History Of Eye Trauma Research Articles

Scleral buckling in retinal detachment due to retinal dialysis - A vitreoretina fellow's perspective.

To analyze the efficacy of scleral buckling in the hands of vitreo-retina (VR) fellows under training in eyes with retinal detachment associated with retinal dialysis and analyze the patient and retinal characteristics in these eyes. We carried out a retrospective consecutive case review at a tertiary eye care center in North India. Records of all the patients who had undergone scleral buckling (SB) for retinal dialysis-associated rhegmatogenous retinal detachment by VR fellows (with less than 2 years' experience) between January 2017 and January 2020 were reviewed. Fifty-three eyes of 53 patients with a mean age of 20.77 years were analyzed. Of the patients, 73.58% were males. History of eye trauma was present in 71.69% patients. A total of 21 residents operated these 53 eyes. SB was able to achieve retinal attachment in a single surgery in 84.9% (45/53) eyes. Mean preoperative best corrected visual acuity was 1.9 ± 1.05 log of minimum angle of resolution (logMAR), which improved postoperatively to 1.07 ± 0.72 logMAR (P < 0.001). Surgical success rate was 85.71% (24/28) in eyes with no proliferative vitreoretinopathy (PVR), 66.66% (2/3) in eyes with PVR-A, 91.66% (11/12) in eyes with PVR-B, and 80% (8/10) in eyes with PVR-C1. Fifty-two eyes had a single dialysis and one eye had two separate dialysis. Six eyes had giant retinal dialysis (dialysis greater than 3 clock hours) and all were due to trauma. Five patients had retinal dialysis in the fellow eye and were diagnosed with bilateral idiopathic retinal dialysis. Scleral buckling is a safe and effective management for retinal dialysis retinal detachment even in the hands of VR fellows under training.

Spontaneous Ocular Haemorrhage

Introduction : Hemorrhagic complications are one of the major complications encountered with reperfusion therapies but rarely involve the ocular, especially hyphema.&#x0D; Case Illustration : a 61-year-old woman presented with blurred vision, discomfort, and red eye in her right eye. She had been treated for hypertension, diabetes mellitus, and coronary artery disease with antiplatelet and other oral medication for 5 years. There was no history of eye trauma or Valsalva-like maneuver effort. The best corrected visual acuity was 20/40 in both eyes and there was no relative afferent pupillary defect. Both eyes had normal IOP. A slit lamp examination revealed pool blood in the anterior chamber as hyphema grade 1. Fundus examination showed dot and blot hemorrhage with cupping discs 0.6 and 0.7. USG examination showed no mass and clear vitreous. The antiplatelet was stopped and evaluated by the internal department. The patient was observed and treated with topical medication, and the hyphema resolved within less than 7 days.&#x0D; Discussion : Although it is still not clear if there is any increase in intraocular bleeding has been recognized with antiplatelet agents, the concern would be greatest amongst those at high baseline risk due to predisposing conditions, such as elderly with diabetes, hypertension, and usage of antiplatelet agents to maintain cardiovascular disease.&#x0D; Conclusion : This case emphasizes that though the most common cause of hyphema is a traumatic injury, it can be a rare complication of antiplatelet therapy. Patients on antiplatelet therapy should be carefully monitored for ocular bleeding, especially if they have associated systemic or ocular comorbidity.

Combination Therapy of Amniotic Membrane Transplantation with Conjunctival Peritomy and Autologous Serum for Mooren's Ulcer: A Case Report

Introduction : A case report of a patient with Mooren’s ulcer who received partial amniotic membrane transplantation and autologous serum eye drops.&#x0D; Case Illustration : A 44-year-old male patient presented with chief complaint of blurred vision, pain in left eye, and history of eye trauma 6 months prior. Empirical topical antibiotics didn’t improve his condition. VA of left eye was hand movement with good colour/light perception. We diagnosed the patient with marginal ulcer. Partial amniotic membrane transplantation with conjunctival peritomy was planned for this patient along with fortified antibiotic eye drops. Autologous serum eye drops were started at 2 weeks post-surgery. 2 months after surgery, his condition has significantly improved with visual acuity of 6/12 (Snellen), healed corneal defect, and subjective relief of symptoms.&#x0D; Discussion : Mooren’s ulcer is a severe ulcerative inflammation of the cornea with unclear exact pathogenesis. Many therapies of Mooren’s ulcer are recommended in literatures, including surgical and non- surgical treatment. It was reported that amniotic membrane transplantation and conjunctival peritomy may be chosen as alternative surgical procedure for Mooren’s ulcer, as peritomy displaces the source of inflammation away from the cornea and amniotic membrane helps in corneal reepithelialization. Autologous serum is considered as an effective adjuvant therapy for ocular surface diseases such as dry eye disease, cicatricial pemphigoid, Steven-Johnson syndrome, and Mooren’s ulcer—thus the decision to include the therapy in our regiment.&#x0D; Conclusion : The combination of amniotic membrane transplantation, conjunctival peritomy, and autologous serum may help in the overall improvement of patients with Mooren’s ulcer.

