Corneal Laceration Research Articles

Visual outcome of Pars Plana Vitrectomy following Endophthalmitis – A Vitreo-retinal Surgeon's Experience

Purpose: To determine the visual outcome of pars plana vitrectomy following endophthalmitis.
 Methods: A retrospective hospital-based study of 20 eyes of consecutive patients who had pars plana vitrectomy by a particular surgeon following endophthalmitis in the Ispahani Islamia Eye Institute and Hospital, Dhaka, Bangladesh from August – December 2017. Using the Snellen's visual acuity chart, post-operative distant visual acuity improvement was graded 0– 9, with 0 meaning no improvement in visual acuity, and 9 meaning nine lines of improvement in visual acuity from presenting best corrected visual acuity.
 Results: Pre-operative corrected distant visual acuity (CDVA) ranged from perception of light to 6/36. Seventy percent of the patients had postoperative visual improvement of varying degrees. The mean pre-operative and post-operative CDVA were 2.20 logMAR and 1.40 logMAR respectively. All the patients tractional retinal detachment and corneal laceration with rhegmatogeneous retinal detachment as co-morbidities did not have visual improvement, and this was statistically significant (p-value = 0.007). There was an association (although not strong) between age range and postoperative visual improvement (p-value = 0.639).
 Conclusion: Pars plana vitrectomy helps to prevent or minimize ophthalmic complications from endophthalmitis, thus making it a necessary line of treatment endophthalmitis. Pars plana vitrectomy is therefore a safe and desirable definitive treatment for endophthalmitis, and it confers a good chance of visual improvement.

How lethal is a pellet gun for eyes?

Background: Etiologically ocular injuries can be classified into domestic, occupational, sports, road traffic accidents, iatrogenic, fights and assaults, and war injuries. In the 1960s and 1970s, road traffic accidents became the most common cause of serious ocular injuries. In the 1980s, sports and leisure activities became a common cause of severe eye injury. The home is now the most common location for eye injuries. However, bomb blast and battlefield ocular injuries are becoming increasingly common in different parts of the world. Recently introduced non-lethal pellet guns used by law enforcement Indian agencies in Kashmir were the most common cause of ocular injuries in the valley. Objective: The objective of this study was to evaluate ocular pellet gun injuries in patients of a conflict zone by a so called non-lethal weapon as a mass control measure. Method: The study was conducted in post graduate department of Radiodiagnosis and imaging, Government Medical College, Srinagar Jammu and Kashmir. Our study was conducted between January 2019 to 15th May 2019. A total of 30 patients with ocular pellet injuries were taken up for study. Results: The most common type of injuries encountered were corneal laceration in 66.7 % eyes, vitreous haemorrhage in 52.8% and scleral laceration in 33.3% of eyes. Indirect signs like decreased volume of anterior chamber were suggestive of corneal laceration. Retained intraocular foreign body (IOFB) was seen in 7 patients and intraorbital foreign body excluding intraocular foreign body in 3 patients. Conclusion: In conclusion a so called non-lethal pellet gun used by law enforcement agencies has the potential to cause devastating ocular injuries.

Surgical management of pediatric eye injuries.

BACKGROUND:Eye injury is a leading cause of unilateral childhood blindness. The purpose of this research was to study the management and visual outcome of pediatric eye injuries necessitating hospitalization and surgical repair.MATERIALS AND METHODS:This is a retrospective study of children having eye injury that needed surgical repair over the period of 2012 and 2017. Demographic data, place of occurrence, activity at the time of injury, place and cause of injury, presenting signs, surgical interventions, visual acuity (VA) before and after surgery, and causes for vision limitations were studied.RESULTS:Thirty-nine eyes of children were surgically treated. The mean (range) age of the patients was 3 years (1–15 years). Nearly 61.5% were males. Almost 80% of injuries occurred at home and while playing (71.8%). Trauma with sharp objects (35.8%) was the most common cause of injury. Majority presented to the hospital in <6 h (89%), mainly with eye pain (95%). Corneal laceration (53.8%), traumatic cataract (15.3%), and foreign body (15.3%) were the most common clinical findings. Twenty-one (53.8%) eyes sustained open-globe injuries. Fifteen percent had vision of 20/200 or worse at follow-up. The VA improved significantly at follow-up (P < 0.05). The major cause of vision limitation was the cornea (33%).CONCLUSIONS:Eye injury is a major cause of vision loss in children. Despite early presentation to our hospital and prompt interventions, significant number of our pediatric patients sustained limited VA in ruptured globe injuries.

