Corneoscleral Wound Research Articles

Современные методы профилактики пролиферативной витреоретинопатии при обширных проникающих ранениях склеры

Relevance. Currently, there is no single algorithm for the management of patients with extensive penetrating wounds of the sclera, and the frequency of proliferative vitreoretinopathy, leading to adverse outcomes, is very high. Purpose. To present relevant data about prevention of proliferative vitreoretinopathy with extensive penetrating wounds of the sclera, as well as to identify the most effective methods. Material and methods. To complete this review, a literature search was carried out on the databases CyberLeninka, eLIBRARY, PubMed, using the keywords «proliferative vitreoretinopathy», «penetrating wounds of the sclera», «eye injury», «vitrectomy». Preference was given to scientific papers over the past 15 years. Results. There are various approaches in the treatment of severe penetrating wounds. Classical primary microsurgical treatment involves external treatment, suturing of the sclera wound, and delayed optical-reconstructive surgery (including vitrectomy) are performed 1–2 weeks after the acute inflammation reduces. As a rule, in the case of extensive wounds with a whole set of concomitant risk factors, this time is sufficient to trigger pathological proliferation, which aggravates the course of the wound process. This review presents publications proving that the treatment of severe complicated penetrating wounds of the sclera should go beyond the classical treatment and be aimed at early warning and prevention of proliferative vitreoretinopathy. Conclusion. Modern data prove the indisputable advantage of early vitrectomy performed with extensive penetrating scleral and corneoscleral wounds. Vitrectomy in combination with other methods of prevention of proliferative vitreoretinopathy is the most promising direction for the future research. Key words: proliferative vitreoretinopathy, penetrating wounds of the sclera, eye injury, vitrectomy

Assessment of refractive outcomes in eyes that underwent intraocular lens implantation in the posterior chamber but not "in-the-capsular bag:" A comparative retrospective study.

The purpose of this study was to report visual and refractive outcomes in eyes that underwent intraocular lens (IOL) fixation in the absence of capsular support. This was a retrospective chart review of cases undergoing posterior chamber iris-fixated IOL (IFIOL) and scleral-fixated IOL (SFIOL) implants from June 2014 to March 2020 with more than 3 months of follow-up and having a preoperative best-corrected visual acuity of 20/80 and more. Records of 120 eyes of 112 patients were reviewed. The mean age of the patients was 46.9 ± 22.3 (14.4-98.0) years, and 62% (n = 70) of participants were male. Most of the eyes (102: 85%) were aphakic at the time of surgery. The mean follow-up was 22.95 ± 17.1 months. The efficacy index of sutured IFIOL and glued SFIOL outperformed sutured SFIOL at 3 months and final visits postoperatively (P < 0.001). All techniques studied here resulted in a similar safety index at 3 months (P = 0.4). The mean predictive error (postoperative spherical equivalent refraction minus intended target refraction) was +0.07 ± 1.5 D and -0.12 ± 1.4 D at 3 months and the final postoperative visit, respectively. The studied techniques have relatively good visual and refractive outcomes in this series. In addition, techniques involving a small corneal incision with foldable IOL fixation to the iris or scleral tissue have superior efficacy and safety indices compared to creating large corneoscleral wounds for rigid IOL fixation techniques.

Management of scleral tears with concurrent intraocular foreign bodies and factors affecting outcomes.

