Corneal Laceration Research Articles

Corneal Endothelial Changes from Exposure to Povidone Iodine Solution

Povidone iodine (PI) is a common preoperative antiseptic for eyelid and conjunctival preparation. The corneal endothelium may theoretically be exposed to PI during intraocular surgery or during the repair of a corneal laceration. This study explores the changes in corneal endothelial cell density following exposure to 1%, 2%, and 5% concentrations of PI in a porcine model. Four groups of excised porcine corneas were exposed to 1% (group A), 2% (group B), and 5% (group C) PI and balanced salt solution (BSS, Alcon Labs, Fort Worth, TX) (group D) for a 1-minute exposure. Specular microscopy was used to measure endothelial cell density pre- and post-exposure. Group A (1% PI) had reduction of endothelial cell density from 3870 cells/mm2 to 3604 cells/mm2, group B (2%) 3634 preexposure to 3115 postexposure, group C (5%) 3582 preexposure to 2948 postexposure, and group D (BSS) endothelial cell density was 3639 preexposure to 3741 postexposure. A graded increase in endothelial cell loss is seen with increased povidone iodine concentrations.

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

LASIK for High Myopic Astigmatism Resulting From Perforating Ocular Injury

To present a case of successful treatment of high myopic astigmatism after a perforating injury with significant corneal laceration and pupil ectopia using excimer LASIK. A 30-year-old man presented for treatment of high myopic astigmatism in his right eye resulting from perforating ocular trauma, which occurred 8 years prior to presentation. The corneoscleral wound repair was performed with posterior chamber intraocular lens implantation. Uncorrected visual acuity (UCVA) in the right eye was counting fingers at 1 m, best corrected to 20/30 with -7.00 + 5.00 x 110. Visual acuity in the left eye was 20/20 with -1.5 D. The patient was unable to tolerate spectacles and contact lenses because of asthenopia and high astigmatism, respectively. As an alternative, LASIK with the Allegretto Wave excimer laser was performed. Three months postoperatively, UCVA was 20/25 in the right eye and 20/15 in the left eye. This case indicates that LASIK can be a useful surgical method for correcting high myopic astigmatism resulting from ocular trauma with significant corneoscleral laceration.

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:...

Fishing-related ocular trauma

To evaluate the characteristics of fishing-related ocular injuries. Retrospective observational analysis of a computerized databank. The United States Eye Injury Registry was used to analyze 143 patients with fishing-related ocular injury. Epidemiologic and clinical information was evaluated including the age and gender of the subjects, classification of ocular trauma, surgical management, and final visual acuity. Of the 732 cases of sport-related ocular trauma, 143 (19.54%) occurred while fishing; of these, 79% were male patients who ranged in age from 6 to 68 years (mean, 37 years). Corneal laceration, globe rupture, and hyphema were the most common diagnoses at presentation and were caused by fishing hooks, lures, and weights. Thirty-five bystanders are included in the study. Thirty-eight percent of patients had visual acuity less than 20/50, and 21% had a visual acuity of less than 20/200. Open globe injuries portended a poor visual outcome compared with closed globe injuries. Fishing-related ocular injuries represent a large percent of sports-related trauma, often resulting in significant visual loss. Preventive measures such as the use of protective eyewear should be advised in this activity.

Blinding Endophthalmitis from Orthodontic Headgear

To the Editor: Intraocular infection (endophthalmitis) is a serious risk after a penetrating injury to the eye and may result in blindness. We report a severe intraocular infection from an eye injury caused by an orthodontic extraoral traction device (orthodontic headgear). A 12-year-old boy who was being treated for malocclusion with orthodontic headgear without safety features had an accidental release of the device, which apparently struck his right eye while he was sleeping. The patient reported pain in his right eye on awakening. His visual acuity was 20/60. A corneal laceration was found. The posterior segment of the eye appeared . . .