Timely Use of Conventional Vitrectomy and Endoscope-Assisted Vitrectomy for Endophthalmitis Following Open Ocular Trauma: A Retrospective Study of 18 Patients.

BackgroundEndophthalmitis, or inflammation of the internal tissues of the eye, may follow trauma and results in loss of vision if not treated promptly. Vitrectomy is used to debride the inflamed vitreous. This retrospective study aimed to compare the outcome from conventional vitrectomy (CV) and endoscope-assisted vitrectomy (EAV) performed for endophthalmitis within five days and 10 days after open ocular trauma.Material/MethodsThe clinical data from 18 patients (18 eyes) with endophthalmitis caused by open ocular trauma were analyzed at a single center. CV or EAV was performed based on the degree of vision and the involvement of the vitreous cavity.ResultsOf the 18 patients with endophthalmitis, seven patients underwent EAV, and 11 patients underwent CV. The number of cases with preoperative corneal laceration, edema, bleeding, and formation of corneal nebular opacity was higher in the EAV group compared to the CV group. Four patients had retinal detachment, of which three patients were treated with EAV. Seventeen patients had their sight restored by a single vitrectomy procedure. In 10 cases, the culture of the vitreous fluid was positive for infection, and eight patients had Gram-positive Staphylococcus epidermidis infection. Follow-up showed that vitrectomy performed within five days (P=0.001) and 10 days (P=0.047) of open ocular trauma resulted in significant improvement of visual acuity.ConclusionsVitrectomy for endophthalmitis due to open ocular trauma performed within five days of injury restored visual acuity. EAV was shown to be an effective alternative to CV.

EFFICACY AND CORRELATION OF INTRAOCULAR PRESSURE MEASURED BY NON-CONTACT, REBOUND AND GOLDMANN APPLANATION TONOMETER WITH CORNEAL THICKNESS, TRUE IOP AND CORNEAL CURVATURE IN A TERTIARY HOSPITAL.

ABSTRACT:&#x0D; AIM-To compare the intraocular pressure (IOP) measured by Non-Contact tonometer (NCT), Rebound tonometer (RBT) and Goldmann Applanation tonometer (GAT) and their correlation with central corneal thickness (CCT), true IOP and corneal curvature.&#x0D; Reliability of each tonometer.&#x0D; METHODS-500 random patients aged 18 years and above were taken up for the study. Patients with anterior and posterior segment pathologies like corneal ulcer, leukoma, staphyloma, corneal lacerations, ectatic corneal conditions, corneal dystrophies, oedema, perforations, acute angle closure glaucoma, retinal detachments, vitreous haemorrhage and unwilling patients were excluded from the study. IOP was recorded using NCT, RBT and GAT after assessing the patient's visual acuity. Following IOP measurement, central corneal thickness (CCT) of each patient was measured using pachymetry. Kvalues were measured using an autorefractometer. All the data were collected and tabulated for statistical analysis to obtain results.&#x0D; RESULTS: The mean CCT in males was 0.5350 mm and in females 0.5340 mm respectively. The mean IOP measured by NCT is 16.43 mm hg whereas the mean IOP measured by GAT is 15.43 mm hg. IOP measured by NCT is significantly higher than the IOP measured by GAT (p&lt;0.001). When NCT and RBT are compared NCT values are significantly higher than that of RBT(p&lt;0.001). Although the mean RBT IOP 15.83 mm hg is higher than the mean GAT IOP of 15.42 mm hg the values are not statistically significant. When correlated with CCT all the tonometers showed significant correlation with GAT showing the strongest correlation. NCT overestimates IOP in normal, thin and thicker corneas when compared to GAT and are statistically significant. RBT also overestimates in the normal and thick corneas when compared to GAT but their values are much closer to GAT values in thinner corneas. The IOP measured by all the 3 tonometers correlated with corrected IOP with NCT showing the best correlation followed by GAT. There was no significant correlation between K and IOP in our study.&#x0D; CONCLUSION-From the present study we can conclude that IOP measured by NCT and RBT is higher than GAT. NCT values are significantly higher than GAT values in thin and normal corneas whereas it overestimates more in thicker corneas. RBT values are significantly higher than that of GAT in normal and thick corneas. All the tonometers show significant correlation with CCT with GAT showing the strongest correlation. So, it is always advisable to measure the corrected IOP for each patient after considering the CCT.&#x0D; Keywords- Non-contact tonometer; Goldmann applanation tonometer; central corneal thickness; intraocular pressure; Rebound tonometer, true IOP, Corneal curvature.&#x0D;