Post-Traumatic Cilia Remaining Inert in the Posterior Chamber for 50 Years.

Intraocular foreign body injuries (IOFB) can lead to a number of intraocular pathologies; the visual results depend on the mechanism of the injury, the type of foreign body and the subsequent complications. The presence of intraocular cilia (eye lashes) following penetrating injury or surgical intervention is uncommon. In the present paper, we present a case of a 58-year-old woman with a history of eye trauma and a perforated corneal wound in the left eye that occurred 50 years ago. On the ophthalmological exam we noticed in the anterior chamber a straight linear extension, resembling cilia, extending behind the iris. The patient reports that it appeared during COVID-19 infection, after repeated episodes of coughing. After a follow-up period, we decided to remove the eyelash; 24 h after surgery, the patient complained of severe eye pain. Intraocular pressure (IOP) in LE was 54 mmHg. The slit-lamp examination showed perikeratic congestion, corneal edema and mydriasis. Eye hypotensive treatment was started immediately and the patient's general condition slightly improved. Intraocular cilia can be tolerated for many years without causing any ocular reaction. The decision for surgical intervention must be taken according to the individual needs of the patient and his ocular characteristics with careful pre- and post-operative follow up.

Visual outcome and complications after sutureless scleral fixation intraocular lens implantation

Context:In case of weak, inadequate, or total absence of posterior capsule following trauma or surgical complication, a sutureless scleral fixation (SFIOL) technique has been studied to secure good vision with minimal postoperative complications. It remains as a good alternative against anterior chamber intraocular lens (ACIOL), iris claw lens, and sutured scleral fixated intraocular lens.Aims:Visual outcomes after SFIOL implantation. Complications of SFIOL implantation.Settings and Design:A retrospective hospital-based study.Methods and Material:The study was undertaken depending on the data available of the patients who were diagnosed to have postoperative or post-traumatic aphakia and underwent pars plana vitrectomy ± lens explantation ± phacofragmentation with SFIOL implantation from the month of May 2021 to October 2021 and came for regular follow-up for 6 months. The study included patients with total absence of capsular bag or history of eye trauma or complicated cataract surgery causing aphakia. Patients with retinal detachment were excluded from the study. Indication for surgery, best corrected visual acuity, and other complications were studied.Results:Of 25 eyes of 25 patients who completed 6 months of follow-up, 16 (64%) were men and 9 (36%) were women. Mean visual outcome preoperatively and postoperatively were 1.56 ± 0.7 logMAR and 0.46 ± 0.1 logMAR units, respectively. Mild vitreous hemorrhage was found in 8 eyes (32%) which was the most common postoperative complication noted followed by postoperative hypotony in 6 eyes (24%). Transient rise in intraocular pressure, corneal edema, and choroidal detachment were other complications seen postoperatively.Conclusions:A technique of sutureless SFIOL implantation was found to be a cost-effective method of providing a good visual outcome without serious postoperative complications in eyes with aphakia following post-trauma or surgical complications.

‏Impact of Food Habits on Cataract Development Among Adults in Aseer Region, Saudi Arabia: A Retrospective Study.