Scleral and corneal laceration with iris prolapse caused by an eagle claw

To describe the visual rehabilitation after surgical treatment of an ocular injury sustained during an attack by a bird of prey. A 51-year-old woman who was attacked by an eagle in a cage had a laceration of cornea and sclera at 9 o' clock, an iris prolapse that was jammed into the scleral wound, and a flat anterior chamber with hyphema. The uncorrected visual acuity was hand movements. Surgical treatment was performed immediately and included iris repositioning and suturing, scleral and conjunctival suturing, and transscleral cryotherapy to the retina. Eight months later, the best corrected visual acuity was 20/20. The anterior segment showed a posterior synechia in the area of the iris repair and an almost round pupil; the crystalline lens showed only a localized opacification. A bird of prey, even though caged, can injure an eye in humans. With immediate surgical treatment, good visual rehabilitation was achieved in this case. It should be reiterated that spectacles offer no protection against ocular trauma in these cases.

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。

Pars Plana Vitrectomy Foreign Body Extraction Assisted With a 24-Gauge Needle Tunnel

A 54-year-old man presented with corneal laceration, traumatized iris, small vitreous hemorrhage, lens opacity, and a 13-mm intraocular foreign body embedded in the retina. Pars plana vitrectomy and argon laser photocoagulation were performed. Using intraocular forceps, the object was forced into a 24-gauge needle that was inserted through the sclerotomy. The foreign body and the needle were removed from the eye. Phacoemulsification with foldable intraocular lens implantation in the ciliary sulcus was performed. Seven days after the surgery, the patient's visual acuity was 20/20 with spectacle correction of -3.5 diopters. The use of a needle tunnel during pars plana vitrectomy should be considered in similar cases of large, irregular intraocular foreign bodies to avoid severe and irreversible damage to the adjoining tissues.

Clinical features of ocular trauma in emergency department.

This study analyzed a hospital-based study to investigate the incidence and clinical features of ocular traumatic emergencies in Korea. Over a 6-year period, 1809 patients with ocular traumatic emergency each individually underwent clinical study including subject characteristics, type of ocular emergency, disease severity, etiology of ocular trauma, injury location, cause of decreased visual acuity, management of ocular injury, and final visual acuity. The homogeneity of each finding of the clinical features of ocular traumatic emergency was tested by an X2 test at a 95% level of certainty. During follow-up periods ranging from 3 days to 23 months (mean 2.0 months), the 1809 patients with ocular traumatic emergency, 1183 males (65.4%) and 626 females (34.6%), were studied. The incidence of ocular emergencies peaked in the third decade of life, irrespective of gender (P < 0.05). Corneal abrasion was the most common etiology among 1,552 (85.8%) closed injuries, and corneal laceration among 257 (14.2%) open injuries (P < 0.05). There were 542 cases (30%) of severe ocular injury, such as penetrating ocular injury, blow out fracture, and intraocular foreign body (IOF), and 1267 (70%) of less severe ocular injury, such as superficial ocular injury or contusion. The most common etiology of severe ocular injury was penetrating ocular injury, and that of less severe injury was corneal injury (P < 0.05). The main causative activity of ocular injuries was work in 631 cases (34.9%), assault in 398 (22.0%), play in 278 (15.4%), traffic accidents in 145 (8.0%) and sports in 128 (7.1%). Five hundred and fifty-four cases (32.5%) underwent surgical intervention. There was an improvement of visual acuity in 502 cases (70.1%), no change in 122 (17.0%), and worsening in 92 (12.9%). We suggest that preventive educational measures be instigated at workplaces to reduce the incidence of ocular traumatic emergency, especially severe ocular injury.

Dendritic polymers composed of glycerol and succinic acid: Synthetic methodologies and medical applications

Abstract Research on dendrimers continues to expand as further advances in synthetic methodology and characterization techniques translate to additional applications. Recently, dendritic polymers composed of the natural metabolites glycerol and succinic acid were synthesized, functionalized, and evaluated as new medical materials. The design and synthesis of poly(glycerol-succinic acid) dendritic polymers are discussed, including comparing and contrasting the convergent versus the divergent methodologies for preparing such macromolecules. Finally, a photocrosslinkable dendritic macromolecule was prepared and successfully used to close linear corneal lacerations as well as to secure LASIK flaps.