Pattern of Ocular and Adnexal Injuries Requiring Surgical Intervention among Children in a Tertiary Center in North-Central Nigeria: A 14 Year Review

The study assessed the pattern of ocular and adnexal injuries that required surgical intervention among children with the aim of strengthening preventive, curative and promotive eye care services. The ophthalmic surgical database of the facility was retrospectively reviewed to obtain information on children who had surgical intervention due to trauma from 1st January 2004-31st December 2017; these included demographic data; diagnosis, procedure and the type of anaesthesia administered. Epi Info software, version 3.4 was used for analysis. A total of 361 children (aged &lt;18years) underwent a surgical procedure as a result of ocular trauma within the stated period. There were more males 255(70.6%) than females 106(29.4%) with a male:female ratio of 2.4:1. The mean age was 7.7±3.5years, 356(98.6%) participants had general anaesthesia administered, 267(73.9%) were aged ≤10 years. The main indications for surgical intervention were corneal laceration 143(39.6%), traumatic cataract 99(27.4%), corneo-scleral laceration 34(9.4%), lid ± canalicular laceration 21 (5.8%), intraocular foreign body 16(4.4%), ruptured globe 14(3.9%) and limbal rupture 11(3.1%). A higher proportion of males had corneal laceration 104(40.8%, p=0.40), intraocular foreign body 13(5.1%, p=0.25) and ruptured globe 12(4.7%, p=0.17) while a higher proportion of females had traumatic cataract 35(33%, p=0.14), lid laceration 4(3.8%, p=0.76) and scleral laceration 2(2.8%, p=0.33). The observed differences were however not statistically significant. Of 21 participants who had lid injuries 14(66.7%) were aged ≤5years. Of 14 participants who had ruptured globe, 8(57.1%) were aged 11-17years. We observed that a male child is twice more likely to have an ophthalmic surgery due to trauma.

Pattern of Ocular and Adnexal Injuries Requiring Surgical Intervention among Children in a Tertiary Center in North-Central Nigeria: A 14 Year Review

