywords: ophthalmic surgeries, practice, Ilorin, Nigeria The Tropical Journal of Health Sciences Vol. 13(2) 2006: 31-34

Management of Intracorneal Epithelial Cysts With Ethanol Irrigation and Cyst Wall Excision

The clinical and pathologic characteristics and the surgical treatment of 2 patients with intrastromal corneal epithelial cysts are described. This interventional case report presents 2 young patients with decreased vision and cosmetic impairment caused by intracorneal epithelial cysts. The first patient had history of strabismus surgery, and the second patient had undergone corneal laceration repair. The cysts had enlarged gradually and dissected into the cornea, threatening the visual axis. Both patients were treated with drainage of cyst contents, chemical cytodestruction with 96% ethanol for 1 minute in a closed system, followed by cyst wall excision. Corneal clarity and appearance improved significantly after surgery. In the first patient, best-corrected visual acuity was 20/20 before the operation and remained stable. In the second patient, best-corrected visual acuity improved from 20/400 to 20/60 after the procedure. Histopathologic findings revealed that the cyst walls were composed of nonkeratinized stratified squamous epithelium. No recurrence was noted up to 8 and 3 months in the first and second patients, respectively. No complication occurred during the follow-up period. Intracorneal epithelial cysts may be treated safely and effectively with a combination of drainage of cyst contents, irrigation with 96% ethanol, and cyst wall excision with good visual and cosmetic results.

Application of sodium hyaluronate in repair of traumatic corneal laceration combined with cataract extraction and IOL implantation

目的 评价玻璃酸钠在角膜裂伤修补联合白内障摘出人工晶状体植入术中的临床效果.方法在42例(42眼)联合手术中使用玻璃酸钠使前房形成,虹膜复位,维持眼压,保护眼内组织.结果 42例(42眼)均顺利完成手术.术后视力均有不同程度提高,最佳矫正视力≥0.3者34眼,低于0.3者8眼.影响视力恢复的主要原因是角膜中央区瘢痕和角膜不规则散光.结论在联合手术中应用玻璃酸钠有助于前房形成,虹膜复位,保护眼内组织,安全有效地处理并发症。

Ocular injury in hurling

In this study, the authors describe the clinical characteristics of ocular injuries sustained in hurling in the south of Ireland and to investigate reasons for nonuse of protective headgear and eye wear. The case notes were reviewed of 310 patients who attended Cork University Hospital or Waterford Regional Hospital between January 1, 1994 and December 31, 2002 with ocular injuries sustained during a hurling match. A confidential questionnaire on reasons for nonuse of protective headgear and eye wear was completed by 130 players. Hurling related eye injuries occurred most commonly in young men. Fifty-two patients (17%) required hospital admission, with hyphema accounting for 71% of admissions. Ten injuries required intraocular surgical intervention: retinal detachment repair (five); macular hole surgery (one); repair of partial thickness corneal laceration (one); repair of globe perforation (one); enucleation (one); trabeculectomy for post-traumatic glaucoma (one). Fourteen eyes (4.5%) had a final best- corrected visual acuity (BCVA) of <6/12 and six (2%) had BCVA <3/60. In the survey, 63 players (48.5%) reported wearing no protective facemask while playing hurling. Impairment of vision was the most common reason cited for nonuse. Hurling related injury is a significant, and preventable, cause of ocular morbidity in young men in Ireland. The routine use of appropriate protective headgear and faceguards would result in a dramatic reduction in the incidence and severity of these injuries, and should be mandatory.—Hans E. Grossniklaus

Ocular injury in hurling

Objectives: To describe the clinical characteristics of ocular injuries sustained in hurling in the south of Ireland and to investigate reasons for non-use of protective headgear and eye wear. Methods:...