Favorable outcome using a black diaphragm intraocular lens for traumatic aniridia with total iridectomy

A 25-year-old man had a penetrating injury to the left eye. Ocular examination revealed a full-thickness corneal laceration, total aniridia, anterior capsule rupture, and microscopic hyphema. Ten days after the immediate primary-repair surgery, aspiration of the lens secondary to traumatic cataract was performed. Four months later, a black diaphragm intraocular lens was implanted. Postoperatively, the best corrected visual acuity was 20/20 in both eyes. Multifocal spectacles were prescribed to provide the near and far vision required for the patient's job. Normal intraocular pressure and acceptable photophobia were noted during the 18-month follow-up.

Traumatic Birth Injury

After completing this article, readers should be able to: 1. Describe the delivery conditions that increase the risk for birth trauma. 2. Explain why subgaleal hemorrhage can be a medical emergency. 3. Delineate the common presenting findings of traumatic intracranial bleeding. 4. Describe the risk factors for brachial plexus palsy. 5. Differentiate facial nerve palsy from congenital palsies and hypoplasia of the depressor anguli oris muscle. Birth injuries are sustained during the labor and delivery process. They can be divided into those due to physical trauma during the birth process (traumatic birth injury) and those due to lack of oxygen (hypoxic-ischemic injury). These types of injuries can occur separately or in combination. This review focuses on the diagnosis and management of traumatic birth injuries. Traumatic injuries often are the result of a discrepancy between the size or position of the fetus in relation to the birth canal or an unusually rigid pelvis that has not adapted to the size of the fetal head. The reported rate of birth trauma from a 7-year review published in 1990 was 3.2%. Some injuries are avoidable, and with improvements in obstetric care, the frequency of birth injury as a cause for perinatal mortality has decreased over the past 25 years. Predisposing factors for traumatic birth injury are listed in Table 1. Macrosomic fetuses, including those from poorly controlled diabetic pregnancies, represent a particularly high-risk group for birth injury. However, predicting which macrosomic infants will be injured during the birth process is difficult. Injuries also are more frequent with instrumented vaginal deliveries. Use of forceps has been associated with facial nerve and brachial plexus injuries, skull and facial fractures, and intracranial hemorrhages. Ocular injuries, including fracture of the base of the orbit, intraorbital hemorrhage, corneal laceration, and breaks in Descemet’s membrane with corneal opacification, as well as dislocated nasal …

Post traumatic polymicrobial endophthalmitis, including neisseria subflava

Purpose To report the second known case of post-traumatic endophthalmitis caused by Neisseria subflava. Design Interventional case report. Methods A two-year-old child with post-traumatic corneal laceration and uveal prolapse required medical and surgical therapy for endophthalmitis caused by multiple organisms including N. subflava. Results After aggressive therapy, patient had a favorable outcome without vision compromise. Conclusions As there is still not a standard protocol for therapy for post-traumatic endopthalmitis, we recommend the use of broad-spectrum antibiotics via intravitreal, intravenous, and topical routes. Consideration of typical and unusual bacteria that have been reported to cause endopthalmitis, as well as the source of injury, should guide antibiotic choice.

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.