The study assessed the pattern of ocular and adnexal injuries that required surgical intervention among children with the aim of strengthening preventive, curative and promotive eye care services. The ophthalmic surgical database of the facility was retrospectively reviewed to obtain information on children who had surgical intervention due to trauma from 1st January 2004-31st December 2017; these included demographic data; diagnosis, procedure and the type of anaesthesia administered. Epi Info software, version 3.4 was used for analysis. A total of 361 children (aged &lt;18years) underwent a surgical procedure as a result of ocular trauma within the stated period. There were more males 255(70.6%) than females 106(29.4%) with a male:female ratio of 2.4:1. The mean age was 7.7±3.5years, 356(98.6%) participants had general anaesthesia administered, 267(73.9%) were aged ≤10 years. The main indications for surgical intervention were corneal laceration 143(39.6%), traumatic cataract 99(27.4%), corneo-scleral laceration 34(9.4%), lid ± canalicular laceration 21 (5.8%), intraocular foreign body 16(4.4%), ruptured globe 14(3.9%) and limbal rupture 11(3.1%). A higher proportion of males had corneal laceration 104(40.8%, p=0.40), intraocular foreign body 13(5.1%, p=0.25) and ruptured globe 12(4.7%, p=0.17) while a higher proportion of females had traumatic cataract 35(33%, p=0.14), lid laceration 4(3.8%, p=0.76) and scleral laceration 2(2.8%, p=0.33). The observed differences were however not statistically significant. Of 21 participants who had lid injuries 14(66.7%) were aged ≤5years. Of 14 participants who had ruptured globe, 8(57.1%) were aged 11-17years. We observed that a male child is twice more likely to have an ophthalmic surgery due to trauma.

Pattern of Ocular and Adnexal Injuries Requiring Surgical Intervention among Children in a Tertiary Center in North-Central Nigeria: A 14 Year Review

The study assessed the pattern of ocular and adnexal injuries that required surgical intervention among children with the aim of strengthening preventive, curative and promotive eye care services. The ophthalmic surgical database of the facility was retrospectively reviewed to obtain information on children who had surgical intervention due to trauma from 1st January 2004-31st December 2017; these included demographic data; diagnosis, procedure and the type of anaesthesia administered. Epi Info software, version 3.4 was used for analysis. A total of 361 children (aged &lt;18years) underwent a surgical procedure as a result of ocular trauma within the stated period. There were more males 255(70.6%) than females 106(29.4%) with a male:female ratio of 2.4:1. The mean age was 7.7±3.5years, 356(98.6%) participants had general anaesthesia administered, 267(73.9%) were aged ≤10 years. The main indications for surgical intervention were corneal laceration 143(39.6%), traumatic cataract 99(27.4%), corneo-scleral laceration 34(9.4%), lid ± canalicular laceration 21 (5.8%), intraocular foreign body 16(4.4%), ruptured globe 14(3.9%) and limbal rupture 11(3.1%). A higher proportion of males had corneal laceration 104(40.8%, p=0.40), intraocular foreign body 13(5.1%, p=0.25) and ruptured globe 12(4.7%, p=0.17) while a higher proportion of females had traumatic cataract 35(33%, p=0.14), lid laceration 4(3.8%, p=0.76) and scleral laceration 2(2.8%, p=0.33). The observed differences were however not statistically significant. Of 21 participants who had lid injuries 14(66.7%) were aged ≤5years. Of 14 participants who had ruptured globe, 8(57.1%) were aged 11-17years. We observed that a male child is twice more likely to have an ophthalmic surgery due to trauma.

RISK FACTORS, TREATMENT STRATEGIES, AND OUTCOMES OF ENDOPHTHALMITIS ASSOCIATED WITH SEVERE FUNGAL KERATITIS.

To investigate risk factors, treatment strategies, and outcomes of endophthalmitis associated with severe fungal keratitis. Data from 392 patients diagnosed with fungal keratitis were retrospectively examined. Patients had severe disease that was refractory to topical or systemic antifungal therapy, and the infection involved the endothelium or perforated the cornea. The incidence and risk factors for endophthalmitis, and treatment outcomes were evaluated. Thirty-seven of 392 patients (9.4%) had endophthalmitis. Multivariate logistic regression revealed the following risk factors for endophthalmitis: topical steroid use (odds ratio [OR] = 6.35, 95% confidence interval [CI]: 2.01-20.08), previous corneal laceration suturing (OR = 5.05, 95% CI: 1.11-22.93), large corneal ulcer size (≥10-mm diameter; OR = 4.43, 95% CI: 1.71-11.50), hypopyon (OR = 11.05, 95% CI: 2.12-57.55), and aphakia (OR = 15.45, 95% CI: 1.59-149.82). Thirty of the 37 eyes (81.1%) with endophthalmitis were saved by penetrating keratoplasty, vitrectomy, or intravitreal antifungal injection; 7 eyes (18.9%) were eviscerated. Most patients with endophthalmitis secondary to corneal fungal infection were successfully managed by penetrating keratoplasty, vitrectomy, or intravitreal antifungal therapy. Multiple risk factors for endophthalmitis were identified. Timely diagnosis and risk factor assessment were essential for ensuring early surgical intervention for fungal keratitis-related endophthalmitis.

