Open Eye Injury Research Articles

OPEN GLOBE OCULAR TRAUMA

To evaluate characteristics and prognostic factors for functional success in eyes that present with no light perception (NLP) after open globe trauma. The medical records of all subjects presenting to a single university referral center with visual acuity (VA) of NLP after sustaining an open globe eye injury from January 1, 2001, through June 30, 2010, were retrospectively analyzed to determine epidemiologic and clinical factors associated with visual outcomes. Of the 73 NLP eyes (73 patients) that underwent primary repair and were included in the study, final VA was 20/100 in 1 eye (1%), counting fingers in 2 eyes (3%), hand motion in 9 eyes (12%), light perception in 5 eyes (7%), and NLP in 56 eyes (77%). Recovery of some vision on postoperative Day 1, pars plana vitrectomy operation, and Zone 2 injury were significantly associated with an improvement in final VA. Zone 3 injuries were the most likely to result in NLP final VA, although this difference was not statistically significant. Visual recovery to light perception or better on postoperative Day 1 increases the likelihood of having a long-term improvement in VA. Pars plana vitrectomy may be beneficial in such eyes if posterior segment abnormalities are noted.

Kosten- und Leistungsheterogenität bei penetrierenden Augenverletzungen und Amnionmembranaufnähungen unter DRG-Bedingungen

Patients with penetrating eye injuries are a very heterogeneous group both medically and economically. Since 2009, treatment involving sutures for open eye injuries and cases requiring amniotic membrane transplantation (AMT) were allocated to DRG C01B of the German diagnosis-related group system. However, given the significant clinical differences between these treatments, an inhomogeneity of costs to performance is postulated. This analysis describes case allocation problems within the G-DRG C01B category and presents solutions.A retrospective analysis was conducted from the standardized G-DRG data of 277 patients with open eye injuries and AMT between 2007 and 2008, grouped under the 2008 G-DRG system version to the G-DRG C01Z category. This data was provided by the Department of Ophthalmology at the University Hospital Regensburg. Additionally case-based data of the following were supplemented: length of surgery, time of anesthesia and intensity of patient care. Fixed and variable costs were determined for surgery and other inpatient treatment. Finally, an analysis of the heterogeneity of costs within the G-DRG C01B of the G-DRG system 2009 was implemented.Inhomogeneity was evident within the G-DRG C01B of the G-DRG system 2009 for the two groups suture of open eye injuries and AMT concerning the parameters length of stay, proportion of high outliers and cost per case. Multiple surgeries during an inpatient stay lead to an extended length of stay and increasing costs, especially within the AMT group. Intensity of patient care and the consideration of patient comorbidity did not yield relevant differences.The quality of the G-DRG system is measured by its ability to obtain adequate funding for highly complex and heterogeneous cases. Specific modifications of the G-DRG structures could increase the appropriateness of case allocation for patients with open eye injuries within the G-DRG C01B of the German DRG system 2009. As a result of the present study, cases with amniotic membrane transplantation should not be allocated to the G-DRG C01B. A petition has been presented by the German Association of Ophthalmology (DOG) to the German DRG Institute to restructure the G-DRG C01B. Data-based analysis is an essential prerequisite for a constructive development of the G-DRG system and a necessary tool for the active participation of medical societies in this process.

Pattern of open eye injuries in northwest of Turkey: Retrospective study

We aimed to review the epidemiology and visual outcome of patients with open globe injuries in the northwest part of Turkey. All patients admitted to the Department of Ophthalmology, Kocaeli University Faculty of Medicine with open globe injuries between 2004-2008 were reviewed retrospectively. Ninety-five eyes of 95 patients, aged between 3 and 79 years, were reviewed. The type of open eye injury was laceration in 76 eyes (80%) and rupture in 19 eyes (20%). In all age groups, projectile objects were the most common cause of injury. In patients 18 years and older, sharp objects (11.1%) were the least prevalent cause of open globe injuries; however, traumas with sharp objects were common in patients younger than 18 years (38.1%) (p=0.01). In patients younger than 18 years, most injuries occurred at home (68.3%), while in patients 18 years and older, the majority of ocular traumas occurred at work (59.2%) (p=0.000). Isolated Zone I lesions showed more improvement in visual acuity than other zones (p=0.043). Open globe injury in northwest Turkey varied with age and gender. Education and safety precautions are essential to prevent open eye injuries.