Background: Cataracts are the main cause of visual impairment among the aging population, with a high impact on patients’ quality of life. It has been suggested that the antioxidant carotenoids lutein and zeaxanthin may play a role in cataract prevention. Recently, significant evidence has associated abnormal glucose metabolism with an increased likelihood of the development of cataracts.Aim: The current study aims to assess the relationship between nutrition and cataracts among adults in the Aseer Region, Saudi Arabia.Methods: A retrospective study was conducted targeting all accessible patients diagnosed with cataracts at Aseer Central Hospital during the period from August 8, 2019, to March 3, 2021, and at Khamis Mushayt General Hospital during the period from June 11, 2018, to March 3, 2021. Data were collected using a pre-structured data collection sheet that covered patients’ socio-demographic data, including age, gender, education, work type, and marital status. Also, the type of cataract diagnosed for the study patients was recorded with associated risk factors of cataracts, including chronic diseases, trauma, eye surgery, and family history. The last section covered patients’ dietary habits and frequency of dietary intake. Results: A total of 140 patients with cataracts who fulfilled the inclusion criteria were included in the study. Patients' ages ranged from 21 to 65 years, with a mean age of 54.2 ± 12.9 years old. Additionally, 12.1% of the study patients were smokers, 44.3% were diagnosed with hypertension, and 45% were diabetic, which was type 1 diabetes mellitus (T1DM) among 36.5% and type 2 diabetes mellitus (T2DM) among 52.4%. A family history of congenital cataracts was reported among 12.9%, and 12.9% had a history of eye trauma. Moreover, 37.1% of the study patients had vegetables once per week. Eating fruits or having juice was reported as once per week among 40% of the study patients and three times per week among 20%. Finally, 31.4% take nutritional supplements or vitamins.Conclusion: There is currently an inquiry to endorse or exclude a specific diet or dietary intake that may reduce or even prevent the development and progression of cataracts. It appears beneficial for people to have some antioxidants in their daily food.

Optical coherence tomography angiography using the black-and-white pixel binarization histogram software: a new technique for evaluating healing of macular holes in two surgical techniques

BackgroundMany factors can influence the functional outcomes of macular hole surgery and some studies have tried to describe anatomical features that could predict successful treatment. The purpose of this study is to describe a new technique for evaluating the healing of macular holes after two surgical techniques using a black-and-white pixel binarization histogram software by optical coherence tomography angiography and its potential functional implications.MethodsThis was a retrospective, observational case series of patients who presented with idiopathic full-thickness macular holes and underwent vitreoretinal surgery for successful macular hole closure using the internal limiting membrane peeling technique or the inverted peeling technique or the free internal limiting membrane flap technique. Optical coherence tomography angiography 3.0 × 3.0-mm scans were obtained postoperatively. The outer retina layer was analyzed separately; three different analyses were performed within a 3.0-mm-diameter area central circle, a 1.5-mm-diameter area, and a 0.5-mm-diameter area from the foveal center. The outer retinal layer images were evaluated by counting the number of black and white pixels. The inclusion criteria were patients with idiopathic macular holes who underwent ophthalmologic examinations and swept-source optical coherence tomography 1 week and 1 and 6 months postoperatively. The exclusion criteria were a traumatic macular hole or a history of eye trauma and a diagnosis of glaucoma or any other chronic ocular disease. The Mann–Whitney test was used to determine significance; P < 0.05 was considered significant.ResultsTen eyes of 10 patients who underwent vitreoretinal surgery to treat a macular hole either with the conventional peeling technique (n = 5) or the inverted/free internal limiting membrane flap technique (n = 5) were included. In the peeling group, the percentage of white pixels ranged from 7.22% to 18.40% in the 0.5 × 0.5-millimeter area in the macular center; the mean postoperative logarithm of the minimum angle of resolution best-corrected visual acuity was 0.3 ± 0.2. In the inverted flap group, the percentage of white pixels ranged from 3.65% to 8.93% in the 0.5 × 0.5-millimeter area in the macular center; the mean logarithm of the minimum angle of resolution best-corrected visual acuity was 0.9 ± 0.4.ConclusionsA simple method of optical coherence tomography angiography imaging analysis of the outer retina using a binarization technique of the black and white pixels was created and may have functional implications during the analysis of the healing process after macular hole surgery. We hypothesized that higher numbers of white pixels correspond to viable cellularity and better prognoses postoperatively.

"Stars on a clear night"