Is specialized ophthalmologic evaluation necessary after orbital fractures? A prospective 64-case study.

The objective of this study was to determine whether there is a need for ophthalmologists to perform a specialized assessment after the occurrence of orbital fractures. Sixty-three patients (64 orbits) diagnosed with orbital fractures were evaluated preoperatively (up to 24h after the trauma) and in 90-day postoperative period. Eight injuries required either specialized clinical or surgical ophthalmologic intervention. Of these patients, four required emergency eye surgery: two patients with corneal lacerations had lesions larger than 2mm. Two patients had extensive ocular lesions after multiple traumas with uveal exposure and without light perception. Another four patients (iridodialysis associated with lens subluxation, anterior uveitis, direct lesion on the optic nerve, and chorioretinitis sclopetaria) received conservative management. This study concluded that a specialized ophthalmologic examination as soon as possible is important, particularly in cases in which the signs and symptoms of severity are associated. The non-ophthalmologist surgeon must have the basic medical knowledge required to provide basic primary ophthalmologic care and to discern the severity of the injury.

Crab cuticle membrane application for treatment of corneal lamellar laceration in rats: a preliminary study

Corneal lamellar laceration defined as a partial thickness injury to the cornea that may affect vision in various degree. Prompt management is needed to maintain integrity of the cornea and to avoid possible complications resulting from the injury. Material such as amniotic membrane had been widely use to promote reepithelization after corneal injury. Result from previous studies revealed that chitin, the most abundant substance in the cuticle layer of crab shell, is contribute to reepithelization after injury. Crab cuticle membrane preparation were made similar to amniotic membrane that is widely use in the management of corneal injury, therefore chitin might be sought as alternative material in the management of corneal injury which promote reepithelization. This study aimed to assess corneal epithelial proliferation profile and the number of keratocyte in rats after corneal lamellar laceration injury with and without application of crab cuticle membrane. Rats with corneal lamellar laceration injury were divided into groups treated with and without crab cuticle membrane application. Eyes were enucleated on the first and third days after treatment. Histologic preparations were made to assess corneal epithelial proliferation process and number of keratocyte in all groups. Cellular migration of more than 50 % were found in 66.7% of samples on 1 day after treatment and 61.1% of samples on the third days after treatment with crab cuticle membrane. The average number of keratocyte were 33.89 ± 5.27 cells/LPF on 1 day after treatment and 46.22 ± 9.55 cells/LPF on the third days after treatment with crab cuticle membrane. Epithelial proliferation after corneal lamellar laceration in rats treated with crab cuticle membrane application is faster and the number of keratocyte is more abundant compared to treatment without the application of crab cuticle membrane.

Visual Outcome of Corneal Laceration Repair in a Tertiary Hospital, Southwestern, Nigeria

Visual Outcome of Corneal Laceration Repair in a Tertiary Hospital, Southwestern, Nigeria

Computed Tomography Diagnostic Abilities for Open-Globe Injuries in Pediatric Versus Adult Patients.