23-gauge vitrectomy assisted by combined endoscopy and a wide-angle viewing system for retinal detachment with severe penetrating corneal injury: a case report

BackgroundWe report a case of traumatic retinal detachment in an eye with severe corneal opacity that was successfully treated using 23 gauge (G) transconjunctival vitrectomy assisted by endoscope and a wide-angle viewing system.Case presentationA 22-year-old Japanese man was referred to our hospital with the suspicion of traumatic retinal detachment of the right eye, 1 month after an open globe eye injury due to fireworks. At the time of his first visit, his best-corrected visual acuity was hand motion in the right eye. A 23 G three port pars plana vitrectomy was conducted in combination with ophthalmic endoscope and a wide-angle viewing system. Endoscopy revealed a retinal detachment in the inferior quadrant with tiny retinal breaks. Primary reattachment of the retina was achieved by tamponade of SF6 gas. Five months after the vitrectomy, penetrating keratoplasty was performed and visual acuity recovered to 0.02. Optical coherent tomography revealed thinning of the retina, which might be the cause of the remaining poor vision.Conclusion23 G vitrectomy assisted by combined endoscopy and a wide-angle viewing system could be advantageous in managing visualization constraints due to penetrating trauma.

Open Eye Injury with Full Stomach

Open Eye Injury with Full Stomach

Wartime open globe eye injuries

Open globe injuries are the most serious eye injuries in war as in peace time. The purpose of this study is to analyze wartime open globe eye injuries in 72 patients treated at the Department of Ophthalmology, Clinical Hospital of Split from July 1991 to April 1993, during the intensive war in Croatia and Bosnia and Herzegovina, and to evaluate crucial factors responsible for the functional success of the treatment. Wartime open globe eye injuries were retrospectively analyzed in 72 patients (80 eyes) hospitalized at Clinical Hospital of Split, Department of Ophthalmology, between July 1991 and April 1993. The causes and ways of wounding, localization of wounds and presence, nature and localization of the foreign body, as well as admission time, microsurgical management and other factors contributing to poor visual outcome were studied. Standard international classification of ocular traumas (the Birmingham Eye Trauma Terminology and the International Ocular Trauma Classification) was used for the classified and graded injuries. Open globe eye injuries amounted to 52.65% of all war injuries to the eyes. Bilateral injuries were found in eight patients (11.11%). The most frequent cause of the injures were fragments of explosive devices (more than two-thirds). Most of the patients were admitted to the hospital within 24 hours of the injury. Using current microsurgical techniques, the attempt was made to achieve not only anatomical but also functional recovery already in the primary treatment. In 30 eyes (37.50%) final visual acuity amounted to more than 0.1, and in 22 eyes (27.50%) it reached 0.5. There was a statistically significant correlation between admission within the first 12 hours and postoperative improved visual acuity (chi(2) = 4.53; p = 0.033). Statistically significantly better visual acuity was found in patients with lesions limited to the anterior segment of the eye. Primary enucleation or evisceration was performed only exceptionally: one enucleation and six eviscerations (8.75%). The most important factors in the prognosis of postoperational visual acuity for wartime open globe eye injuries were: (1) preoperative condition of the eye, (2) localization and extent of the wound, (3) presence, size and nature of foreign bodies, and (4) adequate surgical treatment in specialized institutions.

Analysis of the prognosis and risk factors of mechanical eye injury following vitrectomy

目的 分析评价机械性眼球伤,特别是开放性眼外伤,玻璃体手术的效果及相关危险因素.方法 机械性眼外伤398例(409眼),开放性眼外伤357眼,闭合性眼外伤52眼,均行玻璃体切除手术.术后随访至少6个月.各合作单位将所有的患者信息填表,录入数据库供统计分析.结果 最终视力≥0.025者260眼(63.57%).获得解剖功能修复者289眼(70.66%);获得解剖修复者34眼(8.31%);低眼压、眼球萎缩、硅油支持眼球和眼球摘除(预后不良)者86眼(21.03%).增生性玻璃体视网膜病变(PVR)、视网膜脱离(RD)、伤后14 d以上实施玻璃体手术者预后较差.受伤至手术时间与PVR的发生率密切相关.伤时有RD发生者促进PVR的发生.RD和PVR合并存在使后果更差.伤后30 d以后实施手术者RD的发生率显著增加.单变量Logistic分析提示伤后无光感、视网膜闭合漏斗脱离、PVR形成、脉络膜上腔大出血4个变量是手术效果不良的危险因素.结论 玻璃体手术时机和损伤程度直接影响眼外伤的治疗结果。

Prognostic factors in posterior open globe injuries (zone‐III injuries)