To report the clinical settings and factors predicting outcomes in scleral tears with concurrent retained intraocular foreign bodies METHODS: All cases with scleral and corneoscleral wounds with retained intraocular foreign bodies (RIOFB) from January 2014 to January 2021 were retrospectively analysed. Favourable anatomic outcome was defined as presence of globe integrity, attached retina, absence of hypotony and active inflammation at last visit. Favourable functional outcome was defined as final visual acuity (VA) > 20/200. Total 139 eyes were included. Mean age was 30.66 ± 13.32 years (median 29 years, IQR 17). Penetrating trauma accounted for 87.1%, rupture for 5.8%, perforation for 7.2%. In 5.8% of the eyes the injury involved zone I extending till Zone II while in 66.9% it involved Zone II and in 27.3% in Zone III. Snellen visual acuity at presentation was logMAR 2.97 ± 1.01 and at last visit was logMAR 2.38 ± 1.45 (p < 0.0001). Time between presentation and repair was 13.93 ± 19.56 h (median 7.6 h, IQR 17.17). Favourable functional outcome was seen in 34.5% eyes and 2/3rd achieved favourable anatomic outcome. Absence of endophthalmitis (OR = 6.25, p = 0.003) and ability to remove the foreign body (OR = 7.05, p = 0.003) were associated with a favourable anatomic outcome. Better presenting Snellen visual acuity (OR = 2.77, p = 0.003), manifest scleral tear (OR = 3.36, p = 0.04), and absence of endophthalmitis (OR = 50, p = 0.0009) were associated with a favourable functional outcome. A third of the cases achieved favourable visual outcome while 2/3rd achieved favourable anatomic outcome. Absence of endophthalmitis is an important factor predicting both.

Method of Extended Primary Microsurgical Treatment of Extensive Penetrating Scleral Wounds

Purpose: to expand and modernize the technology of primary microsurgical treatment of extensive scleral wounds due to simultaneous subtotal vitrectomy, primary treatment of retinal and choroid wounds, filling of tissue defects with autologous conditioned plasma (ACP), tamponade with silicone oil or C3F8 gas.Methods. 15 patients (15 eyes) with extensive penetrating scleral and corneoscleral wounds ranging from 8 to 15 mm in length, with concomitant complex injuries of various structures of the eye: traumatic cataract, wound of the ciliary body, injury or loss of the iris, subtotal/total hemophthalmos, retinal detachment were monitored. All patients underwent primary surgery according to the original extended technique.Results. The functional results of surgical treatment in patients, taking into account the severity of the injury, were high: in the early postoperative period, 1 month after primary surgery, visual acuity with correction ranged from 0.02 to 0.5. Signs of proliferative vitreoretinopathy were not observed in any case.Conclusion. The proposed method of extended primary microsurgical treatment for extensive penetrating scleral and corneoscleral wounds with severe concomitant damage to intraocular structures is effective and has a number of advantages: early prevention of severe complications in the form of proliferative vitreoretinopathy, shortening the rehabilitation period. The method allows to achieve high functional results in the most severe cases of penetrating eye injury.

Clinical Presentations, Management, and Factors Affecting Outcomes in Posterior Segment Open Globe Injuries: An Analysis of 2,360 Eyes

Introduction: The aim of the study was to report the clinical presentations, management, and factors affecting the outcomes of posterior segment open globe injuries in 2,360 consecutive eyes. Methods: This was a retrospective, consecutive, non-comparative interventional case series. All cases with scleral and corneoscleral wounds presenting to these centers from January 2014 to January 2021 were included. The cases were defined according to the Birmingham Eye Traumatology Terminology system (BETTs) classification. The Ocular Trauma Score (OTS) was applied to the dataset. Results: Mean age of presentation was 36.63 ± 19.92 years (median 35 years). Penetrating trauma accounted for 70.92%, rupture for 18.6%, perforation for 4.60%, and IOFB in 5.88% eyes. In 76.60%, the location of injury involved zone 1 extending till zone 2, while in 23.40% it involved zone 2 and/or zone 3. Vision at presentation was logMAR 3.03 ± 0.99 and at the last visit was logMAR 2.47 ± 1.42 (p < 0.0001). Time interval between presentation to the treatment center and globe repair was 13.93 ± 19.56 h (median 7.60 h). Favorable functional outcomes were seen in 29.20% eyes and favorable anatomic outcomes in 66.90%. Decreasing age at presentation, penetrating injury instead of rupture or perforating injury, a higher OTS, absence of corneal involvement, absence of retinal detachment at presentation, and absence of concurrent orbital fracture were associated with a favorable functional outcome (>20/200). Final visual acuity in logMAR correlated with the OTS value calculated at presentation. Conclusions: In the absence of retinal detachment and orbital fracture, posterior open globe injuries typically have a favorable functional outcome. OTS correlated with the final visual acuity.