The aim of this study was to compare the role of computed tomography (CT) in the diagnosis of open-globe trauma and intraocular foreign body (IOFB) in pediatric and adult age groups. Medical records of cases with open-globe trauma at Inonu University Hospital's Ophthalmology Emergency Service were retrospectively evaluated. Preoperative orbital CT images of the cases obtained at emergency services and their clinical and/or surgical findings were compared in pediatric and adult groups. We included 47 eyes of 47 cases aged 18 years and below (pediatric group) and 85 eyes of 82 cases over 18 years (adult group). The mean ± SD age was 10.80 ± 5.11 years (range, 2-18 years) in the pediatric group and 46.34 ± 19.01 years (range, 19-82 years) in the adult group. Computed tomography images revealed 21.7% of the cases with corneal lacerations, 55.5% with scleral lacerations, and 91.6% with corneoscleral lacerations in the pediatric group, whereas the respective numbers were 48.4%, 66.6%, and 61.9% in the adult group. The detection rates of corneal penetrations and vitreous hemorrhage with CT were significantly lower in the pediatric group than in the adult group (P < 0.05). The CT scans diagnosed 66.6% of the pediatric cases and 90% of the adult cases with an IOFB. Corneal lacerations and IOFBs can be missed, especially in the pediatric group, because the eye is smaller in adults. Pediatric patients with a history of ocular trauma should undergo an examination under general anesthesia followed by surgical exploration if necessary.

Ocular Fireworks Injuries in Eastern Nigeria: A 3-Year Review.

Aim:The aim of this study is to determine the incidence and types of ocular injuries caused by fireworks in patients seen at Guinness Eye Centre Onitsha and their effects on vision.Methods:This was a 3-year retrospective study evaluating case files of patients with ocular fireworks injuries seen at Guinness Eye Centre Onitsha during the Christmas and New Year festivities (2010–2012). Information was extracted into a pro forma and analyzed using Excel, AutoSum, and calculators.Results:Subconjunctival hemorrhage, corneal lacerations, and hyphema were the most common injuries seen. Patients had multiple ocular pathologies, and the left eye was affected in 62.5% of cases. Bystanders accounted for 75% of those with ocular fireworks injuries. All were males. Half of the affected eyes went blind.Conclusion:Fireworks injuries constituted only 5.1%, 0%, and 10% of ocular injuries in 2010, 2011, and 2012, respectively, with devastating consequence of blindness in 50% of affected eyes.

Ocular injuries caused by improvised explosion devices - case series of patients seen in national eye centre, Kaduna Nigeria

Aim: To highlight the pattern of ocular injuries as a result of improvised explosive devises by insurgents in Kaduna metropolis. Background: Ocular trauma is a cause of blindness in approximately half a million people worldwide and many more have suffered partial loss of sight. Trauma is the most important cause of unilateral loss of vision, particularly in developing countries. An improvised explosive device, also known as a roadside bomb, is a homemade bomb constructed and deployed in ways other than in conventional military action. In line with the insurgency in parts of northern Nigeria, there is need to identify the common associated ocular injuries with the view to recommending preventive measures and providing adequate resources to managing the challenges. Methodology: Consecutive patients who presented with bomb blast associated ocular injuries and consented to the study from December 2011 through November 2012 were prospectively followed up. Demographic, clinical and operative data was entered into preformed questionnaire and analyzed with SPSS V16. Results: Seven eyes of five patients (2 bilateral) met the inclusion criteria with a mean age of 20 years (7-29 years), male to female ratio of 1.5: 1. Only one of the seven affected eyes had presenting VA of 6/60, 2 had NPL and 4 HM. Open globe injury was present in 3 eyes (1-ruptured, 2 corneal laceration) and retinal detachment in two eyes. Conclusion: Bomb blast explosion is associated with catastrophic blinding ocular pathology thus the need to providing needed equipment/manpower to contain it and seek lasting solutions to the wave violent insurgency.