We report a case of a 65-year-old-man, who suffers from high blood pressure, and diabetes, with no history of eye trauma. The patient presented to ophthalmology consultation for a routine eye examination. The biomicroscopic examination after pupillary dilation of the right eye, found a large number of small white spherical opacities in the vitreous, those refringent bodies were mobile with eye movement, and did not affect the patient vision. The B-scan ocular ultrasound examination revealed on the vitrious spherical opacities, which were mobile, and highly echogenic, with flat retina. Considering that these vitreous particles did not affect vision, we decided to survey regularly the patient. In our case of the retained diagnosis was asteroid hyalosis, which is a rare degenerative condition of the vitreous, which is marked by an accumulation of calcium-lipid complexes in collagen fibrils of the vitreous, commonly unilateral, benign and usually asymptomatic. And regarding the therapeutic management, rarely the floating opacities can be a cause of myodesopsia, and usually no treatment is necessary, except if there is decreased vision. The first clinical description of this condition was in 1894 by Benson. And because the opacities appears while vitreous examination as “stars on a clear night” he termed the pathology asteroid hyalitis. Previous studies have reported that the prevalence of asteroid hyalosis is about 1.2%. They have reported also that is increasing with age. and that asteroid hyalosis can be confused with other vitreous degeneration as synchysis scintillans, and vitreous amyloidosis.

Bacterial Profile and Antibiotic Susceptibility Pattern of Bacterial Keratitis at a Tertiary Hospital in Riyadh.

BackgroundThe most common cause of ocular infections worldwide is bacteria; therefore, bacterial keratitis requires rapid and proper intervention because it is a major cause of loss of vision and ocular morbidity. Resistance studies have found increases in the resistance to ciprofloxacin, cefazolin, and gentamicin in bacterial keratitis cases that are caused by gram-positive organisms.AimTo identify the common predisposing factors, causative organisms, and antibiotic profile of bacterial keratitis (BK) in a tertiary care hospital in Riyadh, Saudi Arabia.MethodThis is a retrospective study of the microbiological record of all patients diagnosed with BK at KAUH. From the first of May 2015 until the first of January 2018. Demographic data, diabetes mellitus, contact lens use, history of eye trauma, ocular surface disorders, recent ocular surgeries, current and recent medications, initial and final visual acuity, and location and size of the infiltrate were all used in the study. VA was converted to the logarithm of the minimum angle of resolution (LogMAR) for statistical analysis.Results177 cases positive for BK were included. 100 (56.5%) were males, and 77 (43.5%) were females. The mean age was 43.15. Trauma was the most common predisposing factor, which was observed in 68 (38.4%) cases, followed by Ocular surface disease [52 (29.4%)]. Staphylococcus epidermidis was the most commonly isolated organism [61 (34.5%)], followed by Streptococcus pneumoniae [23 (13%)], and Staphylococcus aureus [18 (10.2%)]. All gram-positive cases were Vancomycin sensitive. Staphylococcus epidermidis showed only 4 resistant cases to chloramphenicol (7.27%), and resistance to penicillin and ampicillin was found in 55 (90%) and 53 (89.83%) cases, respectively. All Streptococcus pneumoniae cases were resistant to gentamicin (100%). Staphylococcus aureus showed high sensitivity for erythromycin [18 (100%)].ConclusionThe most common cause of bacterial keratitis was Staphylococcus epidermidis (N=61), followed by Streptococcus pneumoniae (N=23). Trauma was the most common predisposing factor (38.4%), while contact lens use was only identified in 14 cases (7.9%). All organisms tested were sensitive to vancomycin, and there was high resistance toward penicillin (90%).

A Preliminary Report of Predisposing Factors and Predominant Microbiological Diagnosis of Corneal Ulcers Seen at the Federal Teaching Hospital Abakaliki, Nigeria

Background: Microbial keratitis often results in poor visual outcome despite treatment. A revision of treatment protocol based on local evidence may be required in order to obtain better treatment outcome. Objectives: To determine the predisposing factors and predominant microbiological diagnosis of corneal ulcers seen at the Federal Teaching Hospital Abakaliki (FETHA), Ebonyi State, Nigeria. Materials and Methods: This is a preliminary report of an on-going longitudinal descriptive study of all consenting corneal ulcer patients managed at the FETHA eye clinic over a 4-month period. Information obtained were socio-demographic data, presenting complaints, duration of symptoms prior to presentation, history of preceding trauma, medications used before presentation, presenting and final visual acuity and microbiological diagnosis. Results: A diagnosis of corneal ulcer was made in 8 out of the 852 outpatients seen over the study period giving a hospital prevalence rate of 0.59%. Five patients (62.50%) were males, five (62.50%) were farmers and 4 patients (50%) were above 60 years of age. The microbial diagnoses were bacterial keratitis 37.5% (Staphylococcus aureus), fungal keratitis 25% (Fusarium spp. and aspergillus) and acanthamoeba (25%). None of the patients ever used contact lenses. There was a history of eye trauma in 50% of the patients. All the eyes presented blind after a period of failed attempts to treat by self or quacks. Mean duration before presentation was two weeks. Treatment improved the visual acuity in 37.5% of patients. Conclusion: Bacteria, fungi and acanthamoeba organisms were the microbiological isolates from the scrapings of corneal ulcer patients seen in the eye clinic of FETHA; with bacterial organisms being the most common. Farming activities, preceding eye trauma, delayed presentation, self-medication and use of traditional eye medications (TEM) were common findings among the patients. A future larger study is recommended to confirm the findings of this study. Eye health education campaigns should be directed at farmers to encourage early presentation to hospitals.