Traumatic pseudophacocele: A case report with review of literature

A elderly male presented with painful loss of vision in the left eye for 20 days with expulsion of intra-ocular content following a blunt trauma. The best corrected visual acuity was counting fingers close to face (CF-CF). Slit lamp examination revealed ciliary tissue prolapse with gaping of incision scar along with a posterior synechia, iris pigments, vitreous in Anterior chamber, cells and flare. Patients presented aphakic and had the extruded rigid PMMA IOL with a broken haptic with him. Fundoscopic examination and B scan imaging were suggestive of vitreous haemorrhage. Pseudophacocele happens following blunt trauma leading to dehiscence of the corneo-scleral wound scar. Subconjunctival dislocation is the most common type, however sub-choroidal dislocation has also been seen. Our case is an extreme one where the IOL is completely extruded from the eye.An early diagnosis can help prevent serious infective complications and have good visual outcomes.

International Globe and Adnexal Trauma Epidemiology Study (IGATES): Visual outcomes in open globe injuries in rural West India.

To evaluate the factors influencing final visual outcome after surgical repair of open globe injuries (OGIs) in a rural population using the International Globe and Adnexal Trauma Epidemiology Study (IGATES) online registry. Retrospective cohort study of patients with OGI. OGIs were identified from the IGATES database at a tertiary referral eye care centre in rural West India over a period of 12 years. Patient demographics, clinical and pre-operative factors affecting final visual outcome was evaluated. A total of 791 eyes with OGIs were included in data analysis. 11 eyes that were lost to follow-up and 12 eyes with incomplete data were excluded. Most of the patients were male (559, 70.6%) and mean age of all patients was 23.9 years ± 19.4 years. Occupational hazards (including domestic housework) (307, 38.8%) and leisure play (324, 41.0%) were the leading causes of OGI. The most common mechanism of injury was being struck by a wooden stick (250, 31.6%). Univariate analysis of pre-operative variables showed initial visual acuity (VA), zone of injury, size of wound, structures involved in the injury and presence of infection were significant prognostic factors for worse final visual outcome (p < 0.001). Multivariate analysis showed VA ≤ 3/60 or worse at presentation had statistically significantly higher odds ratio of ending up with worse visual outcomes (p < 0.012). Males in working age groups suffer from OGIs more frequently, usually from agricultural and pastoral activities. Initial VA, zone 3 injuries, corneoscleral wound, large wound size and presence of post-traumatic infections are significant prognostic factors.

Open-globe wounds in operation Iraqi Freedom and Operation Enduring Freedom: risk factors for poor visual outcomes and enucleation.

To determine the rates and types of open-globe wounds in soldiers admitted to Walter Reed Army Medical Center from 2001 to 2011 after sustaining combat injuries. Data were collected in the Walter Reed Ocular Trauma Database. Inclusion criteria were patients who suffered open-globe injuries. Open-globe injuries were classified by type of wound: corneal, corneo-scleral or scleral, or type of open-globe injury: perforating, rupture, penetrating or intraocular foreign body. The primary analysis assessed the effect on final visual acuity (VA) and the risk of enucleation. In this study, 285 (32.02%) open-globe injuries were recorded in 890 eyes in the data set. Corneal wounds were noted in 127 (44.56%) eyes, corneo-scleral wounds in 78 (27.37%) and scleral wounds in 129 (45.26%) eyes. The involvement of both the corneal and sclera was associated with poorer visual outcome (BCVA < 20/200) compared to injuries with an injury confined to either the cornea or scleral alone (p = 0.038). At a wound length of greater than approximately 14 mm, patients had 75% chance of having a poor final VA. Enucleation was performed in 64 (22.46%) eyes of patients with wounds. The type of wound was not found to be predictive of enucleation in multivariate analysis, but rather the type of open-globe injury was predictive. Perforating (OR: 1.58, 95% CI: 1.43-1.72) and globe rupture injuries (OR: 1.49, 95% CI: 1.33-1.66) were more likely to undergo enucleation. Open-globe injuries occur frequently in combat ocular trauma. Poor final VA was noted most with corneo-scleral wounds with approximately 50% of patients having a final VA less than 20/200.