The aim of this study is to describe and identify clinical characteristics, prognostic factors and visual outcome in a group of patients with posterior open globe injuries (zone III injury). A retrospective review was made of all cases of open globe injuries that were examined at the Ophthalmology Department of Soroka Medical Center, Beer-Sheva, Israel, from 1995 to 2005. One hundred and eight consecutive patients diagnosed with open globe injuries were reviewed. Of these, 21 eyes from 21 patients with zone III injuries were analysed and are the subject of this study. We assessed the relationship of presenting visual acuity, cause and extent of injury, as well as the number of surgical procedures, postoperative complications with the final outcome. The study group comprised 95% male subjects with a mean age of 35.8 years (range 20-60 years). The median follow up was 21.2 months (range 6-66 months). In 72.7% of the cases metal was the causative factor. Clinical signs associated with an adverse outcome included poor-presenting acuity, eyelid injury, cornea lamellar lacerations or abrasions, iris deformity, lens damage, ocular hypotony, coexisting injuries and a low ocular trauma score. No cases presented with post-traumatic endophthalmitis. From this study we determined the most important prognostic factor in zone III open globe injuries is the presenting acuity. Other prognostic factors associated with a poor final outcome are eyelid injury, iris deformity, lens damage, ocular hypotonia, coexisting injuries and low ocular trauma score (< or =2). Posterior open eye injuries were most commonly owing to metal entering the eyes of young men.

The mechanism, influential factors and prevention of cough reflex induced by fentanyl

芬太尼是人工合成的阿片类药物,具有镇痛作用强、作用时效中等、对血流动力学影响小等特点.但是,芬太尼静脉注射后常引起病人的呛咳反应,Lin等[1]研究发现在2 s内经外周静脉注射芬太尼2.5μg/kg的呛咳发生率为65%.呛咳常引起机体内环境瞬间发生剧烈变化,胸膜腔内压明显升高,影响静脉回流,脑脊液压力升高,可能导致严重的并发症.预防芬太尼诱发的呛咳反应,对提高病人麻醉安全具有重要意义。

Traumatismes oculaires perforants de l'enfant: Étude rétrospective de 57 cas

The purpose of this study was to investigate the current causes and outcomes of open eye injuries in children. We reviewed the hospital records of 57 patients under 14 years of age who were treated for open globe injuries at Edouard Herriot Hospital, Lyon, France, between January 1999 and December 2003. This review includes 57 patients: 41 males and 16 females. The mean age at admission was 6.8 +/- 3.5 years. The injury involved the right eye in 27 cases and the left eye in 30 cases. Sharp or pointed objects accounted for the majority of injuries. The most common location for a perforating ocular injury to occur was at home. Wounds involved the cornea in 41 cases. There was iris hernia in 21 cases, hyphema in 15 cases, vitreous prolapse in 14 cases, lens damage in 12 cases, and shallow anterior chamber in 11 cases. The most frequent complication was traumatic cataract. Secondary lens removal was performed in 15 cases. Visual acuity was 0.5 or better in 27 of the 57 eyes, with a mean follow-up period of 12 months. Perforating ocular injuries are a frequent cause of unilateral visual loss. The highest proportion of injuries occurred at home and sharp objects were the most frequent causative agents. More adequate adult supervision and educational measures are necessary in order to reduce the prevalence of these accidents.

Iatrogenic open globe eye injury following sinus surgery

Purpose To report a case of iatrogenic open globe eye injury occurring during endoscopic sinus surgery. Design Case report and literature review. Methods A 10-year-old boy presented with periorbital swelling and subconjunctival hemorrhage of the left eye following bilateral nasal adenoidectomy. Funduscopic examination showed evidence of a full-thickness open globe injury at the equator in the inferior nasal midperiphery. Results The injury most likely was secondary to inadvertent perforation of the lamina papiracea with entrance into the orbit and subsequent penetration of the globe. Conclusion Sinus surgery has been reported previously in association with severe orbital complications. We are unaware of previous reports of open globe injury following sinus surgery.

Do motor vehicle airbags increase risk of ocular injuries in adults?