The phacoemulsification and IOL implantation combined with repair of corneal laceration

目的 评价角膜穿孔修补、外伤性白内障超声乳化吸出及人工晶状体植入联合手术的临床效果.方法对该联合手术38例38眼进行回顾性评价.首先完成角膜裂口修补,然后对损伤的晶状体进行超声乳化吸出,必要时行前段玻璃体切除,然后植入人工晶状体.术后随访1～36月,平均10.3月.结果38眼中20眼(52.6%)最终最佳矫正视力在0.5以上;30跟(38.9%)最终最佳矫正视力在0.3以上.结论选择角膜穿孔、晶状体损伤,进行角膜穿孔修补、白内障超声乳化吸出、人工晶状体植入联合手术,可以获得较好的视力。

Corneal surgical techniques

Although challenging from a technical perspective, many corneal surgical procedures can be mastered by the general practitioner. This article describes a number of procedures that can potentially save both the eye and vision. Procedures include corneal laceration repair, conjunctival pedicle graft, tarsoconjunctival island graft, advancement graft, total conjunctival graft, frozen tectonic corneal graft, porcine small-intestine submucosa graft, and superficial keratectomy. In addition to considerations on how to properly perform these procedures, emphasis is placed on common causes of failure and how to avoid them.

Topography after repair of full-thickness corneal laceration

Purpose: To characterize corneal topography after repair of full-thickness corneal laceration.Setting: Ophthalmic emergency room serving as a trauma referral center.Methods: Twenty-two eyes with full-thickness corneal lacerations were prospectively studied after standardized surgical repair. Computerized videokeratography was done 2 and 14 weeks after surgery, with the latter measurement corresponding to 6 to 8 weeks after all sutures were removed. Fellow uninjured eyes served as the control group.Results: Twenty eyes (91 %) had a significant reduction in topographic distortion after suture removal. Mean corneal astigmatism, measured by simulated keratometry, was 10.70 diopters (D) ± 5.90 D (SD) with sutures in place and 2.25 ± 4.90 D after their removal (P < .005). Eighteen patients (82%) had 2.00 D or less of corneal astigmatism 6 to 8 weeks after all sutures were removed. The final distribution of topographic patterns was bow tie (50%), spherical/oval (36%), and irregular (14%). There was no significant correlation between laceration configuration (curvilinear, jagged, branched wound margins) and final topography. Lacerations that passed within 2.0 mm of the line of sight, however, were significantly more likely to have more than 2.00 D of final astigmatism. Mean central corneal power was 42.40 ± 3.20 D in the injured eyes and 42.40 ± 2.40 D in the uninjured fellow eyes.Conclusion: Although high astigmatism is frequently produced by corneal sutures used to repair full-thickness lacerations, the cornea has a substantial topographic memory that results in a marked normalization of contour after suture removal.

Posterior chamber lens implantation for primary repair of corneal lacerations and traumatic cataracts in children.

Children older than 3 years of age rarely tolerate contact lenses for unilateral surgical aphakia. This problem is even more pronounced following repair of corneal lacerations or perforations that are associated with traumatic cataracts. Even if surgery is successful, such eyes are functionally doomed because of deep anisometropic amblyopia. We evaluated prospectively in 15 children (3 to 8 years) the results of combined operation of corneal repair, aspiration of traumatic cataract, and primary posterior chamber lens implantation. Postoperative occlusion treatment was carefully monitored. Follow up ranged from 6 to 60 months, with an average of 39.2 months. The final best corrected visual acuity at the patient's last visit was 20/40 or better in 11 of 15 children (73.3%). The most frequent complication was a nonfunctional pupil due to traumatic iris damage or posterior synechiae in 13 cases. The most visually significant complication was posterior membrane formation and/or posterior capsule opacification, which required additional surgeries in six children.

The repair of corneal and scleral lacerations.

(1994). The Repair of Corneal and Scleral Lacerations. Seminars in Ophthalmology: Vol. 9, No. 3, pp. 165-176.