Analysis on correlative factors of sympathetic ophthalmia after ocular trauma

Objective To analyse the correlative factors of sympathetic ophthalmia after ocular trauma. Methods The statistical data about 20 eyes of 20 cases of sympathetic ophthalmia secondary to ocular trauma were studied and the related factors were analyzed. Results The corneoscleral wound leading to sympathetic ophthalmia accounted for the highest proportion of 75.00%. The patients were aged 7-56 years old and patients aged 7-12 years accounted for 50.00%. The sex ratio of male versus female was 3∶1. Conclusion The corneal limbus wound is in the majority among patients with sympathetic ophthalmia secondary to ocular trauma .The ocular trauma in children should be paid more attention to because of its particularity. Key words: Sympathetic ophthalmia, ocular trauma; Analysis, correlative factors

Penetrating ocular trauma associated with blank cartridge

BackgroundBlank cartridge guns are generally regarded as being harmless and relative safe. However recent published articles demonstrated that the gas pressure from the exploding propellant of blank cartridge is powerful enough to penetrate the thoracic wall, abdominal muscle, small intestine and the skull. And there has been a limited number of case reports of ocular trauma associated with blank cartridge injury. In addition, no report on case with split extraocular muscle injury with traumatic cataract and penetrating corneoscleral wound associated with blank cartridge has been previously documented. This report describes the case of patient who sustained penetrating ocular injury with extraocular muscle injury by a close-distance blank cartridge that required surgical intervention.Case presentationA 20-year-old man sustained a penetrating globe injury in the right eye while cleaning a blank cartridge pistol. His uncorrected visual acuity at presentation was hand motion and he had a flame burn of his right upper and lower lid with multiple missile wounds. On slit-lamp examination, there was a 12-mm laceration of conjunctiva along the 9 o'clock position with two pinhole-like penetrating injuries of cornea and sclera. There was also a 3-mm corneal laceration between 9 o'clock and 12 o'clock and the exposed lateral rectus muscle was split. Severe Descemet's membrane folding with stromal edema was observed, and numerous yellow, powder-like foreign bodies were impacted in the cornea. Layered anterior chamber bleeding with traumatic cataract was also noted. Transverse view of ultrasonography showed hyperechoic foreign bodies with mild reduplication echoes and shadowing. However, a computed tomographic scan using thin section did not reveal a radiopaque foreign body within the right globe.ConclusionTo our best knowledge, this is the first case report of split extraocular muscle injury with traumatic cataract and penetrating ocular injury caused by blank cartridge injury. Intraocular foreign bodies undetectable by CT were identified by B-scan ultrasonography in our patient. This case highlights the importance of additional ultrasonography when evaluating severe ocular trauma. And ophthalmologists should consider the possibility of penetrating injury caused by blank ammunition.

Implants à fixation sclérale sans suture : série de neuf cas et revue de la littérature