Primary versus secondary intraocular lens implantation in traumatic cataract after open-globe injury in pediatric patients

To compare the visual and refractive outcomes and complications of primary and secondary intraocular lens (IOL) implantation after open-globe injury in pediatric patients. Sadguru Netra Chikitsalaya, Madhya Pradesh, India. Retrospective case series. Patients had primary cataract extraction with IOL implantation with globe repair (Group A) or repair followed by secondary IOL implantation (Group B). Preoperative and surgery data, visual outcomes, and postoperative complications were recorded. The study included 139 patients. Thirty (49%) of 61 patients in Group A and 47 (60%) of 78 patients in Group B achieved a corrected distance visual acuity (CDVA) of 20/40 or better. In both groups, a central corneal scar and amblyopia were the main reasons for not achieving a CDVA better than 20/40. The mean spherical equivalent (SE) was 1.81 diopters (D) in Group A and 1.55 D in Group B. Forty patients (66%) in Group A and in 60 patients (77%) in Group B achieved a desirable refractive outcome (SE <2.00 D). A large wound was the greatest risk factor for not obtaining desirable refractive outcomes. Fibrinous uveitis was the most common postoperative complication in both groups. Pupillary optic capture and IOL decentration were significantly more common in Group A than in Group B (P=.02), while strabismus was significantly more common in Group B (P=.04). Both approaches had satisfactory and comparable visual and refractive outcomes. However, primary IOL implantation can be considered in cases with small peripheral corneal lacerations with the goal of providing early visual rehabilitation and avoiding repeat general anesthesia.

Combined Keratoplasty, Pars Plana Vitrectomy, and Flanged Intrascleral Intraocular Lens Fixation to Restore Vision in Complex Eyes With Coexisting Anterior and Posterior Segment Problems.

To restore vision in complex eyes with coexisting anterior and posterior segment problems, combined corneal transplantation (penetrating keratoplasty [PK] or Descemet-stripping automated endothelial keratoplasty [DSAEK]), pars plana vitrectomy (PPV), and/or flanged intrascleral intraocular lens (IOL) fixation, designated vitreocorneal surgery are performed. In this study, we evaluated the usefulness of vitreocorneal surgery for eyes with complex comorbidities. Thirteen consecutive eyes in 13 patients with coexisting corneal pathology (ie, corneal scarring, bullous keratoplasty, corneal laceration) and posterior segment pathology (ie, aphakia without capsular support, retinal detachment, intravitreal foreign body) underwent vitreocorneal surgery. Visual outcomes, intraoperative and postoperative complications, and additional surgery were retrospectively evaluated. Vitreocorneal surgery included PK + PPV + intrascleral IOL fixation (n = 5), PK + PPV (n = 3), PK + intrascleral IOL fixation (n = 1), DSAEK + intrascleral IOL fixation (n = 1), and DSAEK + PPV + intrascleral IOL fixation (n = 3). An intraoperative Eckardt temporary keratoprosthesis use enabled safe PPV. No vitreoretinal/IOL complications occurred. One eye required repeat DSAEK to repair endothelial graft detachment and inversion. In 3 eyes, secondary glaucoma was subsequently treated by glaucoma drainage device implantation through the pars plana. Mean best spectacle-corrected visual acuity (logMAR) improved from 1.8 ± 0.9 preoperatively to 1.1 ± 0.6 at 11.2 ± 14.6 months postoperatively (P = 0.002). Postoperative refraction was -0.68 ± 2.56 D (spherical equivalent). PK or DSAEK with PPV and/or flanged intrascleral IOL fixation is useful for complex eyes with coexisting anterior and posterior segment problems.

Einseitige kombinierte Augenmuskeloperation zur Korrektur der Esotropie

The aim of strabismus surgery to correct esotropia is orthotropic alignment or microstrabismus to achieve best possible binocularity, alarger visual field, better appearance, and a frequently connected improved self-esteem. Awidely used technique to correct esotropia is combined unilateral strabismus surgery with recession of the medial rectus muscle and plication of the lateral rectus muscle. Indications are esotropia of various origins or decompensating esophoria over 15prism diopters. Absolute contraindications are insufficient optical correction of hyperopia and sixth nerve palsy with unfinished spontaneous regeneration. Arelative contraindication in children is untreated amblyopia. The technique consists of unilateral recession of the medial rectus muscle and tucking of the lateral rectus muscle. The surgical technique is demonstrated in detail in two videos of the operation, which are available online. Antibiotic and lubricating eye drops are applied during the first week after surgery. In the early postoperative period, patients should be monitored for postoperative infection, conjunctival dehiscence, or corneal laceration. We review patients 4months postoperatively for evaluation of the long-term result. Recent randomized controlled studies have shown that unilateral medial rectus muscle recession and resection surgery is comparable to bilateral recession surgery with regards to postoperative results in esotropia. The effect of lateral rectus muscle tuck is comparable to muscle resection with less trauma and potential reversibility during the first days after surgery.