Ipsilateral White Cataract Following Percutaneous Nephrolithotomy

Purpose: There is a rising concern over the increasing amount of radiation exposure in patients undergoing diagnostic imaging and medical procedures. A case of rapid visual deterioration following a percutaneous nephrolithotomy (PCNL) has been described. The aim of this paper is to report the formation of semi-acute white cataract following a PCNL procedure. Method: Case Report Results: A 57-year-old gentleman with underlying hypertension, gout and history of right nephrolithiasis complained of rapid deterioration in his right eye (RE) vision for 3 months duration. It was not associated with eye pain, redness, eye discharge or history of eye trauma. He denied taking steroids or any over-the-counter medication. However, prior to that he underwent a PCNL procedure for right nephrolithiasis. His visual acuity was 6/60 on the affected eye. Anterior segment examination reveals dense white cataract on the RE which turned out to be dense cortical matter following phacoemulsification. Conclusion: Although uncommon and not routinely discussed between surgeons and patients, PCNL may cause a semi-acute cataract formation secondary to radiation associated with the procedure. In view of the increasing trend of radiation involved in the management of nephrolithiasis, both surgeons and patients need to be made aware of this complication and the possible ways to overcome it.

A Case of Phacoanaphylactic Uveitis Presenting as Endophthalmitis

Purpose: To report a case of phacoanaphylactic uveitis presenting as endophthalmitis. Case summary: A 77-year-old woman presented with sudden visual disturbance and painful red right eye. She did not have a history of trauma or surgery in her right eye. Her best corrected visual acuity was hand movement in the right eye and log MAR 0.22 in the left eye; intraocular pressure was 27 mm Hg in the right eye and 15 mm Hg in the left eye. Slit-lamp examination revealed corneal edema and prominent inflammation with hypopyon in the anterior chamber. B-scan showed vitreous opacity behind the lens. Based on the diagnosis of endophthalmitis, anterior chamber paracentesis and irrigation were performed. After irrigation, a hypermature cataract with intact anterior capsule was observed. Therefore, we performed extracapsular cataract extraction and intravitreal antibiotics injection. Gram staining of the aqueous humor revealed numerous macrophages filled with lens protein but no organisms. She was treated with hourly topical corticosteroid and an antibiotic agent. One month later, the anterior chamber is clear, and the cultures remained negative. Conclusions: We report a case of spontaneous phacoanaphylactic uveitis presenting as endophthalmitis in a patient with no history of eye trauma or surgery. J Korean Ophthalmol Soc 2016;57(9):1480-1483

Evaluation of polymerase chain reaction (PCR) as a diagnostic technique for acanthamoebic keratitis

Background Techniques used to diagnose Acanthamoeba keratitis (AK), a sight-threatening corneal infection, are either insensitive or time-consuming. Early and accurate diagnosis and appropriate therapy are the key to a good prognosis.Objective The objective of this study is to shed light on the efficacy of PCR in the diagnosis of AK in comparison with other diagnostic techniques.Patients and methods Corneal swabs and scrapings from 95 cases suspected to have AK were examined by microscopy, culture on non-nutrient agar seeded with the avian fecal Escherichia coli AFEC49, and by PCR targeting the 18S rRNA gene.Results The highest number of positive swabs and scrapings was detected by the PCR technique (5.26 and 27.37%, respectively), followed by culture (1.05 and 13.68%, respectively), and the lowest was detected by direct microscopy (0 and 7.37%, respectively). Corneal scrapings showed more positive cases than corneal swabs with statistically significant differences irrespective of the technique used. PCR results were significant versus culture (P<0.05) and direct microscopy (P<0.001). Out of the 26 positive cases, 20 were contact lens wearers, 13 were swimming pools users, five had a history of eye trauma, and five had undergone previous eye operation.Conclusion PCR proved to be a better technique for the detection of Acanthamoeba infection compared with direct microscopy and culture techniques. Scrape specimens are more efficient than swabs in detecting Acanthamoeba by different diagnostic techniques. The important risk factors of AK were contact lens wearers, use of swimming pools, a history of previous eye operation as well as eye trauma.