To report the results of a technique of sutureless intrascleral fixation of a three-piece foldable hydrophobic acrylic posterior chamber intraocular lens (PC IOL) in the absence of capsular support and to compare our results to those reported in the literature. We report a single-center (Limoges University Medical Center) retrospective series of nine patients with deficient posterior capsular support who underwent sutureless sulcus fixation of a hydrophobic acrylic Tecnis Aspheric(®) model ZA9003 (AMO, Inc.) PCIOL using permanent incarceration of the haptics in scleral tunnels parallel to the limbus, between November 2010 and November 2011. All patients were evaluated for surgical indications, pre- and postoperative refractive status (visual acuity and corneal cylinder), and intra- and postoperative complications. We included six men and three women with post-traumatic subluxed IOL's in three cases and lack of iris and capsular support secondary to traumatic corneoscleral wounds in six cases. Mean age was 63.22 ± 18.79 years. Posterior vitrectomy was performed in all cases. Mean 3-month postoperative visual acuity was 0.42 ± 0.16 LogMAR, and mean corneal postoperative astigmatism was 1.39 ± 0.78 diopters. Complications included IOL decentration of 1.5mm in one case, haptic rupture requiring intraoperative IOL exchange in one case, and transitory postoperative macular edema in two cases. Artificial intraocular lens implantation in the absence of capsular support is always a surgical challenge. Currently, the two most widely used approaches include fixation to the iris by suturing or iris claw, and fixation to the sclera with sutures. However, these techniques require wide corneal or scleral incisions resulting in significant postoperative astigmatism. Furthermore, iris fixation is impossible in cases of significant iris trauma, and scleral sutures are often technically difficult and expose the patient to late IOL dislocation or tilt. Sutureless intrascleral fixation of foldable hydrophobic acrylic three-piece IOL's inserted through a conventional sub-2.8mm clear corneal incision is a recent technique. This technique is compatible with cases of iris trauma and allows sutureless fixation of the haptics in scleral tunnels parallel to the limbus, while minimizing the risk of postoperative astigmatism. In addition, it allows the repositioning of IOL's dislocated into the vitreous without re-opening the corneal incision. Complications are mainly related to IOL manipulation and positioning. Results obtained after sutureless intrascleral PCIOL implantation showed good visual outcomes with minimal complications in eyes with deficient capsular support.

Epidemiological pattern of ocular trauma ( retrospective study)

Introduction Worldwide interest in the field of ocular trauma is rapidly growing as increasingly effective techniques for its prevention and treatment are being developed. Ocular trauma is often disabling and involves enormous costs to both the victim and society. Objective The objective of this study was to review the epidemiology of serious ocular trauma in patients presenting at Kasr El Aini Hospital, Cairo University. Design This study is a retrospective epidemiological study. Patients and methods This is a retrospective epidemiological study on ocular trauma patients admitted to Kasr El Aini Hospital during a 1-year period (2008). Patients were analyzed with respect to the following: (a) demographics, (b) time, place, activity during trauma, and cause of trauma, and (c) findings from examination. Results A total of 510 patients (five bilateral injuries) sustaining serious ocular injury, requiring hospitalization, were included during the study period. Sixty-five percent of ocular trauma occurred in men with an average age of 23 years. There were 415 (81.3%) open-globe injuries and 95 (18.7%) closed-globe injuries. Of patients with open-globe injuries, 40% had a corneal wound, 6.6% had a limbal wound, 24% had a scleral wound, 27.8% had a corneoscleral wound, 37% had iris prolapse, 20.5% had traumatic hyphema, 29.4% had traumatic cataract, and 9.8% had an intraocular foreign body. Conclusion The majority of ocular trauma cases in our population was due to violence-related injuries, occurring mainly in male patients.

Predictive factors and outcomes for posterior segment intraocular foreign bodies

Sir, We read with interest the article on ‘Predictive factors and outcomes of posterior segment intraocular foreign bodies' by Choovuthayakorn et al.1 In the results section, 4 (4.76%) of the 84 eyes with intraocular foreign bodies (IOFB) underwent primary enucleation. Given the trend to avoid primary enucleation following trauma, it would have been helpful if the authors had described the indications for primary enucleation in these eyes and why enucleation was preferred over evisceration. One of the key conclusions drawn, and perhaps the most controversial, is that good outcome can be achieved even if there is delay in removal of IOFB. The incidence of endophthalmitis reported by the authors in this series was 9.1% that, though comparable with the literature, was still quite high. In another case series of 1421 eyes with IOFB by Zhang et al,2 the reported rate of endophthalmitis was much higher at 16.76%, pointing possibly to the influence of IOFB presence. The two referenced papers3, 4 citing low-risk or no risk of endophthalmitis with delayed removal of IOFB were in the context of war injuries, whereby high-velocity explosives and the heat generated before impact could potentially partially account for the relatively lower incidence of endophthalmitis. Furthermore, there was no mention about the use of intravitreal antibiotics in this case series, which has a major role in prevention and treatment of post traumatic endophthalmitis.5 In conclusion, we are concerned that the article may create the impression that delayed removal of IOFB can achieve good visual outcome by giving systemic antibiotics and prompt primary repair. On the contrary, especially if there is presence of a vegetative foreign body, prompt wound closure with simultaneous removal of IOFB with systemic and intravitreal antibiotics should be the preferred practice pattern for most ophthalmologists.5 Second sitting removal of IOFB should be considered only in patients with significantly large corneoscleral wounds that may leak during vitrectomy and in cases with associated retinal detachment requiring complex vitreoretinal surgery.5