Simultaneous Corneal Laceration Repair, Cataract Removal, and Posterior Chamber Intraocular Lens Implantation

Frequently, patients with lens laceration or traumatic cataract coincident with corneal laceration, or both, must undergo two separate procedures-primary repair of the corneal laceration and secondary lens removal with or without intraocular lens implantation. We performed simultaneous corneal laceration repair, extracapsular cataract extraction, and posterior chamber lens implantation in seven patients with lacerating ocular injuries who met inclusion criteria for this procedure. With average follow-up of 10 1/2 months, all seven patients achieved visual acuity of 20/40 or better with spectacle correction. YAG posterior capsulotomy was the only additional procedure. One patient had macular pigmentation consistent with either traumatic or photic maculopathy. There were no other complications attributable to the surgical procedures. We believe that certain lacerating injuries of the anterior segment are particularly amenable to cataract extraction and lens implantation at the time of primary laceration repair. This approach obviates additional operative and anesthetic risks, while affording more timely visual rehabilitation.

Results of Penetrating Keratoplasty for the Treatment of Corneal Perforations

We retrospectively analyzed 46 consecutive cases of penetrating keratoplasty performed as part of the treatment of corneal perforations; the minimum follow-up time after keratoplasty was 7 months. Predisposing conditions leading to perforation were an infectious keratitis in 26 eyes (57%), trauma in 14 eyes (30%), and corneal melt associated with ocular surface disorder in 6 eyes (13%). The success of penetrating keratoplasty in the treatment of corneal perforation depended on the timing of surgery and the cause of the perforation. If the perforation was traumatic in origin, delaying surgery for at least 3 months significantly improved the chances for graft success. Eighty percent of the penetrating keratoplasties delayed 3 months following primary repair of corneal laceration remained clear, and 50% of these patients had a visual acuity of 20/60 or better. If penetrating keratoplasties were performed for an infectious corneal perforation, grafts had a better chance to remain clear if surgery could be delayed. All grafts performed for corneal perforation associated with melting and ocular surface abnormalities failed.

Contact Lenses for Visual Rehabilitation after Corneal Laceration Repair

A contact lens fitting was tried after corneal laceration repair in 26 eyes. The mean patient age was 25 years; 22 eyes were aphakic and there were 23 males. Many patients had been referred for penetrating keratoplasty. Intact sutures in 13 eyes did not hinder contact lens fitting which was performed within 6 months in 12 cases. A contact lens was fit and successfully worn in 21 eyes (81%) and was fit in the remaining five patients, but not worn because of suboptimal vision (4 eyes) or an unsatisfactory fit (1 eye). Success rates were higher for small, peripheral lesions and in younger patients. Visual acuity was at least 20/30 in 12 patients and follow-up averaged 10.1 months. A contact lens can usually be fit after corneal lacerations, despite aphakia, with good visual results, thereby avoiding penetrating keratoplasty and intraocular lens implantation.

Repair of corneal lacerations and perforations.

Lin, David T. C. MD; Webstar, Robert G. Jr. MD; Abbott, Richard L. MD Author Information

Bowman's layer in penetrating keratoplasties of the human eye.

Light microscopy disclosed ten examples of Bowman's layer incarcerations into the stromal wound in nine of 23 penetrating keratoplasty globes obtained either after death or by enucleation. Two cases involved separation of Bowman's layer from the underlying stroma. In the others, this layer remained attached to its stroma, and incarceration resulted from either fragmentation or malapposition of wound edges. Six of the incarcerations produced wound defects, and, of these three were associated with epithelial growth into the wound. These properties of Bowman's layer must be considered in the repair of corneal lacerations as well as in the performance of penetrating keratoplasties and epikeratophakia.

Separation of the Iris Pigment Epithelium

Surgical repair of traumatic corneal and scleral lacerations with uveal prolapse postoperatively disclosed a separation of the pigment epithelium. Posterior synechiae and a dense occlusion of the pupil tightly bound the papillary margin to the lens capsule. Traumatic, surgical, and mydriatic agents tore the anterior pigment epithelium layer loose from the adherent pupillary margin and induced a complete separation of the iris along the original lumen of the embryonic cup, between the two epithelial layers. Once the consolidated fibrin cleared, the posterior pigment layer retraccted from the visual axis but did not reattach to the iris.