Acute onset anterior uveitis after darbepoetin alfa infusion.

A 79-year-old female with a 2-month history of newly diagnosed myelodysplastic syndrome for which she received blood transfusion with darbepoetin alfa presented with bilateral anterior uveitis 1 day after her fourth transfusion. On exam, visual acuity was 20/20 in both eyes with biomicroscopy notable for conjunctival injection and anterior chamber cell and flare consistent with anterior uveitis. She had no systemic symptoms, no history of eye trauma, and no known infections. This case, along with prior reports in the literature, suggests that anterior uveitis may be an idiosyncratic complication of darbepoetin alfa therapy.

Incidence, Risk Factors, and Impact of Age on Retinal Detachment after Cataract Surgery in France: A National Population Study

To assess the incidence, risk factors, and impact of age on retinal detachment (RD) after cataract surgery. Cohort study. All patients older than 40 years of age who underwent a primary cataract surgery in France between January 2009 and December2012. A Cox proportional-hazard regression model was used to analyze risk factors of RD after cataract surgery. Risk factors of RD after cataract surgery. Over 4 years, 2680167 eyes in 1787021 patients (59.4% women; mean age, 73.9±9.5 years) underwent cataract surgery. A total of 11 424 patients experienced RD after cataract surgery, with an estimated risk of 0.99% at 4 years after surgery. The odds ratio associated with increased risk of RD was 3.87 (95% confidence interval [CI], 3.79-3.95) for cataract surgery itself. The multiadjusted hazard ratio (HR) associated with increased risk of RD was 5.22 (95% CI, 5.05-5.39) for patients 40 to 54 years of age, 3.69 (95% CI, 3.60-3.79) for those 55 to 64 years of age, and 1.98 (95% CI, 1.93-2.03) for those 65 to 74 years of age as compared with those 75 years of age or older. Retinal detachment was associated with high myopia (HR, 6.12; 95% CI, 5.84-6.41), vitrectomy for perioperative capsular rupture (HR, 4.36; 95% CI, 4.07-4.68), history of eye trauma (HR, 3.98; 95%CI, 3.69-4.30), extracapsular extraction (HR, 3.11; 95% CI, 2.94-3.30), male gender (HR, 2.39; 95% CI, 2.35-2.44), and history of diabetes (HR, 1.18; 95% CI, 1.15-1.21). In myopic patients, the multiadjusted HR associated with increased risk of RD was 25.02 (95% CI, 24.76-25.18) for patients 40 to 54 years of age, 20.37 (95% CI, 20.21-20.53) for those 55 to 64 years of age, and 17.05 (95% CI, 16.85-17.25) for those 65 to 74 years of age as compared with nonmyopic patients 75 years of age or older. We provide a hierarchy of risk factors for RD onset: high myopia, young age, capsular rupture, history of eye trauma, extracapsular extraction technique, male gender, and diabetes. Young age was an additional risk factor in myopic patients.

Ciliary Body and Choroidal Pseudomelanoma from Ultrasonographic Imaging of Hypermature Cataract in 20 Cases

To describe a series of 20 patients with opaque media, referred with uveal melanoma, but subsequently found to have pseudomelanoma from oblique imaging of hypermature cataract on ultrasonography. Case series. Twenty patients. Retrospective chart review. Ultrasound imaging. All eyes had opaque media from hypermature cataract with no view of the fundus. All were referred because of suspected uveal melanoma, based on ultrasonographic imaging. The echogenic mass appeared to be in the ciliary body (n = 17) or choroid (n = 3). The median patient age was 54 years (range, 17-86 years). Most patients were white (n = 13) or black (n = 4). There was a history of eye trauma (n = 3) and ocular surgery (n = 1). Visual acuity was light perception to hand movements (n = 18) and 20/50 to 20/100 (n = 2). The cataract was in an anatomic position (n = 18) or subluxated (n = 2). On B-scan ultrasonography, the mass was dome-shaped (n = 10) or elliptical (n = 10), displayed an acoustically hollow center with a dense rim (n = 20), and was located in the ciliary body (n = 17) or choroid (n = 3). The mean thickness was 7.2 mm and the mean base was 9.3 mm. Features suggestive of cataract rather than melanoma included a lack of contiguity with the uvea (n = 20) on videoimaging using standard ultrasonography and ultrasound biomicroscopy, a lack of a transillumination shadow, and a lack of a sentinel vessel. For those in the ciliary body region, an additional feature was the ultrasonographic presence of mass in all 4 quadrants (n = 17), representing oblique imaging of the lens equator. For those in the choroid region, the pseudomelanoma shifted when the patient was imaged in a reclined compared with an upright position. After cataract surgery, the lack of melanoma was confirmed. Dense cataract can preclude a fundus view, necessitating ultrasonography for imaging the posterior segment of the eye. Ultrasonographic confusion with a ciliary body and choroidal melanoma can occur because the dome-shaped cataract can simulate a dome-shaped melanoma.