The application of bimanual irrigation-asiration system in treatment of adolescence traumatic cataract

Objective To observe the clinical results of bimanual irrigation-aspiration(I/A) system in treatment of adolescence traumatic cataract. Methods Eleven adolescence patients( 11 eyes ) were performed traumatic cataract surgery by using bimanual I/A system,including corneal penetrating injuries in 5 eyes,sclera injury in 1 eye,and corneoscleral wounds in 5 eyes. All surgeries were performed 8 - 15 days after primary wound closure surgeries. Postoperatively, we investigated the effects and results of bimanual I/A system used for removing the cortex of lens. Results All cases had undergone successfully surgeries and IOL implantation. Postoperative best corrected visual acuity (BCVA) after 1 month were 0.1 to 1.0, no serious postoperative complication was observed. Conclusions The bimanual I/A system is simple,safe and efficinet technique in treatment of adolescence traumatic cataract,which minimize the risk of intra- and post-operative complications,and lead to favorable visual outcomes. Key words: Traumatic cataract; Irrigation-aspiration system, bimanual; Adolescence; Eye injury

Autogenous lamellar scleral graft in the treatment of scleral melt after pterygium surgery

We report a case series of three patients who developed scleral melting 18-26 months after pterygium removal with beta-irradiation that refused to use any donor tissue. All patients presented with constant pain, redness and foreign body sensation on their eye. Initial evaluation revealed the presence of an area of scleral melt and epithelial defect with an underlying calcific plaque over the necrotic area in the nasal conjunctiva. Fluorescein staining and pooling was present at the base of the defect, indicating epithelial loss, in two patients. No signs of infection were present, and screening for associated systemic risk factors for melting was negative in all cases. The patients refused to use any kind of donor tissue to cover the area of melting. An autogenous lamellar scleral graft harvested from the superotemporal quadrant and an advancement of the nasal tenon was used. The use of autologous sclera and tenon has been described in the treatment of avulsive corneoscleral wounds and corneal fistulas. This case series describes the successful management of scleral melting with autogenous tissues.

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.

Combined topical anesthesia and sedation for open-globe injuries in selected patients