Elastic cord-induced ocular injuries

Purpose: To evaluate the incidence and severity of ocular injuries caused by elastic cords. Patients and method: A retrospective review of patients’ records from the Emergency Department was conducted to identify cases of elastic cord-induced ocular injuries. Over a 67-month period starting in October 1996, 28 patients (24 males and 4 females, mean age 38.6 years) with elastic cord-associated ocular trauma were identified. Patient demographics, mechanism of injury, presenting and final visual acuity, ocular injuries, medical and surgical intervention and length of follow-up were noted. Results: The most common anterior and posterior segment injuries were hyphaema/microhyphaema (71.4%) and commotio retinae (60.7%), respectively. The most severe injuries sustained were corneal or scleral lacerations (7.1%), formation of retinal tears (10.7%) or retinal detachment (3.6%), lens subluxation (7.1%) and traumatic cataract (7.1%). Eight patients (28.6%) were admitted for surgical or medical treatment. Mean visual acuity was 20/40 on presentation and 20/25 at the end of the follow-up period. Conclusions: Elastic cords may cause a wide range of ocular traumas of varying severity. Appropriate design modifications that would prevent the spontaneous release of their hooks are likely to make their use significantly safer.

Biodendrimers: New Polymeric Biomaterials for Tissue Engineering.

Dendrimers composed entirely of building blocks known to be biocompatible or degradable in vivo to natural metabolites were synthesized using a high yield divergent approach. This synthesis is amenable to the design and development of new biomaterials that are of interest for a variety of medical applications, including tissue engineering. In a novel application, photocrosslinkable dendrimers are used to seal large corneal lacerations.

Biodendrimers: New Polymeric Biomaterials for Tissue Engineering

Dendrimers composed entirely of building blocks known to be biocompatible or degradable in vivo to natural metabolites were synthesized using a high yield divergent approach. This synthesis is amenable to the design and development of new biomaterials that are of interest for a variety of medical applications, including tissue engineering. In a novel application, photocross-linkable dendrimers are used to seal large corneal lacerations.

A photopolymerized sealant for corneal lacerations.

To determine whether a novel photocrosslinkable polymer synthesized from hyaluronic acid would seal experimental full-thickness corneal lacerations in a rabbit model. A solution of hyaluronic acid was modified with methacrylate groups (HA-MA), precipitated, dried, reconstituted in an aqueous solution, and sterilized before use. The viscous polymer solution was applied to 38 of 43 experimental corneal lacerations in rabbits and subsequently irradiated with a low-intensity argon laser beam to produce a clear flexible polysaccharide hydrogel patch. The ability of this sealant to repair corneal lacerations was evaluated in four types of full-thickness, 3-mm corneal wounds (linear, linear + epithelium removed, stellate, and stellate + epithelium removed). Slit-lamp examinations, measurements of intraocular pressure, Seidel tests, and histologic studies were performed at selected intervals to evaluate the wound and determine the rate of healing. Corneal perforations were completely sealed and the anterior chambers had reformed by 6 hours in HA-MA-treated eyes. There was no evidence of leakage at this or later times in 37 of the 38 eyes. Intraocular pressure had risen to near-normal levels by day 7 in all four groups, and the sealant was still present in most eyes at day 7. In contrast, the anterior chambers did not re-form in control eyes (five) with untreated perforations because of aqueous leakage through the wounds. Minimal inflammation was observed clinically or in histologic sections of treated corneas. There was extensive proliferation of stromal cells and formation of new extracellular matrix at the wound edges, which became tightly adherent between days 4 and 7. Our novel photocrosslinkable methacrylated hyaluronan polymer sealed 97% (37/38) of the experimental corneal lacerations. HA-MA may prove useful for sealing corneal lacerations in patients and for other sutureless ophthalmic surgical procedures.

Hybrid dendritic-linear polyester-ethers for in situ photopolymerization.

Novel first through fourth generation hybrid dendritic-linear copolymers, composed entirely of building blocks known to be biocompatible or degradable to natural metabolites in vivo, are described. Specifically, these copolymers are composed of poly(ethylene glycol), glycerol, and succinic acid and are synthesized using a divergent approach in high yield. A photo-cross-linkable derivative of this copolymer successfully seals 4.1 mm corneal lacerations. The mechanism of tissue repair is likely one of physical entrapment where an interpenetrating network (IPN) is formed between the cross-linked copolymer and the tissue.