Endogenous Klebsiella endophthalmitis in a Vietnamese immigrant

A previously healthy 54-year-old carpenter presented with a 13-day history of redness, tearing and pain in his left eye, which was associated with a progressive reduction in visual acuity. He had no fever or other systemic symptoms. He had no history of eye trauma or surgery, and he regularly used

Diagnosis and treatment of ciliary epithelium tear combined with retinal detachment

To analyze the clinical characteristics and treatment of the ciliary epithelium tear combined with retina detachment of the eye, and consequently, to reduce mistaken and missed diagnosis and to improve the cure rate. The clinical data, treatment, and follow up results of 17 eyes from 16 cases of ciliary epithelium tear combined with retina detachment were analyzed retrospectively. All of the patients had a history of eye trauma. All eyes showed ciliary epithelium tear combined with retina detachment by the fundus examination. All eyes were treated with sclera buckling and cryotherapy. Subretinal fluid draining was applied in 13 eyes and combined pneumatic retinopexy was performed in 4 eyes. The detached retina was reattached in all eyes and visual acuity was improved during the follow up period. Ciliary epithelium tear combined with retina detachment always appears after eye injury. The super nasal quadrant is the most frequently affected region. The use of ultrasound biomicroscopy, gonioscopy and binocular indirect ophthalmoscopy combined with sclera pressure technique helps to obtain a correct diagnosis. Sclera buckling surgery results in a high success rate.

A 47-Year-Old Man With Sudden Onset of Blindness, Pleocytosis, and Temporary Hearing Loss

The clinicopathologic findings of this patient were typical for Vogt-Koyanagi-Harada syndrome. Clinically, the patient had sudden onset of blindness, pleocytosis, and temporary hearing loss, with no history of eye trauma or surgery. Histopathologically, the choroid and iris showed chronic inflammation, loss of choroidal melanocytes, and dense chorioretinal adhesions. Presence of HLA-DRB1*0405 was consistent with the chronic phase of this syndrome.

A Study of Bedside Ocular Ultrasonography in the Emergency Department

AbstractThe use of ocular ultrasonography for the evaluation of emergency patients has recently been described in the emergency medicine (EM) literature. There are a number of potential uses that may greatly aid the emergency physician (EP) and avoid lengthy consultation or other diagnostic tests. Objective: To examine the accuracy of bedside ultrasonography as performed by EPs for the evaluation of ocular pathology. Methods: This prospective, observational study took place in a high‐volume, suburban community hospital with an EM residency program. All patients arriving with a history of eye trauma or acute change in vision were eligible to participate in the study. A 10‐MHz linear‐array transducer was used for imaging. All imaging was performed through a closed eyelid, using water‐soluble ultrasound gel. Investigators filled out standardized data sheets and all examinations were taped for review. All ultrasound examinations were followed by orbital computed tomography or complete ophthalmologic evaluation from the ophthalmology service. Statistical analysis included sensitivity, specificity, and positive and negative predictive values. Results: Sixty‐one patients were enrolled in the study; 26 were found to have intraocular pathology on ultrasound. Of these, three had penetrating globe injuries, nine had retinal detachments, one had central retinal artery occlusion, and two had lens dislocations. The remaining pathology included vitreous hemorrhage and vitreous detachment. Emergency sonologists were in agreement with the criterion standard examination in 60 out of 61 cases. Conclusions: Emergency bedside ultrasound is highly accurate for ruling out and diagnosing ocular pathology in patients presenting to the emergency department. Further, it accurately differentiates between pathology that needs immediate ophthalmologic consultation and that which can be followed up on an outpatient basis.