Purpose This study was undertaken to evaluate the risk of eye injury in motor vehicle accidents in which airbags deploy. An attempt was made to assess the possible associations between eye injuries and eyewear in these accidents. Design Retrospective observational case series and literature review with analysis. Participants/methods We conducted a literature review of 62 case reports and articles describing 110 adult cases of eye injury after deployment of an airbag and examined two Finnish accident cohorts. The fatal accident series (FAS; fatal injuries with one or more cars involved) included 121 individuals sitting behind an airbag that deployed (65 survivors), and the Airbag study (AB; nonfatal, relatively serious accidents) included 210 individuals (survivors). Main outcome measures The type of eye injury, eyewear, and crash dynamics were studied in each of the reviewed case reports. The fatal accident series and AB studies were analyzed to disclose the eye injuries and use of eyewear and to estimate their possible relation to deployment of airbags. Results Analysis of the published reports revealed that airbag-induced eye injuries were not more frequently reported among wearers of eyeglasses than among nonwearers. However, open-eye injuries were reported three times more often among eyeglass wearers ( P = 0.04), whereas all injuries from airbag chemicals occurred among nonwearers. With the exception of one orbital fracture with hyphema, all eye traumas (n = 7) in the FAS and AB cohorts were mild (eyebrow laceration, lid contusion, bruising). The risk of airbag-related eye injury was 2.5% for any eye injury and 0.4% for severe eye injury. In single accidents when seat belts were used, the risks were 2.0% and 0.5%, respectively. In the accidents from the FAS data no difference was observed in the risk for eye injury between survivors in incidents involving airbag deployment and incidents not involving airbags. This risk was not found to be greater among eyeglass wearers. Conclusions Despite reported cases in the literature, we found that the risk of severe eye injury from airbags was very low (0.4%) in fatal or relatively serious accidents. Eyewear did not seem to increase this risk but might interfere with the injury pattern.

Four-year review of open eye injuries at the Royal Adelaide Hospital.

To review the epidemiology of penetrating eye injuries and ruptured globes presenting to the Royal Adelaide Hospital, South Australia. A retrospective case review over a 4-year period. There were 109 penetrated or ruptured globes in 105 patients. The average age was 41 years and 80.2% were men. Over half were from rural areas. The commonest cause of injury was hammering metal followed by motor vehicle accidents. Falls in the elderly were the commenest cause of globe ruptures. A final visual acuity of 6/12 or better was found in 40% of eyes and no perception of light in 27%. At the Royal Adelaide Hospital, the predominant referral centre for serious ocular injury in South Australia, approximately 25 open globe injuries are encountered a year. Although the epidemiology of these injuries was found to be similar to those previously reported in Victoria and rural New South Wales, differences were thought to reflect to the ageing population of South Australia. Rupture of an old, healed large-incision cataract extraction wound was the commonest cause of ruptured globe. An effective preventive strategy to reduce the incidence of severe ocular trauma has yet to be implemented. The concept of a national population-based severe ocular trauma database is considered.

Open Eye Injuries in the Pediatric Population in Kuwait

Objective: To report the epidemiological characteristics of pediatric open globe injuries and to discuss treatment, management and outcomes of such injuries. Materials and Method: The hospital records and operative notes of 95 patients 16 years old and younger who were treated for open eye injury at Ibn Sina Hospital, Kuwait between September 1995 and January 1999 were reviewed. The average age of patients was 6.6 years. Patients were divided into three groups according to their final visual acuity (FVA): group 1, FVA of 20/40 or better; group 2, 20/40–20/200, and group 3, 20/400 or worse. The FVA of each group was compared to initial visual acuity (IVA), wound entry site, injury-to-presentation interval, injury-to-surgery interval, time of surgery, duration of surgery, associated injuries and medical treatment. Results: Injury was most common in children 3–6 years old. Most injuries occurred during play at home (46%), between the months of July and November (58%), and evening time (42%). The most common causes were glass, pencil, stick, soft drink bottle, metal bar, and stone. The cornea was the most common entry site (59 cases). Seventy-three patients presented on the day of injury, and 38 of them had surgical repair that same day. The follow-up period ranged from 2 weeks to 58 months. Thirty-eight patients (40%) had an FVA of 20/40 or better (group 1), 23 (24%) between 20/40 and 20/200 (group 2), 12 (13%) 20/400 or worse (group 3), and 22 (23%) had no record of FVA. The difference between IVA and FVA of wound entry site was statistically significant (p < 0.005). Differences due to injury-to-presentation interval, injury-to-surgery interval, time of surgery, duration of surgery, associated injuries, and the use of systemic antibiotics were found not to be statistically significant (p > 0.2). Conclusion: The prevalence of open globe injury among the pediatric population in Kuwait was high. Most injuries were due to household objects and occurred at home in the evening during the summer and autumn. IVA and anatomical location of the wound impacted on final outcome.