Purpose To evaluate the efficacy and safety of topical anesthesia (TA) and IV sedation in surgery for less severe open-globe injury (OGI). Design Noncomparative consecutive interventional case series. Participants Of 67 OGI cases reviewed at the Department of Ophthalmology and Otolaryngology, University of Bari, Bari, Italy, in the period from 1999 to 2000, 10 eyes (14.9%) of 10 consecutive patients (age range, 6–58 years) were repaired using TA and IV sedation. All patients belonged to the American Society of Anesthesiologists risk class I or II. Nine eyes had corneoscleral wounds, four had vitreous loss, two had traumatic cataract, and three had an intraocular foreign body (IOFB); one patient had interruption of a continuous penetrating keratoplasty suture. Preoperatively, best-corrected visual acuity (BCVA) ranged from hand movement to 20/20. Intervention Corneoscleral suture was performed in nine patients, vitreous excision in four, uveal excision or reposition in four, IOFB removal in three, and cataract extraction in two; corneal button resuture was carried out in one patient. All patients received topical oxybuprocaine hydrochloride 0.4%, and IV propofol, midazolam, and fentanyl for anesthesia. Main outcome measures The change in BCVA was evaluated. Within 24 hours after surgery, each patient was asked to grade subjective pain and discomfort on a 4-point scale. The surgeon was asked to report difficulties attributable to the operating conditions. Complications related to anesthesia and to surgery were assessed. Results Best-corrected visual acuity stabilized or improved in all patients. All patients had grade 1 pain and discomfort during most of the procedure. All patients had grade 2 (mild) pain and discomfort during external bipolar cautery and conjunctival closure. No patient required additional anesthesia. The operating conditions as reported by the surgeons were graded slightly difficult in all cases but one, which was graded moderately difficult. No patient had surgical or anesthesia-related adverse events or life-threatening complications. Conclusions Topical anesthesia and IV sedation are safe and effective and could be a reasonable alternative for less severe OGI. The degree of patient discomfort is only marginal during surgery and postoperatively. However, surgical training and patient preparation are the keys to the safe use of this anesthetic modality.

Phacoemulsification and thermal wound injury

The technique of lens nucleus phacoemulsification has revolutionized cataract surgery. However, the production of ultrasound energy is associated with heat generation that can result in damage to ocular tissue, in particular the corneoscleral wound site. Thermal damage to the corneoscleral wound site may result in difficulty with wound closure and consequent risk of wound leakage, as well as damage to the adjacent corneal stroma and endothelium, fistula formation, and the induction of high degrees of post-operative astigmatism. The loss of adequate flow of irrigation fluid around the phacoemulsification tip is the key factor in the development of phacoemulsification-induced thermal injury. Use of excessive ultrasound power and production of excessive frictional forces generated by contact of the vibrating phacoemulsification needle with the irrigation sleeve are also factors involved. In the event of a “phacoburn,” a specialized “gape suture” may help minimize surgically-induced astigmatism. The degree of induced astigmatism tends to wane over time; astigmatic keratotomy is an option in the setting of high degrees of residual astigmatism.

Phacoemulsification and thermal wound injury

The technique of lens nucleus phacoemulsification has revolutionized cataract surgery. However, the production of ultrasound energy is associated with heat generation that can result in damage to ocular tissue, in particular the corneoscleral wound site. Thermal damage to the corneoscleral wound site may result in difficulty with wound closure and consequent risk of wound leakage, as well as damage to the adjacent corneal stroma and endothelium, fistula formation, and the induction of high degrees of post-operative astigmatism. The loss of adequate flow of irrigation fluid around the phacoemulsification tip is the key factor in the development of phacoemulsification-induced thermal injury. Use of excessive ultrasound power and production of excessive frictional forces generated by contact of the vibrating phacoemulsification needle with the irrigation sleeve are also factors involved. In the event of a “phacoburn,” a specialized “gape suture” may help minimize surgically-induced astigmatism. The degree of induced astigmatism tends to wane over time; astigmatic keratotomy is an option in the setting of high degrees of residual astigmatism.

Topography-guided excimer laser ablation of irregular cornea resulting from penetrating injury

A 26-year-old woman with irregular astigmatism caused by ocular perforation became aphakic in the injured left eye 2 years after the initial trauma. The initial corneoscleral wound repair was performed without intraocular lens implantation. The patient’s uncorrected visual acuity in the right eye was 20/20 and in the left eye, counting fingers at 50 cm. The vision in the left eye could not be corrected with a spectacle because of high corneal astigmatism so a rigid gas-permeable contact lens was tried. With a contact lens, the acuity improved to 20/80; however, the patient could not wear the lens because of intolerance and severe astigmatism. As an alternative, topography-guided ablation was performed to correct the corneal astigmatism. Treatment of the irregular central cornea reduced the astigmatism. Three months postoperatively, the corrected visual acuity was 20/20 with a refraction of +8.00 −1.50 × 26. This case indicates that topography-guided ablation can be a useful surgical method for correcting surgically induced irregular astigmatism.