Primary Combined Pars Plana Vitrectomy and Phacoemulsification With Anterior Segment Removal of Posterior Segment Intraocular Foreign Bodies: A 30-Month Longitudinal Study

Purpose: To describe a surgical technique and report visual and anatomical outcomes after primary combined pars plana vitrectomy (PPV) and phacoemulsification in patients with posterior segment intraocular foreign bodies (IOFBs) removed via the anterior chamber without enlarging preexisting sclerotomies. Posterior IOFBs are generally managed in a stepwise surgery consisting of phacoemulsification/lensectomy for traumatic cataract removal then PPV and removal of IOFB through enlarged sclerotomies. Enlarged sclerotomies may carry a significant risk of hypotony, vitreous hemorrhage, vitreous and retinal incarceration, and rhegmatogenous retinal detachment with proliferative vitreoretinopathy. Limited studies exist on long-term results of primary anterior segment removal of posterior IOFB combined with primary phacoemulsification. Methods: Medical records of consecutive patients who had ocular lacerations and posterior segment IOFB between October 2003 and June 2017 in a university hospital were reviewed. Patients who received a combined primary IOFB removal and phacoemulsification were included in the study. The postoperative evolution including visual acuity and complications were all recorded. Results: Thirteen patients (13 eyes) were included in the study. All patients were men, and the average age at presentation was 38 years. All IOFB were metallic, and their size ranged from 2 to 7 mm. All patients were operated within 24 hours of presentation. Six (46%) of the 13 lacerations were corneal, and 7 (54%) were scleral. Overall, 9 of 13 (69%) had a final postoperative best-corrected visual acuity equal to or better than 20 of 25. There were 3 (23%) postoperative complications of recurrent rhegmatogenous retinal detachment that occurred within the first postoperative year. Conclusion: Primary combined PPV and phacoemulsification with the removal of IOFB via the anterior segment is a safe and promising approach for repairing open globe injuries. Our results demonstrate the favorable prognostic benefit of this technique, which is recommended in cases with small corneal laceration and posterior segment pathology resulting from IOFB.

Quantitative Analysis of Macular Thickness following Open Globe Injury in Subjects with Clear Media and no Retinal Damage.

Purpose:To evaluate the change in macular thickness after open globe injury (OGI) in patients with clear media and without retinal damage using optical coherence tomography (OCT).Methods:In this longitudinal observational pilot study, 17 patients with clear media and without retinal damage who underwent repair of OGI for corneal, corneoscleral, or scleral laceration were studied. In addition to routine follow-up, all patients were examined at the first and third postoperative months and best corrected visual acuity (BCVA), slit-lamp examination, applanation tonometry, dilated fundus examinations, and macular OCT scans were documented.Results:In all patients, no signs of macular edema, macular thickening, cystic changes, or other signs of cystoid macular edema were present in OCT images and examinations. The Early Treatment Diabetic Retinopathy Study map indicated that there were no significant differences in macular thickness between the first and third months in all patients (P > 0.05). There was no significant relationship between macular thickness and uveal or vitreous prolapse and the size or site of laceration (P > 0.05). BCVA in the first and third months also showed no significant change (P > 0.05). There were no cases of intraocular pressure increase in any of the patients.Conclusion:Macular thickness had no significant change following OGI repair in eyes with clear media and without retinal damage; thus, it seems that OGI of this extent and its surgical repair have no effect on macular thickness.