Clinical predictors of retinal detachment after open globe injury

A retinal detachment after open globe injury has important prognostic and therapeutic implications. To determine whether retinal detachment following open globe injury could be predicted by clinical factors, we retrospectively evaluated 52 patients (52 eyes) with open globe injury admitted to our department. The Birmingham Eye Trauma Terminology System was used. Only patients which open eye injuries were evaluated. The results were registered during the 7 days after the accident. In the week after the open globe injury, retinal detachment was present in 40.3 %. 100 % of the patients with previous cataract operation (with IOL) developed a retinal detachment (p < 0.01). Retinal detachment also correlated significantly with visual acuity less than hand movement and retained intraocular foreign bodies. 19 (95 %) of the 20 patients with a visual acuity less than hand movement had retinal detachment versus only 2 (9 %) patients with visual acuity of hand movement or better (p < 0.01). 6 (66.6 %) of the 9 patients with intraocular foreign bodies had retinal detachment compared to 15 (34.8 %) of the 46 patients without intraocular foreign bodies (p=0.01). Logistic regression analysis confirmed this variables as independent predictors of retinal detachment. We conclude that previous cataract operation, versus less than hand movement and the presence of intraocular foreign bodies are predictive to retinal detachment.

Epidemiology of open globe injuries

Severe open globe injuries are frequent emergencies in an ophthalmologic clinic and required immediate operation. The extent of these injuries is various depending on the mechanism of the injury and involvement of ocular tissue. In many cases a full visual rehabilitation can be achieved but in a lot of cases blindness results. To prevent such severe eye injuries it is important to judge the leading injury mechanisms. For this we collected our data about open globe injuries. Retrospectively we collected the data from 103 consecutive patients in the year 1996 and 1997, presenting with an open globe eye injury followed by operation. The data contained personal patients data, information about mechanism of injury, visual acuity, operation and rehabilitation. Statistical analysis was performed using binomimal-test and t-test for paired and unpaired samples (p < 0.05). 85.4% were male. Most of the injuries happened at home (38%) and at the working place (31%). Assaultive injuries happened in 6.8%. 35% of all patients were craftmen (mechanics, electricians, or the locksmith were preferred). Pensioners were affected in 14.6% of all cases followed by small children (7.8%) and school children (7.8%). In 50% of all cases metal and glass were responsible for the trauma, explosions were noticed in 8.7%. An intraocular foreign body was found in 37.9%. In 62% of all cases no second operation was necessary. An enucleation during the follow-up was performed in 2 cases. At least a third of all severe eye injuries would have been preventable. Concerning the non-preventable injuries accidents at home and in children were predominating. The rate of the open globe injuries was 2.32 in 100.000 people, which is about the same like in US-American studies. Most of the injuries happened at home because of carelessness and would have been avoidable. The rate of injuries at the working place is significantly higher than in the USA but there were significantly more gun-shot-injuries or offensive accidents abroad. The rate of accidents at home and in traffic were the same. We think that public campaigns and prevention strategies can help to reduce the potential risk of severe eye injuries.

Effect of rocuronium compared with succinylcholine on intraocular pressure during rapid sequence induction of anaesthesia

We have compared the effect of rocuronium and succinylcholine on intraocular pressure (IOP) during rapid sequence induction of anaesthesia using propofol and fentanyl, in a randomized double-blind study. We studied 30 adult patients, allocated to one of two groups. Anaesthesia was induced with fentanyl 2 micrograms kg-1 and propofol until loss of verbal response. This was followed by succinylcholine 1.5 mg kg-1 (group S; n = 15) or rocuronium 0.9 mg kg-1 (group R; n = 15). Laryngoscopy was performed 60 s later. IOP, mean arterial pressure (MAP) and heart rate (HR) were measured before induction, immediately before intubation and every minute after intubation for 5 min. A Keeler Pulsair air impulse tonometer was used to measure IOP and the mean of two readings obtained in the right eye at each measurement time was recorded. Intubating conditions were evaluated according to a simple scoring system. IOP in the succinylcholine group was significantly greater than that in the rocuronium group (mean 21.6 (SEM 1.4) mm Hg vs 13.3 (1.4) mm Hg; P < 0.001). Intubating conditions were equally good in both groups. We conclude that with rapid sequence induction of anaesthesia using propofol and fentanyl, rocuronium did not cause as great an increase in IOP as succinylcholine and may be an alternative in open eye injury cases.

Pharmacologic Aids to Intubation and the Rapid Sequence Induction

Endotracheal intubation usually can be performed in the emergency setting without the use of pharmacologic adjuncts. However, local airway anesthesia lessens patient discomfort, and the use of sedation and muscle relaxants occasionally may be necessary. Rapid sequence induction of general anesthesia adds benefits as well as risks to airway management; used in the circumstance of a full stomach combined with open eye injury or closed head injury associated with raised intracranial pressure, it should be practiced only by physicians appropriately trained and skilled at the procedure.

Succinylcholine and Open Eye Injury. II

Succinylcholine and Open Eye Injury. II

Succinylcholine and Open Eye Injury

Succinylcholine and Open Eye Injury